Is Ethiopian community-based health insurance affordable? Willingness to pay analysis among households in South Central, Ethiopia

Abstract

Background Community-based Health Insurance (CBHI) is a voluntary prepayment mechanism that guarantees the provision of basic healthcare services without financial barriers to underserved segments of the population in developing countries. The Government of Ethiopia launched the CBHI program to protect the community from high out-of-pocket health expenditure and improve health service utilization a decade ago. However, to improve the quality of healthcare services delivery in health facilities and cover the changing costs of healthcare, the government should revise the contribution of the CBHI scheme. Therefore, we determined the willingness to pay for a CBHI scheme and associated factors among rural households of Lemu and Bilbilo district, South Central Ethiopia. Methods We conducted a community-based cross-sectional study design to assess willingness to pay for the CBHI scheme and its associated factors among households in Lemu and Bilbilo districts, South Central Ethiopia. We used a double bounded contingent valuation method to elicit households’ willingness to pay for the CBHI scheme. Data were coded, cleaned, entered into Statistical Package for Social Science (SPSS) version 25, and exported to STATA 16 for analysis. A logistic regression analysis was conducted to determine the presence of statistically significant associations between the willingness to pay for the CBHI scheme and independent variables at a p-value <0.05 and Adjusted odds ratio (AOR) values with 95% CI. Finally, we checked the fitness of the model using Hosmer and Lemeshow’s goodness-of-fit test. Results Of the 476 study participants, 82.9% (95% CI: 79.2%, 86.01%) were willing to pay for the CBHI scheme and only 62% of them can afford the average amount of 358.32ETB ($7.68) per household per annum. Primary education (AOR = 3.17; 95% CI: 1.74–5.80), secondary and above education (AOR = 4.13; 95% CI: 1.86–9.18), large family size (AOR = 2.75; 95% CI: 1.26–5.97), monthly income of 500-1000ETB (AOR = 3.75; 95% CI: 1.97–7.13) and distance to public health facilities (AOR = 2.14, 95% CI: 1.04–4.39 were significantly associated with willingness to pay for the CBHI scheme. Conclusion In this study, around 83% of respondents were willing to pay for the CBHI and meet the government expectation for 2020. The study also revealed that educational status, family size, monthly income, and distance from the health facilities were significant factors associated with WTP for the CBHI scheme. In addition, we found that a large number of the respondents couldn’t afford the average amount of money that the participants were willing to pay for the CBHI scheme. So, the government should consider the economic status of the communities while revising the CBHI scheme premium not to miss those who cannot afford the contribution.

Enrollment of reproductive age women in community-based health insurance: An evidence from 2019 Mini Ethiopian Demographic and Health Survey

“…Women who had a large number of living children were less likely to enroll in CBHI. In contrast, studies in revealed people with large family members were more likely to pay for the CBHI scheme than those with few family members (35,43). This could be attributed to the financial burdens that women with large family size had to enroll and renew their CBHI membership.…”

“…However, this figure is by far higher than study findings in sub-Saharan African countries (8.5%) ( 18 ), Nigeria (less than 3%) ( 20 ), Ethiopia (4.7%) ( 15 ), Kenya (7.0%), and East African countries (7.56%) ( 19 ). Evidences in ethiopia revealed that CBHI enrolment depend on households’ willingness to pay, renew their CBHI membership, and enroll in the CBHI program, which highly dependent on the affordability of premium and availability of service ( 35 ). Besides, a strong government commitment is essential to achieve UHC.…”

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

“…Fee-for-service is the mechanism used to pay the provider ( 13 ). The Ethiopian government revised the CBHI plan premium from 240 Birr to 410 Birr per household per year since the prior contribution plus 25% government subsidies for all members were insufficient to meet the costs of healthcare services ( 14 ).…”