Department of Health Informatics, Debre Berhan University, Asrat Woldeyes Health Science Campus, Debre Birhan, Ethiopia.
Front Public Health. 2024 May 17;12:1305458. doi: 10.3389/fpubh.2024.1305458. eCollection 2024.
Healthcare service utilization is unequal among different subpopulations in low-income countries. For healthcare access and utilization of healthcare services with partial or full support, households are recommended to be enrolled in a community-based health insurance system (CBHIS). However, many households in low-income countries incur catastrophic health expenditure. This study aimed to assess the spatial distribution and factors associated with households' enrollment level in CBHIS in Ethiopia.
A cross-sectional study design with two-stage sampling techniques was used. The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. STATA 15 software and Microsoft Office Excel were used for data management. ArcMap 10.7 and SaTScan 9.5 software were used for geographically weighted regression analysis and mapping the results. A multilevel fixed-effect regression was used to assess the association of variables. A variable with a < 0.05 was considered significant with a 95% confidence interval.
Nearly three out of 10 (28.6%) households were enrolled in a CBHIS. The spatial distribution of households' enrollment in the health insurance system was not random, and households in the Amhara and Tigray regions had good enrollment in community-based health insurance. A total of 126 significant clusters were detected, and households in the primary clusters were more likely to be enrolled in CBHIS. Primary education (AOR: 1.21, 95% CI: 1.05, 1.31), age of the head of the household >35 years (AOR: 2.47, 95% CI: 2.04, 3.02), poor wealth status (AOR: 0.31, 95% CI: 0.21, 1.31), media exposure (AOR: 1.35, 95% CI: 1.02, 2.27), and residing in Afar (AOR: 0.01, 95% CI: 0.003, 0.03), Gambela (AOR: 0.03, 95% CI: 0.01, 0.08), Harari (AOR: 0.06, 95% CI: 0.02, 0.18), and Dire Dawa (AOR: 0.02, 95% CI: 0.01, 0.06) regions were significant factors for households' enrollment in CBHIS. The secondary education status of household heads, poor wealth status, and media exposure had stationary significant positive and negative effects on the enrollment of households in CBHIS across the geographical areas of the country.
The majority of households did not enroll in the CBHIS. Effective CBHIS frameworks and packages are required to improve the households' enrollment level. Financial support and subsidizing the premiums are also critical to enhancing households' enrollment in CBHIS.
在低收入国家，不同亚人群之间的医疗服务利用存在不平等现象。为了获得医疗服务的可及性和利用部分或全部支持的医疗服务，建议家庭参加社区为基础的健康保险制度（CBHIS）。然而，许多低收入国家的家庭会发生灾难性的医疗支出。本研究旨在评估埃塞俄比亚家庭参加 CBHIS 的水平的空间分布和相关因素。
采用两阶段抽样技术的横断面研究设计。使用 2019 年埃塞俄比亚微型人口与健康调查（EMDHS）数据。使用 STATA 15 软件和 Microsoft Office Excel 进行数据管理。使用 ArcMap 10.7 和 SaTScan 9.5 软件进行地理加权回归分析和结果映射。使用多水平固定效应回归评估变量之间的关联。具有 <0.05 的变量被认为具有统计学意义，置信区间为 95%。
近十分之三（28.6%）的家庭参加了 CBHIS。家庭参加健康保险制度的空间分布并非随机的，阿姆哈拉和提格雷地区的家庭参加社区为基础的健康保险的情况良好。共检测到 126 个显著聚类，初级聚类中的家庭更有可能参加 CBHIS。接受过小学教育（AOR：1.21，95%CI：1.05，1.31）、户主年龄>35 岁（AOR：2.47，95%CI：2.04，3.02）、贫穷的财富状况（AOR：0.31，95%CI：0.21，1.31）、媒体接触（AOR：1.35，95%CI：1.02，2.27）和居住在阿法尔（AOR：0.01，95%CI：0.003，0.03）、甘贝拉（AOR：0.03，95%CI：0.01，0.08）、哈拉里（AOR：0.06，95%CI：0.02，0.18）和 Dire Dawa（AOR：0.02，95%CI：0.01，0.06）地区是家庭参加 CBHIS 的显著因素。户主的中等教育程度、贫穷的财富状况和媒体接触对全国各地区家庭参加 CBHIS 的情况产生了稳定的显著的正向和负向影响。
大多数家庭没有参加 CBHIS。需要有效的 CBHIS 框架和方案来提高家庭的参保水平。提供资金支持和补贴保费对于提高家庭参加 CBHIS 也至关重要。
