Factors affecting community-based health insurance utilization among households in Degadamot District, Ethiopia: Community-based cross sectional study

Abstract

Abstract Background: Community-based health insurance is provided in several countries as part of the overall health funding approach, Including Ethiopia. Ethiopia has been utilizing the Basic healthcare model and has endured a number of fundamental issues, such as insufficient service coverage, unequal access, and high out-of-pocket expenses. However, there are few studies showed that low CBHI utilization. However, enrollment is a progressive activity, and there is updated evidence about factors of utilization. Objective: This study was focused on the factors affecting community-based health insurance utilization among households in Degadamot District, Ethiopia, in 2022. Methods: A community-based cross-sectional study was employed among 736 households from August 15 to October 15, 2022. Participants were screened by using a two-stage sampling technique. Data were collected using an interviewer-administered pre-tested questionnaire and entered into EPI-Info 7 and transported to SPSS version 26. Multi-variable logistic regression was performed to further analysis. A p-value less than 0.05 with a 95% confidence interval accounted significantly between dependent and independent variables. Result: Among the total of 736 respondents, 66.7% [63.2%–70.1%] of them reported being members of the CBHI scheme. The mean age (±SD) of the study participants was 44.9 (±16.5) years. The multivariate logistic regression analysis showed that participants who were aged in years of 35-54 years(AOR=2.89; 95% CI: 1.78, 4.69), 55-74 years(AOR=3.84; 95% CI: 2.18, 6.75), >= 75 years(AOR=2.25; 95% CI: 1.04, 4.89), family size of households who had 5 and above members(AOR=2.06; 95% CI: 1.43-2.95), primary education(AOR=2.10; 1.43, 2.95), secondary and above education(AOR=2.50; 95% CI: 1.88, 4.99), had own land (AOR: 1.62; 95% CI: 1.26, 3.54), had own domestic animals (AOR=2.11; 95% CI: 1.26, 3.54), enrolled in Safety net program (AOR=2.80; 95% CI: 1.52-5.15) and had good knowledge about CBHI(AOR=3.16; 95% CI: 2.08, 4.45) factors were significantly associated with CBHI utilization. Conclusion: community-based health insurance utilization was affected by factors with age, family size, residence, educational status, owning land and domestic animals, being enrolled in the Safety Net program, and having good knowledge about CBHI were associated with CBHI utilization. As a result, a strong monitoring and evaluation system, strategies designed to increase awareness levels about the CBHI scheme's benefits, special considerations for aged people, and collaboration with social security sectors.