Health-Related Quality of Life between Insured and Uninsured Households at Rural Communities of Southwestern Ethiopia: A Comparative Cross-Sectional Study

Abstract

Background. Community-based health insurance (CBHI) is one of the strategies among others to be used for the achievement of universal health coverage (UHC) through providing financial protection to the citizens of a country. The schemes have been seen as effective in reducing out-of-pocket (OOP) payments and improving access to the healthcare services. This study tried to assess health-related quality of life between members and nonmembers of the scheme in rural southwest Ethiopia. Study Method. A community-based comparative cross-sectional study was conducted between the insured and uninsured populations. A standardized WHOQOL-BREF questionnaire was used. Cross-tab and frequency table analysis were done to tabulate for monovariable and bivariable analysis. Multiple linear regressions were employed to determine associations by adjusting for potential confounders. The association decision was made after fitted assumptions and adjustments done by modeling. Results. About six hundred thirty-four (634) households completed the survey with a response rate of 97.2%. More than 90% of the participants were illiterate and elementary education completed and farmers. Most uninsured family members claimed that they had difficulty affording annual payments 72.5%, $P$  < 0.001. Willingness to pay was higher for insured members of households (72.2%), $P$  < 0.001. Being insured had experienced a higher quality of life than uninsured, β (95% CI), 4.15 (2.52, 5.77), and $P$  < 0.001. Marital status other than married had lower quality of life experiences than married alone, β (95% CI), −6.83 (−9.75, −3.92), and $P$  < 0.001. Male respondents were experiencing lower quality than females, β (95% CI), −2.49 (−4.25, −0.72), and $P$  = 0.006. Family number of the household and quality of life had positive linear relations, β (95% CI), 0.87 (0.43, 1.31), $P$  < 0.001. Conclusions and Recommendations. Being insured had positive implications for quality of life. Inhabitants have to be encouraged to the scheme membership.