Determinants of enrollment decision in the community-based health insurance, North West Ethiopia: a case-control study

Abstract

Objective: To identify the determinants for enrollment decision in the community-based health insurance program among informal economic sector-engaged societies, North West Ethiopia. Method: Unmatched case-control study was conducted on 148 cases (member-to-insurance) and 148 controls (not-member-to-insurance program) from September 1 to October 30,2016. To select the villages and households, stratified then simple random sampling method was employed respectively. The data were entered in to Epi-info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics, bi-variable, and multi-variable logistic regression analyses were computed to describe the study objectives and identify the determinants of enrolment decision for the insurance program. Odds ratio at 95% CI was used to describe the association between the independent and outcome variables. Results: A total of 296 respondents (148 cases and 148 controls) were employed. The mean age for both cases and controls were 42 ± 11.73 and 40 ± 11.37 years respectively. Majority of respondents were males (87.2% for cases and 79% for controls). Family size between 4 and 6 (AOR = 2.26; 95% CI: 1.04, 4.89), history of illness by household (AOR = 3.24; 95% CI: 1.68, 6.24), perceived amount of membership contribution was medium (AOR = 2.3; 95% CI: 1.23, 4.26), being married (AOR = 6; 95% CI:1.43, 10.18) and trust on program (AOR = 4.79; 95% CI: 2.40, 9.55) were independent determinants for increased enrollment decision in the community-based health insurance. While, being merchant (AOR = 0.07; 95% CI: 0.09, 0.6) decreased the enrollment decision. Conclusion: Societies' enrollment decision to community-based health insurance program was determined by demographic, social, economic and political factors. Households with large family sizes and farmers in the informal sector should be given maximal attention for intensifying enrollment decision in the insurance program.

Willingness to Join Community Based Health Insurance and Its Predictors Among Informal Sectors in Buno Bedele Zone, South West Ethiopia

“…Study participants with large family size were more likely to join CBHI scheme than those with few family size. This finding is similar with those of other studies conducted in Selected Districts of Jimma Zone [8], North West Ethiopia [21], Debub Bench district [20] and west Gojjam zone [19]. This similarity might be attributed to the excessive out of pocket expenses from medical bills that large households faced at a time of occurrences of unpredictable illnesses might lead to catastrophic health expenditure and move them to below poverty line.…”

“…The probability of willingness to join CBHI scheme was higher among those who had experienced an illnesses in the last three months than their counter parts. This finding was supported by study conducted in Simada district [16], North West Ethiopia [21] and Cameroon [17]. This could be due to risk averse individuals are more likely to join CBHI scheme.…”

Uptake of Health Insurance and Its Associated Factors Among Informal Sector Workers in Dar Es Salaam, Tanzania

“…Moreover, this study pointed out that insufficient knowledge about health insurance is the hindering factor for uptake of health insurance. This finding is along with two studies by who reported that lack of basic knowledge and understanding about health insurance are the barriers to enrolment into health insurance (Atafu 2018;Taddesse et al, 2020). In Ghana and Ethiopia studies documented that limited knowledge about the role of insurance in terms of risk sharing and resource redistribution are likely to reduce enrolment and renewal into the health insurance (Mebratie et al, 2015;Kotoh and Geest 2016).…”

Factors that affect enrollment into a community-based health insurance scheme among households in Arba Minch Zuria District, Gamo Zone, Southern Ethiopia, 2023: A community-based unmatched case-control Study

“…Our study revealed that households with a larger family size were more likely to enroll in the CBHI scheme than their counterparts. This finding was supported by studies conducted in Ethiopia and Nigeria[30, 31]. The main reason for this could be because the likelihood of having health problems in a family depends on household size.…”