Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise
Abstract Background Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden dis...
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| Format: | Article |
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BMC
2024-09-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-024-02226-z |
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| author | Solomon Tessema Memirie Muluken Argaw Mieraf Taddesse Tolla Frehiwot Abebe Wubaye Walelgne Dagnaw Ole F. Norheim Amanuel Yigezu |
| author_facet | Solomon Tessema Memirie Muluken Argaw Mieraf Taddesse Tolla Frehiwot Abebe Wubaye Walelgne Dagnaw Ole F. Norheim Amanuel Yigezu |
| author_sort | Solomon Tessema Memirie |
| collection | DOAJ |
| description | Abstract Background Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia. Methods Aligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition. Results The average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table. Conclusions The Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available. |
| format | Article |
| id | doaj-art-7ba6f5f514db49adb4e6686d1afc0b5f |
| institution | Kabale University |
| issn | 1475-9276 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-7ba6f5f514db49adb4e6686d1afc0b5f2024-12-08T12:22:21ZengBMCInternational Journal for Equity in Health1475-92762024-09-012311710.1186/s12939-024-02226-zEquity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exerciseSolomon Tessema Memirie0Muluken Argaw1Mieraf Taddesse Tolla2Frehiwot Abebe3Wubaye Walelgne Dagnaw4Ole F. Norheim5Amanuel Yigezu6Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa UniversityEthiopian Health Insurance ServiceAddis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa UniversityEthiopian Health Insurance ServiceCenter for Integration Science, Department of Global Health Equity, Brigham and Women’s HospitalBergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of BergenEthiopian Health Insurance ServiceAbstract Background Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia. Methods Aligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition. Results The average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table. Conclusions The Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available.https://doi.org/10.1186/s12939-024-02226-zEquityHealth benefit packageCost-effectiveness analysisUniversal health coverageEthiopia |
| spellingShingle | Solomon Tessema Memirie Muluken Argaw Mieraf Taddesse Tolla Frehiwot Abebe Wubaye Walelgne Dagnaw Ole F. Norheim Amanuel Yigezu Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise International Journal for Equity in Health Equity Health benefit package Cost-effectiveness analysis Universal health coverage Ethiopia |
| title | Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise |
| title_full | Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise |
| title_fullStr | Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise |
| title_full_unstemmed | Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise |
| title_short | Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise |
| title_sort | equity considerations for the implementation of health insurance benefit package in ethiopia result of expert delphi exercise |
| topic | Equity Health benefit package Cost-effectiveness analysis Universal health coverage Ethiopia |
| url | https://doi.org/10.1186/s12939-024-02226-z |
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