Abay Asfaw

Is Consumption Insured Against Illness? Evidence on Vulnerability of Households to Health Shocks in Rural Ethiopia

Low and volatile incomes and absence of well‐developed financial markets make consumption smoothing an important issue in low‐income countries. Based on the theory of full insurance and using 2 years of panel data, this study examines the impact of illness on the consumption of rural households and the capacity of existing risk‐sharing mechanisms in insuring consumption against health shocks in the rural areas of Ethiopia. The results show that illness has a statistically significant negative impact on the stability of consumption and the capacity of households or existing intra‐ and interhousehold risk‐sharing arrangements in insuring consumption against illness varies across different consumption items. The regression results show that the hypothesis of consumption insurance cannot be rejected in the case of total food consumption, implying that basic items that come from own production and from external sources (gifts) are better insured and insensitive to the illness of the head. However, the implication of risk sharing is rejected in the case of nonfood consumption items. The restriction test results reveal that the movement of the household head from a healthy to an unhealthy status would lower the growth rate of quarterly nonfood consumption items of the household by more than 24 percentage points. This clearly demonstrates that there would be a significant amount of welfare gain if existing endogenous risk sharing arrangements can be strengthened or some kind of community health insurance scheme can be introduced in the rural areas of Ethiopia.

Impact of Community Health Funds on the Access to Health Care: Empirical Evidence from Rural Tanzania

Abstract In 1996 the Tanzanian government initiated community health insurance schemes to improve access to health care and to protect people against the financial cost of illness in an environment with shrinking budgets for the health sector. This study aims to evaluate the role of the community-health funds (CHF) in lowering the barriers to assessing health care. Three important results emerge from this study: first, the results show that income is amongst the most important factors determining household participation in the schemes. This means that despite exemption mechanisms, the poorest of the poor within the society are not reached as they can not afford to pay regular insurance premiums. Secondly, though we find no significant differences between members and non-members in the overall amount of health expenditure and in the use of preventive measures, sick individuals in member households were 15 percentage points more likely to get treatment than non-member households. Hence, being insured leads to an increase in the effective utilization of health care. Third, the analysis reveals that members of the CHF are better financially protected against health shocks than non members. The result of this work provides further evidence of the important role that micro-insurance schemes can play in the risk management of people in developing countries.

INNOVATIONS IN HEALTH CARE FINANCING: NEW EVIDENCE ON THE PROSPECT OF COMMUNITY HEALTH INSURANCE SCHEMES IN THE RURAL AREAS OF ETHIOPIA

It has become clear that due to market failure, state failure, and other reasons, the conventional sources of finance alone could not solve the health problem of the rural population, particularly that of the socially excluded and disadvantaged groups. Community Based Health Insurance Schemes (CBHIS) are one of the most recently mentioned options to narrow the existing inequalities in access to basic health services. This study assesses the prospect of CBHIS in the rural areas of Ethiopia using a double bounded dichotomous contingent valuation method. The results show that even in one of the poorest countries of the world, there is a promising prospect to introduce CBHIS.

The Role of Health Insurance in Poverty Reduction: Empirical Evidence From Senegal

Abstract This study analyzes the potential role of health insurance for poverty reduction taking Senegal as an example. The results suggest that health insurance plays a significant role in enhancing health care utilization and in protecting households from catastrophic out-of-pocket health payment. However, most of the population especially the poor and rural households are not covered by any health insurance plans. Given these findings, policy makers and donors should pay more attention to expand the coverage of health insurance, in particular to embrace the poorest section of the population in the country.

Intra-Household Gender Disparities in Children's Medical Care Before Death in India

The excess female mortality in India and other South Asian countries is no longer contentious. Less known are the reasons for such excess female mortality in the country. In this study, we argue that intra-household gender-discrimination in receipt of medical attention can be one of the most important factors for the unbalanced sex ratio in the country. The 52nd Indian National Sample Survey, which collected for the first time detailed verbal autopsies of deceased persons, is used in the analysis. Place of death, which indicates whether a person get medical help immediately before her/his death, is used as a health indicator variable. The multinomial logit results show that keeping all other factors constant, girls are 1.7 percent less likely to die in hospital than their brothers. The coefficients of different interaction variables also reveal that the probability of infant and very young girls with live female siblings to die in hospital is extremely low. The robustness of the results is also checked using different indicators. The results confirm that girls are highly discriminated in access to hospital treatment and in the number of times being hospitalized before their death compared to boys. Therefore, in addition to the current effort of the government to control sex-selective abortions, efforts should be made to reduce the current intra-household gender-disparities in getting medical care at least for life threatening illnesses.