Dropping out of Ethiopia’s Community Based Health Insurance scheme

Low contract renewal rates have been identified as one of the challenges facing the development of community based health insurance schemes (CBHI). This paper uses longitudinal household survey data to examine dropout in the case of Ethiopia’s pilot CBHI scheme, which saw enrolment increases from 41 percent one year after inception to 48 percent a year later. An impressive 82 percent of those who enrolled in the first year renew their subscriptions, while 25 percent who had not enrolled join the scheme. The analysis shows that socio-economic status, a greater understanding of health insurance, and experience with and knowledge of the CBHI scheme reduce dropout. 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 signal their desire to renew contracts.