Abstract
BackgroundIn most developing countries, healthcare cost is mainly paid at the time of sickness and out-of-pocket at the point of service delivery which potentially could inhibit access. The total economic cost of illness for households is also estimated to be frequently above 10% of household income which is categorized as catastrophic. The purpose of this study was to assess factors that determine decisions to join the community based health insurance in West Gojjam zone.MethodsA community based cross sectional survey was conducted to collect data from 690 household heads using a multistage sampling technique. A binary logistic regression was used to identify the determinants of household decisions for CBHI enrollment.ResultsOut of the participants, 58% were CBHI members. Besides, family size (AOR = 1.17; CI = 1.02–1.35), average health status (AOR = .380; CI = .179–.805), chronic disease (AOR = 3.42; CI = 1.89–6.19); scheme benefit package adequacy (AOR = 2.17; CI = 1.20–3.93), perceived health service quality (AOR = 3.69; CI = 1.77–7.69), CBHI awareness (AOR = 4.90; CI = 1.65–14.4); community solidarity (AOR = 3.77; CI = 2.05–6.92) and wealth (AOR = 3.62; CI = 1.67–7.83) were significant determinant factors for enrolment in the community based health insurance scheme.ConclusionCBHI awareness, family health status, community solidarity, quality of service of health institutions, and wealth were major factors that most determine the household decisions to enroll in the system. Therefore, in-depth and sustainable awareness creation programs on the scheme; stratified premium- based on economic status of households; incorporation of social capital factors, particularly building community solidarity in the scheme implementation are vital to enhance sustainable enrollment. As perceived family health status and the existence of chronic disease were also found significant determinants of enrollment, the Government might have to look for options to make the scheme mandatory.
Highlights
In most developing countries, healthcare cost is mainly paid at the time of sickness and out-of-pocket at the point of service delivery which potentially could inhibit access
Factors associated with community-Based Health Insurance (CBHI) enrollment The outcome variable (CBHI enrollment decision) was treated as a binary outcome: “1” for enrolled and “0” for un-enrolled households and 19 explanatory variables were considered in the econometric model
The econometrics logistic analysis showed that household family size was significantly associated with CBHI enrollment
Summary
Healthcare cost is mainly paid at the time of sickness and out-of-pocket at the point of service delivery which potentially could inhibit access. The total economic cost of illness for households is estimated to be frequently above 10% of household income which is categorized as catastrophic. Healthcare cost is mainly paid at the time of sickness and out-of-pocket (OOP) at the point of service delivery which potentially could inhibit access [1]. The total economic cost of illness for households is estimated to be frequently above 10% of household income This is potentially catastrophic: as such expenditure levels are “likely to force households to cut their consumption of other minimum needs, trigger productive asset sales or high levels of debt, and lead to impoverishment” [2]. Community-Based Health Insurance (CBHI) is being promoted for its potential to pool risks and resources so as to reduce households out off pocket expenditure and improve access to health care [3]
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