An Ethiopian child's 18th birthday causes a 27% drop in medical vaccinations for their younger siblings.
April 25, 2026
Original Paper
Priced out at age 18: Premium Increases and Community Based Health Insurance Disenrolment in Ethiopia
SSRN · 6611919
The Takeaway
Bureaucratic age limits for health insurance create invisible health crises for the most vulnerable. When a child in Ethiopia turns 18, the family's insurance premium jumps significantly to cover the adult rate. Many families respond by dropping the insurance entirely to save money. This loss of coverage leads to a 27.2 percentage point decrease in vaccination completion for the younger children remaining in the home. Policy design that ignores household budget thresholds can accidentally kill children by making preventative care unaffordable for the whole family.
From the abstract
Does a discrete increase in health insurance premiums cause households to disenroll, and if so, who exits and at what cost to child health? I answer these questions using a regression discontinuity design that exploits a sharp, administratively determined increase in Ethiopia's community-based health insurance (CBHI) contributions triggered when the oldest dependent child reaches age 18; a rule that raises the household premium by as much as 25% of the fixed annual fee at the point of renewal. A