Determinants of household enrollment into community-based Health insurance scheme in manna distric, jimma zone, oromia, Ethiopia: a case-control study

Abstract

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-ofpocket 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 enrolment into the scheme remains very low. Objective:-To identify determinants of household enrollment into CBHI in manna district, Jimma zone, Oromia, Ethiopia. Methods: Community based case-control study design was conducted on randomly selected 183 cases and 183 controls from June1-July30/2022 in manna district. 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. Bivariable and Multi-variable logistic regression analyses were conducted to identify determinants of enrolment in CBHI. Adjusted odds ratios with 95%CI 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: A total of 366 (100% response rate) were participated in the study. complete secondary education and above [AOR=4.28(2.19-8.38)],family size>5 members[AOR=3.83(2.33-6.31)], Highest wealth quintile [AOR=.299(.132-.677)],having favorable attitudes [AOR=2.96(1.78-4.93)], history of chronic illness[AOR=7.27(3.58-14.74)], trust on health facility[AOR=2.59(1.39-4.82], premium affordability[AOR=5.95(2.90-12.19)],scheme experience [AOR=5.37(2.89-9.98)], premium collection convenient[AOR=7.16(3.63-14.14)], availability of drugs/supplies [AOR=3.95 (1.55-10.07)], often get treatment/medical care[AOR=7.25(4.27-12.28)],were showed significantly associated/ predictors with enroll-ment to CBHI. Conclusion: educational level, family size, Wealth quintile, attitude towards CBHI, benefit package given in CBHI, premium affordability, scheme experience, Availability of drugs/ supplies, history of chronic illness and trust on health facility and often get treatment/medical care were the main predictors/determinants of enrolment to CBHIS. Recommendation: revisiting the premium amount, maybe sliding the contribution based on economic level and family size and Ensuring the convenience of the premium collection; e.g. Time of collection, place and process of collection, ID provision is important. Build the broader understanding and positive attitude among communities. Wealthy family is less enrolled-the recommendation should enforce, mobilizing the rich to join the scheme and Households with large family like to join the scheme. This creates burden to health care financing and households with small family size should also be mobilized and educate and encouraged to join the scheme and providing quality healthcare service with equipping health facility with resources and drugs/medication would help in increasing enrollment of all HHH to the CBHI. Further is needed new strategic plan on payment of CBHI according to their economic status by identifying household head as poor, medium and rich at HH level which shows economic status of households.