This dataset on baseline findings from the historic claims and enrolment data in the CBHI pilot and control in the Tigray region of Ethiopia was conducted among 367,030 lines of claims data entered across all six Woredas between June 1 2017 to June 30, 2018.  The objective of this study was to establish a baseline on select parameters that will be used to detect changes brought by the pilot intervention. In that regard, 367,030 lines of claims data were entered across all six woredas for the two years. The findings of this survey showed the following. 

1. Based on the reports from CBHI schemes the average enrolment rate for 2011 EFY in the pilot woredas was 50.72% (12.30% indigents and 38.42% paying members) which is below the required enrolment rate. Of all the CBHI members in each woreda, indigents constitute 20.5% (12% of eligible Households) (Hawzen Woreda) to 31.1% (13% of the eligible households) in Atsibi Wemberta woreda.
2. The trend of enrolment rate in pilot woredas decreased from 77% in 2017 (2009 EFY) to 51% in 2018 (2010 EFY) and 2019 (2011 EFY) which is a 33.9% decrease.
3. The CBHI members seek health services from contracted health centers, and hospitals including primary, general and referral hospitals. For this report, the health facilities were grouped into two major levels i.e. health centers and hospitals. Both pilot and control woreda CBHI schemes have contracted health centers, primary, general, and referral/tertiary hospitals to provide health care services to the CBHI members. Reimbursements are made to contracted health facilities and in the case of out-of-pocket expenditure, reimbursements are made directly to the clients/patients by the schemes. Regarding the proportion of reimbursements made, reports of schemes showed that much of the reimbursement was made to health centers followed by primary hospitals.
4. The scheme's annual reports showed that most of the health facility visits were made to health centers in both pilot and control woreda schemes. The average cost of a claim is 56 Birr in control and 54 Birr in the pilot woreda CBHI schemes. Of all the observations 95% of the claims were of less than 146.2 Birr and 133 Birr in control and pilot woredas respectively. The health service utilization rate in both the pilot and control woredas was much higher among paying CBHI members than indigents.

• Claims and Enrolment data
• community-based health insurance
• Tigray region

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This dataset on baseline findings from the historic claims and enrolment data in the CBHI pilot and control Woredas in Tigray was conducted between June 1 2017 to June 30, 2018.  The data analysis was conducted using MS-Excel and STATA 15. The dataset captures information about schemes in the pilot and control Woredas in terms of enrolment and renewal rates, who is providing health care services to the CBHI beneficiaries in the schemes and how much is spent for each type of provider, the magnitude of claim expenditure on an overall and per capita basis, categories of expenditure that were the schemes’ revenue used, the health service utilization rate of CBHI beneficiaries overall and disaggregated by status i.e. payers versus indigents, and the financial position of schemes in relation to the ratio to revenue to expenditure were included. Generally, the findings of this assessment will also be used as input in planning and when the change in the CBHI model is required.

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