Factors associated with enrollment for community-based health insurance scheme in Western Ethiopia: Case-control study

Abstract

Introduction Modern health services utilization in developing countries has continued low. Financial shortage to access health-care services might be averted by stirring from out-of-pocket payment for health care at the time of use. The government of Ethiopia; depend greatly on foreign aid (50%) and out-of-pocket payments (34%) to fund health services for its population. This study was aimed to identify factors associated with households’ enrollment to CBHI scheme membership. Methods Case-control study design was conducted from May 18–July 27, 2019 among 332 participants (166 enrolled and 166 non-enrolled to CBHI scheme). Simple random sampling technique was used to select the study participants. Bi-variable and multivariable logistic regression model were fitted to identify factors associated with enrollment to community based health insurance. Adjusted odds ratio (AOR) with 95% CI was used to report association and significance was declared at P<0.05. Result A total of 332 (100% response rate) were involved in the study. Educational status (College and above, AOR = 3.90, 95%CI; 1.19, 12.75), good awareness about CBHI scheme (AOR = 21.595, 95% CI; 7.561, 61.681), affordability of premium payment (AOR = 3.403, 95% CI; 5.638–4.152), wealth index {(Poor, AOR = 2.59, 95%CI; 1.08, 6.20), (Middle, AOR = 4.13, 95%CI; 1.11, 15.32)} perceived health status (AOR = 5.536; 95% CI; 1.403–21.845), perceived quality of care (AOR: 21.014 95%CI; 4.178, 105.686) and treatment choice (AOR = 2.94, 95%CI; 1.47, 5.87) were factors significantly associated with enrollment to CBHI. Conclusion Enrolment to CBHI schemes is influenced by educational level, awareness level, affordability of premium, wealth index, perceived health status, perceived quality of care and treatment choice. Implementation strategies aimed at raising community awareness, setting affordable premium, and providing quality healthcare would help in increasing enrollment of all eligible community groups to the CBHI scheme.

Factors Associated With Community Based Health Insurance Healthcare Service Utilization of Households in South Gondar Zone, Amhara, Ethiopia. A Community-Based Cross-Sectional Study

“…This indicates households who had primary (1-8) education level was 9.44 times more likely, households who had secondary (9-12) education level was 50.43 times more likely, and households who had college and above education level was 13.31 times more likely utilized CBHI scheme health care service compared with household’s who cannot read and write respectively. This result was supported by most other studies, 7 , 16 , 21 , 22 , 28 - 32 which show education was positively related to the scheme's utilization. As one might think, education has an impact on people's knowledge, attitude, and practice on the importance of CBHI healthcare service utilization.…”

Towards universal health coverage: The level and determinants of enrollment in the Community-Based Health Insurance (CBHI) scheme in Ethiopia: A systematic review and meta-analysis

“…The studies were conducted from 2017 to 2022. Regarding the distribution of the studies across the region, five were from Amhara [ 40 , 41 , 43 , 45 , 47 ], four from Oromia [ 34 , 35 , 44 , 46 ], two from Sidama [ 39 , 42 ], one from Somali [ 37 ], one from Southern Nations, Nationalities, and Peoples’ Region (SNNPR) [ 36 ], and two from Addis Ababa [ 38 , 48 ]. In all of the studies, data was collected by a face-to-face interview using a pretested, interviewer-administered questionnaire ( Table 1 ).…”

“…The effect of affordability (people’s ability to pay) for CBHI enrollment was assessed using the findings of five studies [ 35 , 37 , 42 , 46 , 47 ]. Compared to their counterparts, individuals who thought that the CBHI premium payment was affordable were 2.58 times more likely to enrol in the scheme (OR = 2.58, 95% CI: 1.68, 3.47) ( Fig 7 ).…”

Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis

“…•Contribute to essential drugs and good perception of quality of care and treatment choice [ 64 , 65 ]…”

“…Health insurance is reduced inequitable healthcare services for all citizens and improves healthcare delivery [ 11 , 29 , 36 ] and facilitates the path toward UHC [ 14 , 45 ]. Community-based health insurance also contributes to avail essential drugs, good quality of care and treatment of choice to the users [ 64 , 65 ]. Health facility governance autonomy is instrumental in increasing facility performance, fair resource allocation and quality of healthcare services to achieve better health outcomes [ 39 , 74 ].…”