Determinants Of Community-Based Health Insurance Enrolment Scheme Among Households In Nekemte Town, East Wollega Zone, Oromia Region, Western Ethiopia: A Case-Control Study

Abstract

Background: Community-based health insurance emerged with exciting ideas in accessing reliable health care services for low and middle-income countries, with a goal of additional fund mobilization to the health sector and creating risk-pooling mechanisms for the poorest. However, despite increasing efforts, recent empirical evidence revealed enrolment has remained low. Objective: The main objective of the study was to identify factors determining community-based health insurance enrolment schemes in Nekemte Town, East Wollega zone, Oromia region, western Ethiopia, 2023 Methods: A community-based un-matched case-control study was carried out in Nekemte town on 488 households who were randomly selected. The study population comprised enrolled (case group; n=244) and non-enrolled (control group; n=244) to Community Based Health Insurance Scheme. Data were collected by interview using a structured and pre-tested questionnaire. Epi Data version 4.6 was used for data entry and SPSS version 25 was used for data analysis. Both bivariable and multivariable logistic regression analyses were used. In a multivariable model, the adjusted odds ratio together with the corresponding 95% confidence interval was used to assess the strength of the association between the dependent variable and covariates. Statistical significance was declared at p-values<0.05. Results: A total of 488 Households (cases =244 and controls = 244) participated in the study with a response rate of 100%. Having awareness of Community Based Health Insurance (AOR=7.92, 95%CI=3.55,17.65), affordable/low cost of enrolment (AOR=9.0, 95%CI=3.24,25.00), medium affordable/medium cost (AOR=4.0, 95%CI=1.567,10.25), trustworthiness of CBHI Scheme (AOR=5.0, 95% CI=2.08,15.09), and having good knowledge about Community Based Health Insurance (AOR=3.36, 95% CI=1.14,9.94) were found to be determinants of Community Based Health Insurance enrolment. Conclusions and Recommendations: Having awareness about CBHI, perceived affordability of costs of Community Based Insurance, knowledge of Community health insurance, and trust in the CBHI scheme were determinants of CHI enrolment. As well as improving trustworthiness by strengthening the scheme management system and improving service quality, was recommended for Community Based Insurance Scheme workers to increase household enrolment.