Determinants Of Enrollment To Community Based Health Insurance Among Households In Dandi District, Oromia, Ethiopia, 2021: A Case-Control Study

Abstract

Background: Community-based health insurance is typically voluntary, available to the poor and informal workers to cover the cost of healthcare. It provides the benefit of closing the equity gap, easing financial barriers, increasing health-care utilization. In Ethiopia, although there is increasing advocacy on such scheme, the enrollment still remains low; as a result people are suffering by out of pocket payment to purchase health care services. Objective: To identify determinants of enrolment to community-based health insurance among households in Dandi district, Oromia, Ethiopia, 2021. Methods: Community based unmatched case control study was conducted in Dandi district from October 20-November 20/2021. Six hundred twenty two (311 cases and 311 controls) study participants were included in study. Study participants were selected using simple random sampling procedure. Data were collected using an interviewer administered structured questionnaires by trained Health extension workers. Data were entered into Epi-info 7.2.2.6 and exported to SPSS version 23 for analysis. All independent variables with p-value < 0.25 in the bivariable logistic regression analysis were entered into multivariable logistic regression analysis. Strength of association was measured using adjusted odds ration with its 95%CI and significance was declared at 0.05 p-values. Result: Out of 622 study participants, 610(98% response rate) were involved in the study. Family size five and less (AOR = 0.62, 95%CI: 0.42,0.91), being aware of the scheme (AOR = 4.18, 95%CI: 2.54, 6.87), favorable attitude (AOR= 1.61, 95%CI: 1.10, 2.37), being model household(AOR = 1.71, 95%CI: 1.10, 2.67), local idir participation(AOR = 2.52, 95%CI: 1.53,4.15), perceived good quality of health services(AOR = 1.42, 95%CI: 1.12, 2.09), and travel greater than one hour to reach nearby health facility(AOR = 0.57, 95%CI: 0.35, 0.94) were significantly associated to community based health insurance enrollment. Conclusion and Recommendation The enrollment to community based health insurance is determined by family size, awareness on scheme, attitude towards scheme, model household by HEW program, local social(idir) participation, perceived quality of health services, and average time to reach nearby health facility. These determinants should be addressed to enhance the scheme enrollment