Abstract for: Health Financing Reform and Noncommunicable Diseases Care: A Modeling Analysis in Ethiopia

Noncommunicable diseases (NCDs) are an increasing contributor to mortality in Ethiopia, where hypertension and diabetes account for a growing share of the disease burden. Although the country has implemented healthcare financing reforms to expand access to care, gaps remain in diagnosis and treatment uptake for NCDs, particularly hypertension and diabetes. We developed a system dynamics model to examine how financing reforms influence hypertension and diabetes care in the Amhara region of Ethiopia. The model captures interactions between disease progression, service utilization, and facility financing, and projects ten-year changes in insurance coverage and treatment uptake. Policy scenarios vary three levers: community-based health insurance (CBHI) enrollment, fee-waiver coverage, and reimbursement delays. Baseline projections show gradual increases in coverage and treatment uptake. Expanding CBHI enrollment yields the largest gains, raising coverage from about 75% in 2025 to >90% by 2035 (vs 83% baseline), with hypertension treatment reaching 38.5% (vs 28.0%) and diabetes 14.8% (vs 11.0%). Fee-waiver expansion has modest effects, while reducing reimbursement delays has minimal impact. Our preliminary results suggest that expanding CBHI enrollment drives the largest improvements in treatment uptake for hypertension and diabetes, while other policy levers have modest additional effects. The findings highlight how financing reforms shape access through service delivery conditions and point to the need for additional policy design that more directly targets system constraints affecting treatment continuity.