Determinants of enrollment to community-based health insurance among rural households in Jimma zone, Southwest Ethiopia: Case control study

Abstract

Background: Community-based Health Insurance is not-for-profit type of health insurance in which members regularly pays small premiums into a collective fund to be used for medical care and treatment during illness. It has an advantage of minimizing the equity gap, reducing out-of-pocket spending and enhancing utilization of the health care system. In Ethiopia, even though there is an increasing advocacy for this scheme as part of a broader solution to health care financing problems, in Oromia region particularly in Jimma zone, enrolment in such scheme remains very low. Objective: To identify determinant factors for enrolment to community-based health insurance scheme among rural households in CBHI implementing districts of Jimma zone, southwest Ethiopia. Methods: A population based Case-Control study was conducted on randomly selected 355 cases and 355 controls from March15-April15/2018 in CBHI implementing districts of Jimma Zone. Face to face interview technique using structured questionnaire was used for household survey to collect data. Data was coded and entered in Epi data v.3.1 and exported to SPSS v. 23 for statistical analysis. Multivariable logistic regression analysis was conducted to identify determinants of enrolment in CBHI. Finally adjusted odds ratios with 95% confidence intervals and p-values <0.05 were considered to declare statistically significant variables as independent predictors of CBHI-enrolment. The study had gotten ethical approval from Institutional Review Board of Jimma University. Results: Seven hundred and ten (355 cases and 355 controls) household heads were participated in the study out of 724(362 cases and 362controls) yielding a response rate of 98%. Household heads from middle wealth quintile [1.23(1.08-2.97)], poor health status [10.32(3.8-27.7)], family size>5members [3.0(1.3-6.7)], being model household [4(1.5- 11.6)], <60min travel time on foot[3.7(1.9-7.0)], being exposed to health facilities[2.4(1.6- 4.5)], being exposed to indigenous community insurances[2.9(1.5-5.7)],those who trust on CBHI committee[23.2(9.2-46.8)],having favorable attitude towards CBHI [6.8(3.4-13.8)] and having awareness on CBHI [8.3(3.4-13.8)] were more likely to be enrolled in to CBHIS than those households in lowest wealth quintile, having good health status, family size<5 members, those who are not considered as model households, those who travel >60min to the health facilities, those who are not exposed to HF, those who are not exposed to indigenous community insurances, those who not trust CBHI committee, having unfavorable attitude and lack of awareness towards CBHI with their respective AOR with 95%C. I. Conclusion: Wealth quintile, perceived health status, family size, being a model household, distance to health facilities, being exposed to health facilities, being exposed to indigenous community insurances (iqub, idir), trust on CBHI committee, attitude and awareness towards CBHI were determinants of enrolment to CBHIS. Recommendation: Equipping rural households with a good understanding about CBHI, availing new CBHI contractual health facilities at reasonable distance and collaboration with education sector to enhance the CBHI scheme membership is recommended.