Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia.
BMJ Open. 2024 Feb 29;14(2):e078733. doi: 10.1136/bmjopen-2023-078733.
In Ethiopia, despite increased health service coverage, health service utilisation remains very low. However, evidence on the level of health service utilisation between insured and non-insured households in the study area was scanty. Therefore, this study aimed to assess health service utilisation and its predictors among insured and non-insured households of community-based health insurance in the East Wallaga Zone, Oromia region, Ethiopia, in 2022.
A community-based comparative cross-sectional study was employed. Data were collected using semi-structured interviewer-administered pretested questionnaire by face-to-face interviewing of heads of the households or spouse from 1 January 2022 to 30 January 2022, on 900 (450 insured and 450 non-insured). Epi-Data V.3.1 and Statistical Package for Social Science V.26 were used for data entry and analysis, respectively. The association between dependent (health service utilisation) and independent variables was analysed first using binary logistic regression. Multivariable logistic regression was used to identify potential predictor variables at a p<0.05.
About 60.5% (95% CI 55.7% to 64.8%) of insured households had used health services compared with 45.9% (95% CI 41.4% to 50.9%) of non-insured households in the last 6 months. Family health status (Adjusted Odd Ratio (AOR) and 95% CI=2.74 (1.37 to 5.45), AOR and 95% CI=1.62 (1.01 to 3.14)); family with chronic disease (AOR and 95% CI=8.33 (5.11 to 13.57), AOR and 95% CI=4.90 (2.48 to 9.67)); perceived availability of drugs (AOR and 95% CI=0.34 (0.15 to 0.79), AOR and 95% CI=3.97 (1.69 to 9.34)); perceived transportation cost (AOR and 95% CI=0.44 (0.21 to 0.90), AOR and 95% CI=1.71 (1.00 to 2.93)); participated in indigenous community insurance (AOR and 95% CI=3.82 (1.96 to 7.45), AOR and 95% CI=0.13 (0.06 to 0.29)) and >10 km travel distance from nearby health facilities (AOR and 95% CI=1.52 (1.02 to 2.60), AOR and 95% CI=8.37 (4.54 to 15.45)) among insured and non-insured households, respectively, were predictors of health service utilisation.
Insured households were more likely to utilise health services compared with non-insured households. Family health status, family with chronic disease, perceived availability of drugs, perceived transportation cost, participation in indigenous community insurance and >10 km travel were predictors of health service utilisation among insured and non-insured households. Hence, the greatest emphasis should be given to enhancing enrolment in the community-based health insurance scheme to achieve universal health coverage.
在埃塞俄比亚，尽管卫生服务覆盖范围有所增加，但卫生服务利用率仍然很低。然而，关于该研究地区参保和未参保家庭卫生服务利用率水平的证据很少。因此，本研究旨在评估 2022 年埃塞俄比亚沃洛加大区东沃拉加地区基于社区的医疗保险参保和未参保家庭的卫生服务利用情况及其预测因素。
采用社区为基础的对比性横断面研究。数据于 2022 年 1 月 1 日至 1 月 30 日期间通过面对面访谈由家庭户主或配偶使用半结构式访谈员管理的预测试问卷收集，共纳入 900 户（450 户参保和 450 户未参保）。Epi-Data V.3.1 和统计软件包 Social Science V.26 分别用于数据录入和分析。首先使用二元逻辑回归分析与因变量（卫生服务利用）和自变量之间的关联。使用多变量逻辑回归在 p<0.05 时确定潜在的预测变量。
与未参保家庭相比，约 60.5%（95%CI 55.7%至 64.8%）的参保家庭在过去 6 个月内使用过卫生服务，而未参保家庭的这一比例为 45.9%（95%CI 41.4%至 50.9%）。家庭健康状况（调整优势比（AOR）和 95%CI=2.74（1.37 至 5.45），AOR 和 95%CI=1.62（1.01 至 3.14））；家庭有慢性病（AOR 和 95%CI=8.33（5.11 至 13.57），AOR 和 95%CI=4.90（2.48 至 9.67））；认为药物供应充足（AOR 和 95%CI=0.34（0.15 至 0.79），AOR 和 95%CI=3.97（1.69 至 9.34））；认为交通费用可承受（AOR 和 95%CI=0.44（0.21 至 0.90），AOR 和 95%CI=1.71（1.00 至 2.93））；参加本土社区保险（AOR 和 95%CI=3.82（1.96 至 7.45），AOR 和 95%CI=0.13（0.06 至 0.29））和距最近卫生机构的距离>10 公里（AOR 和 95%CI=1.52（1.02 至 2.60），AOR 和 95%CI=8.37（4.54 至 15.45））在参保和未参保家庭中分别是卫生服务利用的预测因素。
参保家庭比未参保家庭更有可能利用卫生服务。家庭健康状况、家庭有慢性病、认为药物供应充足、认为交通费用可承受、参加本土社区保险和距离最近卫生机构的距离>10 公里是参保和未参保家庭卫生服务利用的预测因素。因此，应高度重视加强对基于社区的医疗保险计划的参与，以实现全民健康覆盖。
