Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments

Abel Eshetu; Abrham Seyoum

doi:doi:10.11648/j.hep.20190404.16

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Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments

Abel Eshetu, Abrham Seyoum

Published in International Journal of Health Economics and Policy (Volume 4, Issue 4)

Received: 13 July 2019 Accepted: 7 August 2019 Published: 26 December 2019

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Abstract

Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.

Published in	International Journal of Health Economics and Policy (Volume 4, Issue 4)
DOI	10.11648/j.hep.20190404.16
Page(s)	158-167
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Community Based Health Insurance, Behavioral Biases, Discrete Choice Experiment, Willingness to Pay, Addis Ababa

References

[1]	Abiiro GA, Torbica A, Kwalamasa K, De Allegri M. Eliciting community preferences for complementary micro health insurance: A discrete choice experiment in rural Malawi. Social Science & Medicine. 2014; 120: 160-168.
[2]	Amarech O, Ryan M, Heidenreich S, Normand C, Damen H. Eliciting preferences for social health insurance in Ethiopia: a discrete choice experiment. Health Policy and Planning. 2016; 31: 423–1432.
[3]	Amaya-Amaya M, Ryan M, GerardK. Using Discrete Choice Experiments to Value Health and Health Care. The Economics of Non-Market Goods and Resources. 2008; 11: 13-46.
[4]	Anagaw D, Sparrow Z, Yilma GA, Bedi AS. Enrollment in Ethiopia’s Community-Based Health Insurance Scheme. World Development. 2015; 74: 58-76.
[5]	Anoo N. Health Insurance in Developing Countries: Willingness to Pay for Health Insurance in Thailand using Discrete Choice Experiment Methods. Curtin University: Centre for International Health; 2011.
[6]	Asmamaw, A. (2018). CBHI in Ethiopia: Enrollment, Membership renewal and Effect on health care utilization. Seoul: Seoul National University; 2018.
[7]	Baicker K, William JC, Sendhil M. Health Insurance Coverage and Take-Up: Lessons from Behavioral Economics. The Milbank Quarterly. 2012; 90 (1): 107-134.
[8]	Carlsson F, MartinssonP. Design Techniques for Stated Preference Methods in Health Economics. Health Econ; 2003; 12: 281–294.
[9]	De AllegrM, Kouyaté B, BecherH,... Sauerborn R. Understanding enrolment in community health insurance in sub-Saharan Africa: a population based case–control study in rural Burkina Faso. Bulletin of the World Health Organization. 2006; 84: 852-858.
[10]	Dicks DL, Garveny JR, Hilliardz JI. Optimism Bias and the Demand for Insurance. 2016; https://ssrn.com/abstract=1907463.
[11]	Ethiopian Health Insurance Agency. Evaluation of Community-Based Health Insurance Pilot Schemes in Ethiopia: Final Report. Addis Ababa: EHIA; 2015.
[12]	Kananurak P. Willingness to Pay for Voluntary Health Insurance after Retirement in Thailand. NIDA Development Journa. 2014; 54 (2): 118-157.
[13]	Kamara J, Bonet MJ, Mesnard A. A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone. International Journal of Health Economics and Policy. 2018; 3 (1): 1-12.
[14]	Kløjgaard M, Bech M, Søgaard, R. Designing a Stated Choice Experiment: The Value of aQualitative process. Journal of Choice Modeling. 2012; 5 (2): 1-18.
[15]	Louviere J, LancsarE. Choice Experiments in Health: The Good, the Bad, and the Ugly and Toward a Brighter Future. Health Economics, Policy and Law. 2009; 4: 527–546.
[16]	Mangham LJ, Hanson K, Mcpake B. How to Do (Or Not to Do). Designing A Discrete Choice Experiment for Application in A Low Income Country. Health Policy andPlanning. 2009; 24: 151–158.
[17]	Mcfadden D (1974). Conditional Logit Analysis of Qualitative Choice Behavior. In P. Zarembka (Ed.), Frontiers in Econometrics (pp. 105-142). New York: Academic Press; 1974.
[18]	MelakuH, Shimeles O, Berhane M. Willingness to join community-based health insurance among rural households of Debub Bench District, Bench Maji Zone, Southwest Ethiopia. BMC Public Health. 2014; 14: 591.
[19]	Ministry of Health. HSTP 2015/16- 2019/20. Addis Ababa: Federal Ministry of Healt; 2015.
[20]	Ministry of Health. Ethiopia’s Sixth National Health Accounts 2013/2014. Addis Ababa: Federal Ministry of Health; 2017.
[21]	Ozawa S, Grewal S, Bridges J. Household Size and the Decision to Purchase Health Insurance in Cambodia: Results of a Discrete-Choice Experiment with Scale Adjustment. Appl Health Econ Health Policy. 2016; 14: 195–204.
[22]	Rice T. The Behavioral Economics of Health and Health Care. Annual Review of Public Health. 2013; 34: 431-447.
[23]	RyanM, Amaya-AmayaM, Gerard K. Using Discrete Choice Experimentsto Value Health and Health Care. The Economics of Non-Market Goods and Resources. 2008; 11: 73-79.
[24]	Van WinssenK., van KleefR, van de Ven W. The demand for health insurance and behavioral economics. Eur J Health Econ. 2016; 17: 653–657.
[25]	Yamane T. Statistics: An Introductory Analysis, second Ed. New York: Harper and Row; 1967.

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APA Style

Abel Eshetu, Abrham Seyoum. (2019). Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. International Journal of Health Economics and Policy, 4(4), 158-167. https://doi.org/10.11648/j.hep.20190404.16

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ACS Style

Abel Eshetu; Abrham Seyoum. Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. Int. J. Health Econ. Policy 2019, 4(4), 158-167. doi: 10.11648/j.hep.20190404.16

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AMA Style

Abel Eshetu, Abrham Seyoum. Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. Int J Health Econ Policy. 2019;4(4):158-167. doi: 10.11648/j.hep.20190404.16

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@article{10.11648/j.hep.20190404.16,
  author = {Abel Eshetu and Abrham Seyoum},
  title = {Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments},
  journal = {International Journal of Health Economics and Policy},
  volume = {4},
  number = {4},
  pages = {158-167},
  doi = {10.11648/j.hep.20190404.16},
  url = {https://doi.org/10.11648/j.hep.20190404.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20190404.16},
  abstract = {Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.},
 year = {2019}
}

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TY  - JOUR
T1  - Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments
AU  - Abel Eshetu
AU  - Abrham Seyoum
Y1  - 2019/12/26
PY  - 2019
N1  - https://doi.org/10.11648/j.hep.20190404.16
DO  - 10.11648/j.hep.20190404.16
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 158
EP  - 167
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20190404.16
AB  - Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.
VL  - 4
IS  - 4
ER  -

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Author Information

Abel Eshetu

Zemen Bank Risk Management Department, Addis Ababa, Ethiopia
Abrham Seyoum

Center for Rural Development, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia

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APA Style

Abel Eshetu, Abrham Seyoum. (2019). Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. International Journal of Health Economics and Policy, 4(4), 158-167. https://doi.org/10.11648/j.hep.20190404.16

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ACS Style

Abel Eshetu; Abrham Seyoum. Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. Int. J. Health Econ. Policy 2019, 4(4), 158-167. doi: 10.11648/j.hep.20190404.16

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AMA Style

Abel Eshetu, Abrham Seyoum. Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments. Int J Health Econ Policy. 2019;4(4):158-167. doi: 10.11648/j.hep.20190404.16

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@article{10.11648/j.hep.20190404.16,
  author = {Abel Eshetu and Abrham Seyoum},
  title = {Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments},
  journal = {International Journal of Health Economics and Policy},
  volume = {4},
  number = {4},
  pages = {158-167},
  doi = {10.11648/j.hep.20190404.16},
  url = {https://doi.org/10.11648/j.hep.20190404.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20190404.16},
  abstract = {Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments
AU  - Abel Eshetu
AU  - Abrham Seyoum
Y1  - 2019/12/26
PY  - 2019
N1  - https://doi.org/10.11648/j.hep.20190404.16
DO  - 10.11648/j.hep.20190404.16
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 158
EP  - 167
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20190404.16
AB  - Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.
VL  - 4
IS  - 4
ER  -

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