Abstract:
Community-based Health Insurance is not-for-profit type of health insurance in which members regularly
pay small premiums into a collective fund to be used for medical care. It has the advantage of minimizing
the equity gap and reducing out-of-pocket spending, but the concept of Community-based Health Insurance
program and implementation of the program have not received much attention equally and the enrollment
remains low in the study area as well as at the national level. The objective of this paper is to examine the
determinants of community-based health insurance practice in the study area. It also identify the extent of
households participate in the program, investigate the challenges encountered during enrollment and assess
factors affecting to practice in Community-based Health Insurance. A three-stage sampling technique is
employed to select specific households from the study area. Initially, the district was chosen on purpose
from among 22 zonal woredas. Secondly, three kebeles were selected purposively from the 23 kebeles who
have a good performance in practice. Finally, representative households were selected by random sampling
techniques from three kebeles. Cross-sectional research methods were used. Structured interview, key
informant interviews, and focus groups discussion, were used to gather primary data from a respondents.
Descriptive and inferential statistics were used to display quantitative data, while thematic analysis was
used to present qualitative data. Multivariable logistic regression analysis was conducted to identify
determinants factors of enrolment in Community-based Health Insurance. Findings of this research
disclosed that the majority (70%) households were covering their health expenses out of pocket. Some of
the challenge gaps in program were Health institution related like distance; health care service related like
availability of drug and quality care and Challenges posed by program like enough information and Trust
towards health condition are challenges. After the logistic regression, sex, level education, income,
awareness level, distance, availability drug and medical equipment, referral linkage and quality of
healthcare were found to be statistically significantly affecting the variation of decision to practice. Based
on these results, it is concluded that community-based health insurance can't improve health care systems
by it; rather, could do proper design and implementation. Thus, it is recommended that government take
actions on statistically significant issues like Service quality related issues like, medicine provision, fast
and prioritized service , access health centers ratio, awareness creation, training and informal education for
the rural society.
