Table 1
Socio-economic characteristics.
| FULL SAMPLE | EMPLOYEES | PUBLIC SECTOR | PRIVATE/NGO | PENSIONER | |
|---|---|---|---|---|---|
| City | |||||
| Addis Ababa | 0.513 | 0.560 | 0.532 | 0.575 | 0.670 |
| Bahir Dar | 0.115 | 0.105 | 0.118 | 0.071 | 0.176 |
| Hawassa | 0.177 | 0.150 | 0.169 | 0.155 | 0.004 |
| Mekelle | 0.195 | 0.185 | 0.180 | 0.199 | 0.150 |
| Sex (Male = 1) | 0.486 | 0.576 | 0.531 | 0.608 | 0.717 |
| Age | |||||
| Under 18 years old | 0.280 | 0.003 | 0.001 | 0.004 | 0.015 |
| 18–34 years old | 0.399 | 0.505 | 0.464 | 0.619 | 0.524 |
| 35–55 years old | 0.243 | 0.398 | 0.488 | 0.331 | 0.359 |
| More than 55 years old | 0.078 | 0.094 | 0.047 | 0.046 | 0.102 |
| Household size | |||||
| One person | 0.069 | 0.152 | 0.143 | 0.178 | 0.094 |
| 2–3 persons | 0.243 | 0.314 | 0.292 | 0.332 | 0.369 |
| 4–5 persons | 0.454 | 0.385 | 0.410 | 0.346 | 0.395 |
| 6 and more persons | 0.234 | 0.150 | 0.155 | 0.144 | 0.142 |
| Monthly income in Birra (household/individual) | 9027.362 (8971.435) | 530.534 (5781.062) | 4966.103 (5125.078) | 6374.473 (6744.358) | 2682.605 (3522.130) |
| Educationb (head of household/individual) | |||||
| No formal schooling | 0.037 | 0.008 | 0.004 | 0.007 | 0.039 |
| Primary education | 0.154 | 0.063 | 0.039 | 0.054 | 0.266 |
| Secondary education | 0.210 | 0.203 | 0.187 | 0.207 | 0.293 |
| Tertiary or university degree | 0.599 | 0.725 | 0.771 | 0.732 | 0.402 |
| Self-assessment health status | |||||
| Very poor | 0.001 | 0.001 | 0.000 | 0.001 | 0.004 |
| Poor | 0.011 | 0.014 | 0.010 | 0.010 | 0.060 |
| Good | 0.063 | 0.078 | 0.081 | 0.060 | 0.138 |
| Very good | 0.228 | 0.242 | 0.240 | 0.254 | 0.207 |
| Excellent | 0.697 | 0.666 | 0.670 | 0.676 | 0.591 |
| N | 6,894 | 2,749 | 1,475 | 1,041 | 233 |
[i] Notes: Standard deviations are in parentheses; a Income refers to the household income for the full sample and to individual incomes in the employee and sector-specific samples. b Education refers to the education level of the household head in the full sample and to individual education in the employee and sector-specific samples.
Table 2
Characteristics related to health insurance.
| EMPLOYEES | PUBLIC SECTOR | PRIVATE/ NGO | PENSIONER | |
|---|---|---|---|---|
| Heard of health insurance (HI) | 0.939 | 0.938 | 0.954 | 0.884 |
| Fully informed how HI worksa | 0.397 | 0.416 | 0.399 | 0.266 |
| -Only those who fall sick should consider HI (=not correct) | 0.941 | 0.952 | 0.950 | 0.828 |
| -You pay the premium but do not know whether you get the money back (=not correct) | 0.651 | 0.655 | 0.665 | 0.571 |
| -HI is like a saving scheme, you will receive interest and principal (=not correct) | 0.686 | 0.726 | 0.652 | 0.588 |
| -You pay a premium for HI to finance future health care needs (=correct) | 0.816 | 0.809 | 0.844 | 0.730 |
| -With no claim, premiums will be returned (=not correct) | 0.724 | 0.761 | 0.723 | 0.489 |
| N | 2,749 | 1,475 | 1,041 | 233 |
| Any household member has HI | 0.523 | 0.395 | 0.774 | 0.209 |
| Percentage of household members with HI | 18.1 (29.7) | 37.9 (35.14) | 11.32 (27.33) | 25.04 (33.30) |
| Proportion of household members in HI-category | ||||
| 0 % | 0.477 | 0.605 | 0.226 | 0.791 |
| 1–20% | 0.127 | 0.104 | 0.178 | 0.039 |
| 21%–50% | 0.249 | 0.189 | 0.371 | 0.087 |
| more than 50% | 0.147 | 0.103 | 0.224 | 0.083 |
| N | 2,723 | 1,462 | 1,031 | 230 |
| Monthly health insurance premium (Birr) | 82.89 (200.25) | 104.52 (214.26) | 71.07 (193.56) | 0.000 (0.000) |
| N | 471 | 209 | 242 | 20 |
| Annual health insurance cap | 13057.30 (30215.96) | 12614.48 (35415.03) | 13742.89 (24049.1) | 9857.14 (8198.10) |
| N | 532 | 275 | 243 | 14 |
| Ratio of HI premium to income | 0.025 (0.072) | 0.036 (0.090) | 0.017 (0.053) | 0.000 (0.000) |
| N | 471 | 209 | 242 | 20 |
| Who pays for HI | ||||
| Employer | 0.756 | 0.757 | 0.747 | 0.894 |
| Self | 0.011 | 0.021 | 0.004 | 0.000 |
| Both | 0.233 | 0.222 | 0.249 | 0.106 |
| N | 1,414 | 576 | 791 | 47 |
[i] Notes: Standard deviations are in parentheses; a Fully informed how HI works = 1 if the respondent chose the correct answer for all five questions.
Table 3
Healthcare seeking.
| FULL SAMPLE | EMPLOYEES | PUBLIC SECTOR | PRIVATE/ NGO | PENSIONER | |
|---|---|---|---|---|---|
| Illness or injury in the last 2 months | 0.115 | 0.145 | 0.139 | 0.139 | 0.206 |
| Seeking any treatment | 0.855 | 0.871 | 0.897 | 0.853 | 0.813 |
| N | 779 | 394 | 203 | 143 | 48 |
| Who provided treatment | |||||
| Informal treatmenta | 0.061 | 0.057 | 0.090 | 0.008 | 0.054 |
| Self-medication | 0.041 | 0.045 | 0.079 | 0.000 | 0.027 |
| Religious/traditional healer | 0.020 | 0.012 | 0.011 | 0.008 | 0.027 |
| Treatment sector | |||||
| Public health centre, clinic, or hospital | 0.444 | 0.435 | 0.433 | 0.395 | 0.588 |
| Private health centre clinic, or hospitalb | 0.556 | 0.565 | 0.567 | 0.605 | 0.412 |
| Treatment type and sector | |||||
| Health workerc – Public sector | 0.190 | 0.169 | 0.186 | 0.134 | 0.212 |
| Health worker – Private sector | 0.089 | 0.110 | 0.083 | 0.160 | 0.061 |
| Doctor – Public sector | 0.250 | 0.263 | 0.244 | 0.261 | 0.364 |
| Doctor – Private sector | 0.470 | 0.458 | 0.487 | 0.445 | 0.364 |
| Treatment cost (Birr) | 745.972 (2813.531) | 893.958 (3408.822) | 592.294 (941.787) | 1366.310 (5462.932) | 851.400 (2247.338) |
| Delay in seeking treatment (days) | 2.397 (4.120) | 2.435 (4.603) | 2.650 (5.421) | 2.271 (3.895) | 2.000 (2.000) |
| N | 655 | 335 | 177 | 121 | 37 |
| Hospitalization in the last 12 months | 0.018 | 0.025 | 0.024 | 0.030 | 0.013 |
| Inpatient care duration | 9.131 (11.977) | 9.043 (12.695) | 9.444 (15.874) | 8.267 (8.103) | 12.000 (9.644) |
| N | 122 | 69 | 36 | 30 | 3 |
| Inpatient care sector | |||||
| Public sector | 0.625 | 0.612 | 0.559 | 0.633 | 1.000 |
| Private sector | 0.375 | 0.388 | 0.441 | 0.366 | 0.000 |
| Inpatient care cost (Birr) | 5062.39 (6623.97) | 4654.333 (5632.223) | 4026.400 (5635.470) | 5722.321 (5821.649) | 2012.333 (438.641) |
| N | 118 | 66 | 35 | 28 | 3 |
[i] Notes: Standard deviations are in parentheses. a Informal treatment refers to self-medication and religious and traditional healers. b Private sector includes NGO and missionary facilities. c Health worker includes health officers, nurses, and midwives.
Figure 1
Healthcare seeking choices.
Table 4
Properties of healthcare choices.
| HEALTHCARE CHOICE | TWO MAIN REASONS MOTIVATING CHOICE | SATISFIED WITH THE TREATMENT | AVERAGE COST OF TREATMENT (S.D) |
|---|---|---|---|
| Health worker – Public facilities | Cost of care (41%) Proximity (20.5%) | 81.7% | 199.4 (587.9) |
| Health worker – Private facilities | HI covers the cost of treatment (39.6%) Proximity (15.1%) | 92% | 371.0 (473.1) |
| Doctor – Public facilities | Cost of care (19.4%) Medicine is available at the location (16.7%) | 83.9% | 476.0 (1113.1) |
| Doctor – Private facilities | Capable staff (16.1 %) Medicine is available at the location (15.4%) | 92% | 1265.2 (4080.7) |
| Inpatient care – Public facilities | Cost of care (23.1%) Staff availability (18.5%) | 79.2% | 2360.3 (2526.2) |
| Inpatient care – Private facilities | Compassionate staff (29.3%) Staff capability/availability (17.1%) | 93.3% | 9358.1 (8542.9) |
Table 5
Probability of seeking outpatient care and choice of outpatient care provider – marginal effects.
| SEEKING TREATMENT | SEEKING FORMAL TREATMENT | CHOICE OF FORMAL HEALTHCARE PROVIDER | ||||
|---|---|---|---|---|---|---|
| HEALTH WORKER PUBLIC SECTOR | HEALTH WORKER PRIVATE SECTOR | DOCTOR PUBLIC SECTOR | DOCTOR PRIVATE SECTOR | |||
| Sex (female as reference) | –0.016 (0.467) | –0.014 (0.485) | 0.009 (0.777) | 0.009 (0.720) | –0.051 (0.163) | 0.033 (0.413) |
| Age(under 18 years old as reference) | ||||||
| 18–34 years old | –0.045 (0.182) | –0.034 (0.247) | –0.082 (0.083) | 0.072 (0.012) | –0.016 (0.750) | 0.025 (0.642) |
| 35–55 years old | –0.007 (0.835) | –0.020 (0.404) | –0.102 (0.021) | 0.009 (0.727) | 0.050 (0.308) | 0.042 (0.439) |
| 55 years and older | –0.090 (0.041) | –0.013 (0.670) | –0.145 (0.005) | 0.025 (0.516) | 0.146 (0.047) | –0.025 (0.731) |
| Household size(1 person as reference) | ||||||
| 2–3 persons | 0.047 (0.267) | 0.003 (0.912) | 0.031 (0.539) | 0.084 (0.006) | –0.080 (0.184) | –0.036 (0.598) |
| 4–5 persons | 0.061 (0.190) | –0.059 (0.056) | 0.074 (0.186) | 0.026 (0.378) | 0.040 (0.542) | –0.140 (0.046) |
| 6 and more persons | 0.091 (0.059) | 0.000 (0.992) | 0.033 (0.612) | 0.072 (0.051) | –0.029 (0.682) | –0.077 (0.344) |
| Education-Household head (no formal education as reference) | ||||||
| Primary education | –0.133 (0.030) | –0.018 (0.756) | 0.005 (0.964) | –0.140 (0.083) | 0.234 (0.006) | –0.099 (0.438) |
| Secondary education | –0.124 (0.026) | –0.017 (0.769) | –0.132 (0.242) | –0.103 (0.229) | 0.212 (0.007) | 0.022 (0.859) |
| Tertiary/university education | –0.068 (0.161) | 0.004 (0.938) | –0.065 (0.565) | –0.126 (0.107) | 0.109 (0.112) | 0.082 (0.492) |
| Household income (First quintile(poorest) as reference) | ||||||
| Second quintile | –0.013 (0.686) | 0.028 (0.370) | –0.039 (0.487) | 0.099 (0.018) | –0.040 (0.487) | –0.019 (0.775) |
| Third quintile | 0.016 (0.634) | –0.023 (0.558) | –0.053 (0.364) | –0.009 (0.762) | 0.026 (0.674) | 0.036 (0.603) |
| Fourth quintile | 0.016 (0.643) | 0.017 (0.639) | –0.045 (0.498) | –0.010 (0.747) | –0.021 (0.746) | 0.076 (0.316) |
| Fifth quintile | –0.021 (0.624) | 0.052 (0.078) | –0.158 (0.006) | 0.043 (0.251) | –0.134 (0.025) | 0.249 (0.001) |
| Any household member has HI | 0.020 (0.370) | 0.049 (0.019) | –0.076 (0.019) | 0.022 (0.345) | –0.031 (0.396) | 0.085 (0.039) |
| N | 757 | 645 | 594 | |||
[i] Notes: This table reports the determinants of seeking any healthcare (first column), seeking formal healthcare (second column) and the choice of healthcare provider (the last four columns) conditional on the incidence of illness. The first two columns are based on logit models and the last four columns on a multinominal logit model. All models include control variables for region (city). P-values are in parentheses.
Table 6
Probability of using inpatient care from a public facility – marginal effects.
| FULL SAMPLE | EMPLOYEES | |
|---|---|---|
| Sex (female as reference) | 0.120 (0.327) | 0.077 (0.523) |
| Age (under 18 years old as reference) | ||
| 18–34 years old | 0.000 (.) | 0.000 (.) |
| 35–55 years old | –0.011 (0.934) | 0.038 (0.806) |
| 55 years and older | –0.011 (0.963) | 0.218 (0.299) |
| Household size (1 person as reference) | ||
| 2–3 persons | 0.073 (0.663) | 0.061 (0.722) |
| 4–5 persons | 0.001 (0.995) | –0.085 (0.612) |
| 6 and more persons | 0.007 (0.965) | –0.041 (0.791) |
| Educationa (less than secondary education as reference) | ||
| Secondary education | 0.031 (0.840) | 0.083 (0.559) |
| Tertiary/university education | 0.163 (0.390) | 0.282 (0.137) |
| Incomeb (First quintile (poorest) as reference) | ||
| Second quintile | –0.105 (0.272) | –0.104 (0.292) |
| Third quintile | –0.365 (0.003) | –0.487 (0.000) |
| Fourth quintile | –0.563 (0.000) | –0.550 (0.001) |
| Fifth quintile | –0.513 (0.000) | –0.489 (0.001) |
| Any household member has HI | –0.255 (0.034) | –0.174 (0.176) |
| Employment Sector (Public sector as reference) | ||
| Private sector | 0.135 (0.259) | |
| N | 74 | 63 |
[i] Notes: This table reports determinants of inpatient healthcare for the full sample (first column) and for formal sector employees (second column) using logit models. All models include control variables for region (city). P-values are in parentheses. a Education refers to the education level of the head of household for the full sample and to an individual’s education in the employees’ sample. b Income refers to household income for the full sample and to an individual’s income in the employees’ sample. As there were insufficient observations in the first category of the ‘Education’ variable, the first two levels were merged to create a reference category.
Table 7
Attitudes towards Social Health Insurance.
| EMPLOYEES | PUBLIC SECTOR | PRIVATE/ NGO | PENSIONER | |
|---|---|---|---|---|
| Heard of Social Health Insurance (SHI) | 0.832 | 0.872 | 0.758 | 0.906 |
| N | 2,749 | 1,475 | 1,041 | 233 |
| Aware of SHI-covered services/medicines | 0.393 | 0.440 | 0.302 | 0.455 |
| N | 2,273 | 1,276 | 786 | 211 |
| Know SHI premium | 0.396 | 0.410 | 0.352 | 0.469 |
| N | 2,278 | 1,278 | 789 | 211 |
| Knowledge of the SHI premium in Birr | 132.14 (157.14) | 139.28 (173.26) | 157.81 (132.81) | 19.42 (35.44) |
| N | 877 | 513 | 270 | 94 |
| Knowledge of SHI premium as a share of income | 0.031 (0.036) | 0.034 (0.039) | 0.032 (0.031) | 0.013 (0.027) |
| The SHI premium is fair | ||||
| Yes | 0.397 | 0.377 | 0.390 | 0.550 |
| No | 0.399 | 0.441 | 0.345 | 0.341 |
| Don’t know | 0.204 | 0.182 | 0.265 | 0.109 |
| N | 2,270 | 1,274 | 785 | 211 |
| The SHI premium is affordable | ||||
| Disagree | 0.361 | 0.406 | 0.325 | 0.233 |
| Neither agree nor disagree | 0.199 | 0.175 | 0.247 | 0.166 |
| Agree | 0.439 | 0.419 | 0.428 | 0.602 |
| N | 2,253 | 1,265 | 777 | 211 |
| SHI WTP as share of income (%) | 1.624 (1.307) | 1.645 (1.196) | 1.704 (1.516) | 1.207 (0.996) |
| N | 2,163 | 1,210 | 750 | 203 |
| SHI willingness to pay – category | ||||
| No willingness to pay | 0.128 | 0.101 | 0.155 | 0.187 |
| Less than 3% of monthly income | 0.629 | 0.664 | 0.559 | 0.680 |
| 3% and more of monthly income | 0.243 | 0.235 | 0.287 | 0.133 |
| Support SHI | ||||
| Support | 0.665 | 0.669 | 0.658 | 0.663 |
| Neither support nor oppose | 0.074 | 0.060 | 0.102 | 0.058 |
| Oppose | 0.26 | 0.271 | 0.239 | 0.279 |
| Concerned that after paying for SHI, will not receive adequate healthcare service | 0.529 | 0.564 | 0.512 | 0.381 |
| Concerned about: | ||||
| Long waiting time | 0.863 | 0.873 | 0.844 | 0.864 |
| Lack of drugs | 0.837 | 0.859 | 0.799 | 0.827 |
| Lack of adequate diagnosis facilities | 0.724 | 0.726 | 0.715 | 0.753 |
| Quality of staff | 0.660 | 0.642 | 0.684 | 0.704 |
| Availability of staff | 0.517 | 0.528 | 0.484 | 0.593 |
| N | 2,270 | 1,274 | 785 | 211 |
[i] Note: Standard deviations are in parentheses.
Table 8
Probability of opposing SHI and that it is unfair, unaffordable, and opposed – marginal effects.
| SHI IS NOT FAIR | SHI PREMIUM IS NOT AFFORDABLE | OPPOSING SHI | |
|---|---|---|---|
| Sex (female as reference) | –0.023 (0.302) | –0.002 (0.926) | –0.009 (0.642) |
| Age (under 34 years old as reference) | |||
| 35–55 years old | 0.046 (0.052) | 0.071 (0.002) | 0.042 (0.047) |
| 55 years and older | 0.024 (0.591) | –0.001 (0.988) | 0.041 (0.324) |
| Household size (1person as reference) | |||
| 2–3 persons | 0.043 (0.198) | 0.005 (0.882) | 0.021 (0.476) |
| 4–5 persons | 0.017 (0.610) | –0.015 (0.653) | 0.016 (0.586) |
| 6 and more persons | –0.005 (0.905) | –0.006 (0.877) | –0.052 (0.116) |
| Education (no formal education as reference) | |||
| Primary education | –0.123 (0.393) | 0.077 (0.603) | –0.101 (0.492) |
| Secondary education | –0.132 (0.347) | 0.042 (0.766) | –0.142 (0.321) |
| Tertiary/university education | –0.110 (0.430) | 0.089 (0.527) | –0.131 (0.359) |
| Income (First quintile(poorest) as reference) | |||
| Second quintile | 0.062 (0.087) | 0.041 (0.257) | 0.069 (0.026) |
| Third quintile | 0.039 (0.284) | 0.026 (0.488) | 0.051 (0.099) |
| Fourth quintile | 0.108 (0.004) | 0.074 (0.050) | 0.127 (0.000) |
| Fifth quintile | 0.099 (0.013) | 0.059 (0.134) | 0.101 (0.003) |
| Any household member has HI | –0.051 (0.031) | –0.016 (0.476) | 0.024 (0.241) |
| Employment Sector (Public sector as reference) | |||
| Private/NGO sector | –0.073 (0.003) | –0.066 (0.006) | –0.030 (0.154) |
| Pensioners | –0.092 (0.048) | –0.147 (0.000) | 0.002 (0.967) |
| Aware of SHI-covered services/medicines | –0.020 (0.348) | –0.059 (0.004) | –0.064 (0.001) |
| N | 2233 | 2216 | 2189 |
[i] Note: This table reports the determinants of attitudes toward SHI. SHI is not fair (first column), SHI premium is not affordable (second column) and ‘I oppose SHI.’ (third column) using logit models. All three are binary dependent variables (1 = yes, 0 otherwise). All models include control variables for region (city). P-values are in parentheses. As there were insufficient observations in the first category of the ‘Age’ variable, the first two levels were merged to create a reference category.