Willingness to Enroll for Community-Based Health Insurance and Associated Factors in Simada District, North-West, Ethiopia, 2020:A Community-Based Cross-Sectional Study

Abstract

Background

Community-based health insurance is a not-for-profit type of health insurance that has been used by poor people to protect themselves against the high costs of seeking medical care and treatment for illness. This study aimed to assess communities’ willingness to enroll for community-based health insurance (CBHI) and its associated factors in Simada district, Northwest, Ethiopia.

Methods

A community-based mixed cross-sectional study design was conducted. Multistage simple random and purposive sampling techniques were used for quantitative and qualitative studies, respectively. Data were coded and entered into Epi info version 7.2.0.1 and exported to SPSS 20.0 for data analysis. Inferential statistics were done to determine an association between the outcome and independent variables. Statistically significant variables in binary logistic regression analysis with p-value <0.2 were entered for multivariable binary logistic regression analysis and P-value ≤0.05 was considered as statistically significant. Hosmer and Lemeshow’s goodness of fitness test was fitted and qualitative data were analyzed by using thematic analysis.

Results

Among 510 study participants, 454 (89%) [CI: (86.5%-91.6%)] were willing to enroll for community-based health insurance. Members of social capital [AOR: 7.6 (3.78–15.5)], distance from health facilities [AOR: 10.8 (4.9–23.5)], the experience of chronic illness in the family [AOR: 4.6 (1.88–11.4)], medium family wealth status [AOR: 3.1 (1.3–7.5)], and the number of family members [AOR: 2.25 (1.11–4.6)] were significantly associated with willingness to enroll for community-based health insurance.

Conclusion

Willingness to enroll in community-based health insurance in the study area is high. Members of social capital, the experience of chronic illness in the family, distance from a health facility, the number of family members, and medium family wealth status were factors found to be associated with willingness to enroll for the scheme. Therefore, emphasizing redesigning and planning strategies for better expanding the scheme accordingly.

Keywords:

• CBHI
• Ethiopia
• willingness

Acknowledgment

The authors would like to thank Bahir Dar University for its technical support. Besides, we want to acknowledge data collectors and supervisors for collecting data accurately.

Abbreviations

CBHI, community based health insurance; CI, confidence interval; COR, crude odds ratio; EHIA, Ethiopian Health Insurance Agency; ETB, Ethiopian Birr; FGD, focus group discussion; HH, household; LMIC, low- and middle-income countries; OOP, out-of-pocket payment; OPD, out patient department; PCA, principal component analysis; PHCU, primary health care unit; SSA, Sub Saharan Africa; UHC, universal health coverage; WTE, willingness to enroll, WTP, willingness to pay.

Data Sharing Statement

Data will be available upon request from the corresponding author.

Ethical Approval and Consent to Participate

Ethical clearance was obtained from the School of Public health Ethical review board on the behalf of Bahir Dar University. Oral consent was obtained from all study participants before the interview. The verbal informed consent was acceptable and approved by the Ethical review board on the behalf of Bahir Dar University, and that this study was conducted under the declaration of Helsinki. A formal letter of cooperation was written to Simada District from Bahir Dar University and permission was obtained from respective kebele administrators. Study participants were informed about the purpose and their right to refuse the study.

Consent to Publication

Not applicable

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation. And took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work. All authors have read and approved the final manuscript.

Disclosure

The authors report no conflicts of interest for this work.

Additional information

Funding

This research didn’t receive any grant from any funding agency in the public, commercial, or not-for-profit sectors.