Abstract:
Background: Accessibility and price have been among the most important factors that may
cause low utilization of health services in Ethiopia and specifically in Ginbichu District despite
high coverage of primary health care services. To achieve universal access, the government of
Ethiopia has been piloting community based health insurance for three years and started to
scale up recently in which Gimbichu is one of the pilots’ woredas.
Objective: The main objective is to assess the level of utilization of health services and associated
factors among beneficiaries and non-beneficiaries of CBHI in Gimbichu District, Central Ethiopia.
Methods: A community based comparative cross-sectional study design using both quantitative and
qualitative methods of data collection was conducted from Sep16-Oct 25, 2013. A total of 900
household heads out of 916 candidates for survey and 18 in-depth interviews were included. Stratified
sampling based on insured and non insured for the quantitative with proportional allocation of the
households, and purposive sampling technique for the qualitative study were used in the randomly
selected 5 kebeles. The primary quantitative data were coded and entered using Epi data v.3.1 and
predictor variables at p <=0.25 was identified in bivariate analysis and employed in multivariate
analysis at p < 0.05 in logestic regression using SPSS v. 20.0. The qualitative result was thematically
analyzed and triangulated to the quantitative result. Ethical clearance was obtained from the Jimma
University College of Public Health and Medical Sciences.
Result: There is a significant difference between the overall utilization level among beneficiaries and
non beneficiaries of CBHI (p<.0001), 363 (81%) of the respondents of beneficiaries of CBHI had
visited the health institutions, whereas it was only 285(63.1%) from non beneficiaries of CBHI for their
previous history of illness in 12 months having 17.9 percentage point difference. The odds of utilizing
health services were 3 and 2 times likely higher among higher quintiles of respondents’ household
wealth index (richest) compared to lower quintiles (poorest) from respondents of beneficiaries and non
beneficiaries of CBHI {(AOR=3.066 , 95%CI: 1.463, 6.426,) &(AOR=2.276, 95%CI: 1.069, 4.846 )}
respectively. Having history of severe illness and perceived near distance were found to be some of
positive predictos to utilize the health service among non beneficiaries CBHI.
Conclusion: Utilization level of health services was higher among beneficiaries of CBHI even though
there were common predictor variables affecting the utilization of both beneficiaries and non
beneficiaries. Thus, we recommend that the level of health service utilization can be improved by
improving predictors of health care use like insurance status, household wealth status, access to health
services.
