Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Haramaya University, Harar, Ethiopia.
PLoS One. 2021 Jun 10;16(6):e0252303. doi: 10.1371/journal.pone.0252303. eCollection 2021.
Modern health services utilization in developing countries has continued low. Financial shortage to access health-care services might be averted by stirring from out-of-pocket payment for health care at the time of use. The government of Ethiopia; depend greatly on foreign aid (50%) and out-of-pocket payments (34%) to fund health services for its population. This study was aimed to identify factors associated with households' enrollment to CBHI scheme membership.
Case-control study design was conducted from May 18-July 27, 2019 among 332 participants (166 enrolled and 166 non-enrolled to CBHI scheme). Simple random sampling technique was used to select the study participants. Bi-variable and multivariable logistic regression model were fitted to identify factors associated with enrollment to community based health insurance. Adjusted odds ratio (AOR) with 95% CI was used to report association and significance was declared at P<0.05.
A total of 332 (100% response rate) were involved in the study. Educational status (College and above, AOR = 3.90, 95%CI; 1.19, 12.75), good awareness about CBHI scheme (AOR = 21.595, 95% CI; 7.561, 61.681), affordability of premium payment (AOR = 3.403, 95% CI; 5.638-4.152), wealth index {(Poor, AOR = 2.59, 95%CI; 1.08, 6.20), (Middle, AOR = 4.13, 95%CI; 1.11, 15.32)} perceived health status (AOR = 5.536; 95% CI; 1.403-21.845), perceived quality of care (AOR: 21.014 95%CI; 4.178, 105.686) and treatment choice (AOR = 2.94, 95%CI; 1.47, 5.87) were factors significantly associated with enrollment to CBHI.
Enrolment to CBHI schemes is influenced by educational level, awareness level, affordability of premium, wealth index, perceived health status, perceived quality of care and treatment choice. Implementation strategies aimed at raising community awareness, setting affordable premium, and providing quality healthcare would help in increasing enrollment of all eligible community groups to the CBHI scheme.
发展中国家的现代卫生服务利用水平仍然较低。通过在使用时避免自付医疗保健费用，可以避免获取医疗保健服务的资金短缺。埃塞俄比亚政府主要依赖外援（50%）和自付费用（34%）为其人民提供医疗服务。本研究旨在确定与家庭参与社区健康保险计划成员资格相关的因素。
2019 年 5 月 18 日至 7 月 27 日，采用病例对照研究设计，对 332 名参与者（166 名入组和 166 名未入组社区健康保险计划）进行研究。采用简单随机抽样技术选择研究对象。采用单变量和多变量逻辑回归模型来确定与社区参与健康保险相关的因素。使用调整后的优势比（AOR）和 95%置信区间（CI）来报告关联，P<0.05 表示有统计学意义。
共有 332 名（100%的应答率）参与者参与了研究。教育程度（大学及以上，AOR=3.90，95%CI；1.19，12.75）、对社区健康保险计划的良好认知（AOR=21.595，95%CI；7.561，61.681）、保费支付能力（AOR=3.403，95%CI；5.638-4.152）、财富指数{（贫困，AOR=2.59，95%CI；1.08，6.20），（中等，AOR=4.13，95%CI；1.11，15.32）}、感知健康状况（AOR=5.536；95%CI；1.403-21.845）、感知医疗质量（AOR：21.014 95%CI；4.178，105.686）和治疗选择（AOR=2.94，95%CI；1.47，5.87）与入组社区健康保险显著相关。
社区健康保险计划的入组受到教育水平、认知水平、保费支付能力、财富指数、感知健康状况、感知医疗质量和治疗选择的影响。旨在提高社区意识、设定可负担保费和提供高质量医疗保健的实施策略将有助于增加所有符合条件的社区群体对社区健康保险计划的参与。
