Demissie Bekele, Gutema Negeri Keneni
USAID/Integrated Family Health Program, SNNPRS, Hawassa, Ethiopia.
Health Systems Management and Policy Unit, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Risk Manag Healthc Policy. 2020 Feb 25;13:141-153. doi: 10.2147/RMHP.S215836. eCollection 2020.
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.
To analyze the effects of a community-based health insurance scheme on the utilization of health-care services in Yirgalem town, southern Ethiopia.
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.
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].
Community-based health insurance is an effective tool to increase utilization of health-care services and provide the scheme to member households.
基于社区的健康保险计划日益被视为发展中国家实现全民健康覆盖的一项潜在战略。尽管在过去二十年里为提高现代医疗服务的可及性付出了巨大努力，但在埃塞俄比亚，医疗服务的利用率仍然很低。鉴于贫困家庭的经济障碍以及该国缺乏可持续的医疗融资机制被认为是主要因素，埃塞俄比亚已在试点地区实施基于社区的健康保险，旨在通过消除经济障碍来提高医疗服务的利用率。然而，关于已实施的保险计划对医疗服务利用率影响的文献却很匮乏。
分析埃塞俄比亚南部伊尔加莱姆镇基于社区的健康保险计划对医疗服务利用率的影响。
该研究采用定量和定性相结合的方法，定量部分采用比较横断面研究设计，随机抽取405名（135名参保成员和270名非参保成员）户主作为样本。为补充家庭调查的结果，还采用了焦点小组讨论。采用多变量逻辑回归来确定基于社区的健康保险对医疗服务利用的影响。
研究表明，基于社区的健康保险参保成员家庭利用门诊服务的可能性是非参保成员家庭的三倍左右[AOR：2.931；95%CI（1.039，7.929）；p值=0.042]。
基于社区的健康保险是提高医疗服务利用率的有效工具，应向参保成员家庭提供该计划。
