Assessment of Community-Based Health Insurance Dropout rate and Associated Factors in Holeta Town, Ethiopia, 2024

Abstract

Background: Community-based health insurance is a vital initiative to enhance healthcare access and financial protection for low-income and informal sector populations in Ethiopia. Despite its potential to reduce out-of-pocket healthcare expenses and improve service utilization, high dropout rate remains a significant challenge to the sustainability and effectiveness of Community-based health insurance programs. Objective: This study aims to assess the dropout rate of Community-based health insurance membership and identify associated factors in Holeta Town, Ethiopia. Methods: Cross-sectional study design was conducted. Data from primary sources was collected from the sample of 422 households in Holeta town using a structured questionnaire administered through face-to-face interviews with the heads of selected households or their representatives that selected from registered health insurance users randomly using a simple random sampling technique. The data was entered into Epidata Version 3.2 and was exported to SPSS version 22.0 for analysis. Descriptive statistics like frequency tables, percentages, and cross-tabulation was used to describe the data. Also, binary and multiple logistic regression analyses were carried out to determine the association between dependent and independent variables. The variables that showed association in binary logistic regression analysis at p value < 0.25 were entered to multiple logistic regressions and the significance of association using 95% confidence interval and p value < 0.05. Result: out of 422 participant 55(13%) dropped from community-based health insurance scheme. Being male households (AOR = 5.39, 95%, CI: 2.39-12.14), being younger (AOR =0.04, 95%, CI: 0.01-0.18), getting low monthly income (AOR=3.05, 95 % (CI: 4.18(1.65-10.58) and smaller household sizes (AOR= 6.16 (95% CI: 2.69-14.12) were significant factor contributed for dropout rate. Conclusion and recommendation. The study highlights a dropout rate is low from the community-based health insurance scheme as compared to previous study. Significant factors associated with the dropout rate include sex being male, younger household heads, low monthly income, and smaller household sizes. These findings emphasize the need for targeted strategies to address demographic and socioeconomic barriers to retaining households in the Community-based health insurance scheme