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

Abstract

Background Poor health care financing remains a major challenge to health service utilization among the lower socioeconomic society. Consequently, countries have designed different health insurance programs to overcome financial barriers against health services utilization. Similarly, Ethiopia has been implementing community-based health insurance programs since 2011 to improve health care financing system. However, only a small number of people are enrolled which might be attributed to lack of willingness towards the program and the reasons for this remained under reported. This study was intended to examine willingness to join the community-based health insurance program and its associated factors in South Wollo, Northeast Ethiopia. Method A community-based cross-sectional study was conducted among 421 households. A multistage systematic random sampling technique was employed to recruit the study households. Data were entered into EpiData version 3.1 and was exported into SPSS version 24.0 for analysis. Bivariable and multivariable logistic regression analysis with a backward elimination method was performed to identify the determinants of willingness to join community-based health insurance. Finally, a statistically significant level was declared at a p-value of less than 0.05. Results Two hundred and ninety-three [73.6% (95%CI:68.8%-77.9%)] households were willing to join community-based health insurance programs. Being male headed household (AOR:0.2, 95%CI: 0.07–0.58), being a member of Idir (AOR:0.46, 95%CI: 0.25-.84), absence of chronic illness in the household (AOR: 0.31, 95%CI: 0.13–0.77), and family size < 4 (AOR: 0.18, 95% CI:0.08–0.41) were barriers to join community-based health insurance program whereas rural residency (AOR:1.9, 95% CI: 1.09–3.32), perceived quality health services (AOR:2.96, 95%CI:1.4–6.24), and having positive attitude (AOR:4.1, 95%CI:2.32–7.22) and good knowledge to programs (AOR:2.62, 95%CI:1.43–4.8) were enabling factors. Conclusion Nearly three-fourths of the households were willing to join community-based health insurance programs. However, different household and health service-related factors affected their willingness. The ministry of health with the regional and woreda health offices should work towards improving the quality of health services, conduct program advocacy and community sensitization towards the program, and build trust with the community.

Willingness to join community‐based health insurance and its associated factors among households in West Gojjam zone, North Mecha Woreda, Amhara region, Ethiopia

“…Urban household heads are 1.484 times less likely to join the scheme compared to rural household heads (AOR = 1.484; 95% CI: 2.343-6.427). The present findings are consistent with the study done in South Wollo, Northeast Ethiopia, where rural households are two times more likely to joined a CBHI scheme compared to urban households (Biset Wagaw et al, 2022). The findings stand in contrast to a study in Kenya, which found that urban households were more likely than rural households to enroll in the health insurance plan (Kimani et al, 2014).…”

Differentials in the Prevalence of Acute Respiratory Infections Among Under-Five Children: An Analysis of 37 Sub-Saharan Countries

“…7 Despite the fact that many of the sub-regional countries' social health interventions are majorly for the poor and intended to connect the gap linking access to and utilization of health care commodities, including immunization of children. [41][42][43] Research evidence have shown that rich people in the society tend to profit more from such intervention strategies at the expense of the poor people of the society who may actually be the targeted population for the interventions. 44 Globally, inadequate living conditions pose a high-risk factor for negative health condition and are linked to insufficient use of primary health care.…”

Community-Based Health Insurance Utilization and Its Determinants among Informal Workers: Cross-Sectional Study

“…More than half of African nations still rely on OOP healthcare, which affects the frequency of use of health services among impoverished rural communities, ultimately affecting the strategy for achieving UHC ( 4 ). Community-based health insurance (CBHI) has been established in LMICs to reduce OOP healthcare costs and promote the use of health services to attain the UHC objective ( 4 , 5 ).…”

“…More than half of African nations still rely on OOP healthcare, which affects the frequency of use of health services among impoverished rural communities, ultimately affecting the strategy for achieving UHC ( 4 ). Community-based health insurance (CBHI) has been established in LMICs to reduce OOP healthcare costs and promote the use of health services to attain the UHC objective ( 4 , 5 ). The CBHI is a voluntary, non-profit insurance that consolidates premium payments from members into a common fund and covers essential medical expenses at nearby clinics when a member falls ill ( 5 ).…”

“…Since then, more regions, including Addis Ababa, have been incorporated into the program ( 9 ). Ethiopia seeks to achieve UHC by 2035 ( 4 ). However, the low utilization of health services (34.3%) compared with other African countries is attributed to inadequate healthcare financing ( 10 ).…”