Assessment of health care service utilization and associated factors among community-based health insurance enrolled and non-enrolled households in Seka Chekorsa district, south west Ethiopia: A comparative, cross sectional study,202

Abstract

Background: Community-based health insurance (CBHI) schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Objective: To compare the differences in health service utilization between CBHI enrolled households and non-enrolled households and identify factors associated with health service utilization in Seka Chekorsa District2021. Methods: A community-based, comparative cross-sectional study was conducted from April 01 to April 30/2021.A total of 528 sample sizes was calculated using EPI INFO stat calc for the two population proportions to estimate a representative sample.Amulti-stage sampling technique was carried out to address all study participants. Data were entered using Epidata version 3.1 and analyzed usingSPSS version 25. Descriptive statistics were presented in the form of a table, graph, and statistical summary. The binary logistic and multivariate model were used for analysis and the final p-value ≤0.05 was considered to declare the statistically significant factors and the strength of association between a dependent variable and independent variables (covariates) were expressed by odds ratio with 95% confidence interval. Result:Sex(being female)[AOR=2.7, CI (1.31, 5.75)], household size(>6)[AOR=2.9, CI (1.40, 6.28)], asset based wealth status(Rich)[AOR=4.4, CI (4.90, 22.51)] and high quality of care[AOR=3.0, CI (1.87, 13.70)] were factors significantly associated among CBHI enrolled participants whereas Age(>34)[AOR=7.7, CI (1.80, 23.03)],primary education [AOR=10.2,CI(2.08, 50.28)], medium class wealth status(AOR=2.1,CI:[1.97,4.67) and having chronic illness [AOR= 1.8,CI:(1.85, 75.65)] were significantly associated with health service utilization among non-enrolled study participants . Conclusion: In this study, health service utilization among enrolled was high and low among non enrolledparticipants. Their difference was significant. Sex, household size, wealth, and quality of care were statistically significant associated with HSU among CBHI enrolled, and Age, educational status, wealth status, and chronic illness were significantly associated with the HSU among non-enrolled. Households with the identified significant factors deserve special attention.