Health Services Utilization and Associated Factors: A Comparative Study among Beneficiaries and NonBeneficiaries of Community Based Health Insurance in Gimbichu District, Eastern Shoa, Central Ethiopia

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.