Effect of Community-Based Health Insurance on Utilization of Outpatient Health Care Services in Southern Ethiopia: A Comparative Cross-Sectional Study

Abstract

Background

Community-based health insurance schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Despite great efforts to improve accessibility to modern health-care services in the past two decades, in Ethiopia, utilization of health-care services have remained very low. Given the financial barriers of the poor households and lack of sustainable health-care financing mechanisms in the country has been recognized to be major factors, the country has implemented community-based health insurance in piloted regions of Ethiopia aiming to improve utilization of health-care services by removing financial barriers. However, there is a dearth of literature regarding the effect of the implemented insurance scheme on the utilization of health-care services.

Objective

To analyze the effects of a community-based health insurance scheme on the utilization of health-care services in Yirgalem town, southern Ethiopia.

Methods

The study used both a quantitative and qualitative mixed approach using a comparative cross-sectional study design for a quantitative part using a randomly selected sample of 405 (135 member and 270 non-member) household heads. To complement the findings from the household survey, focus group discussions were used. Multivariate logistic regression was employed to identify the effect of community-based health insurance on health-care utilization.

Results

The study reveals that community-based health insurance member households were about three times more likely to utilize outpatient care than their non-member counterparts [AOR: 2931; 95% CI (1.039, 7.929); p-value=0.042].

Conclusion

Community-based health insurance is an effective tool to increase utilization of health-care services and provide the scheme to member households.

Keywords:

• community-based health insurance
• health-care utilization
• health-care financing
• universal health coverage
• developing countries

Acknowledgments

We are grateful for the opportunity given us by the School of Environmental and Public Health, College of Medicine and Health Sciences at Hawassa University in the early stages of conceptualizing and carrying out this study. We would like to appreciate Abt Associate SNNPR RPO, and Yirgalem Town Administration Health Desk and CBHI process owner staff for their support in providing available information to conduct this research project. Special thanks to Dr Bekele Demissie’s wife Miss Mulubrehan Gebeyehu and his daughter Tsion Bekele for their priceless support and encouragement to pursue this study.

Disclosure

The authors report no conflicts of interest in this work.