title: Dropping out of Ethiopia's community-based health insurance scheme.
abstract: Low contract renewal rates have been identified as one of the challenges facing the development of community-based health insurance (CBHI) schemes. This article uses longitudinal household survey data gathered in 2012 and 2013 to examine dropout in the case of Ethiopia's pilot CBHI scheme. We treat dropout as a function of scheme affordability, health status, scheme understanding and quality of care. The scheme saw enrolment increase from 41% 1 year after inception to 48% a year later. An impressive 82% of those who enrolled in the first year renewed their subscriptions, while 25% who had not enrolled joined the scheme. The analysis shows that socioeconomic status, a greater understanding of health insurance and experience with and knowledge of the CBHI scheme are associated with lower dropout rates. While there are concerns about the quality of care and the treatment meted out to the insured by providers, the overall picture is that returns from the scheme are overwhelmingly positive. For the bulk of households, premiums do not seem to be onerous, basic understanding of health insurance is high and almost all those who are currently enrolled signalled their desire to renew contracts.
authors.affiliation: International Institute of Social Studies, Erasmus University Rotterdam P.O. Box 29776, 2502 LT The Hague, The Netherlands.
authors.forename: Anagaw D
authors.initials: AD
authors.lastname: Mebratie
authors.affiliation: International Institute of Social Studies, Erasmus University Rotterdam P.O. Box 29776, 2502 LT The Hague, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Sparrow
authors.affiliation: International Institute of Social Studies, Erasmus University Rotterdam P.O. Box 29776, 2502 LT The Hague, The Netherlands.
authors.forename: Zelalem
authors.initials: Z
authors.lastname: Yilma
authors.affiliation: International Institute of Social Studies, Erasmus University Rotterdam P.O. Box 29776, 2502 LT The Hague, The Netherlands.
authors.forename: Getnet
authors.initials: G
authors.lastname: Alemu
authors.affiliation: International Institute of Social Studies, Erasmus University Rotterdam P.O. Box 29776, 2502 LT The Hague, The Netherlands, International Institute of Social Studies, Erasmus University Rotterdam P.O. Box 29776, 2502 LT The Hague, The Netherlands, bedi@iss.nl.
authors.forename: Arjun S
authors.initials: AS
authors.lastname: Bedi
mesh_terms: D003256:Community Participation; D005002:Ethiopia; D005191:Family Characteristics; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D010549:Personal Satisfaction; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Community-based health insurance; Ethiopia; dropout