<p>Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia</p>

Abstract

Background: Globally, millions of people suffer and die because they do not have the money to pay for health care. A voluntary health insurance scheme is a prepayment mechanism to overcome the financial hardship of poor households. There is a high demand to determine the enrolment rate and ability to pay before scale-up of the scheme by the government to be sure of its feasibility and sustainability. Objective: To determine willingness to join and pay for a community-based health insurance scheme and associated factors among rural households of selected districts in Jimma Zone, 2018. Methods: A community-based cross-sectional study design was employed in selected districts of Jimma Zone, Ethiopia. Multistage simple random sampling was used to select 422 households. Data were collected using a semi-structured interviewer-administered questionnaire. A double bounded contingent valuation method was applied to elicit households' willingness to pay for the scheme. Data were entered into Epi-Data 3.1 and analyzed with SPSS V.23. A binary logistic regression model was fitted to determine the presence of statistically significant associations between the dependent and independent variables at p-value <0.05 and AOR values with 95% CI. Results: Of 422 sampled respondents, 389 participated in this study with a response rate of 92%. Of these, 305 (78%) were willing to join and 274 (90%) of them were willing to pay. The average amount of money the households were willing to pay per household per annum was 228 ETB (8.27 USD), with a range of 100-500 ETB. The older age groups, poor households, and experience of local risk-sharing schemes were found to be determinants for willingness to join the community-based health insurance. Similarly, having a large family size, and low economic and education status of households were significant predictors of willingness to pay for this scheme. Conclusion: A high proportion of households were willing to join and pay for the CBHI scheme. The average amount of money they were willing to pay for the scheme was very slightly lower than what is planned by the government. Thus, the government of Ethiopia should strengthen efforts to scale up this scheme in the rural areas of the country specifically to districts not yet enrolled, to reduce direct out-of-pocket payment at service delivery points. This will also contribute to guaranteeing dwellers of rural areas access to quality health services without facing financial hardship, to achieve universal health coverage for all by the end of 2035.

Willingness to Participate and Pay into a Community- Based Health Insurance Scheme in Imesi-Ile, a Rural Community in Osun State, Nigeria

“…This finding was in contrast to those found among rural households in Southwest Ethiopia, where an older age group, and lower economic status were the determinants of willingness to pay into their CBHIS. However, persons already involved in risk-sharing schemes such as cooperative societies were also more willing to pay into such schemes as found in our study [12].…”

“…It is expected that there should be many people who would be willing to make contributions to a CBHIS even if it will benefit others more. This is important for a social health insurance that is based on risk pooling and the public good [12]. The level of awareness of a community-based health insurance scheme was very low among the household heads in this rural community, 20(13.6%).…”

“…This is common to rural areas [2]. This was expected to be beneficial and should have encouraged more household heads to participate in the proposed CBHIS [12]. Making regular financial contributions was also not strange to a high proportion of the household heads.…”

Community-Based Health Insurance Utilization and Its Associated Factors among Rural Households in Akaki District, Oromia, Ethiopia, 2021

“…Health professionals have been identified as the primary source of information on CBHI. e disparity could have resulted due to study time difference and the initiation of the CBHI scheme in the study areas [16,17].…”

Willingness to join community based health insurance among households in South Wollo, Northeast Ethiopia: A community-based cross-sectional study

“…This low level of willingness could result in low CBHI utilization and a high dropout rate and which in turn affect the 2035 country plan of achieving universal health coverage [21]. Besides, there was regional variation among studies regarding willingness to join the program and associated factors [33][34][35][36][37][38][39][40][41]. This study was intended to examine willingness towards the community-based health insurance and associated factors in south wollo zone northeast Ethiopia.…”