Tafasa Segni Mulugeta, Etana Yonas, Keno Firezer Belay, Fikadu Worku, Seyoum Dejene
School of Public Health, Institute of Health Science, Wallaga University, Nekemte, Ethiopia.
Department of Public Health, Institute of Health Science, Dambi Dollo University, Dambi Dollo, Ethiopia.
Front Public Health. 2025 Jun 12;13:1562257. doi: 10.3389/fpubh.2025.1562257. eCollection 2025.
Despite an initial surge in enrollment in the Community-Based Health Insurance (CBHI) scheme, maintaining the membership remains a significant challenge in Ethiopia, particularly in the study area. High dropout rates jeopardize the program's effectiveness and long-term sustainability. Therefore, this study aimed to assess the CBHI dropout rate and its associated factors among households in Seyo District, Kellem Wollega, Ethiopia.
A community-based cross-sectional study was conducted among 551 randomly selected households from eight kebeles in the Seyo district. This study employed a multistage sampling technique and took place from 1 August to 30 September 2023. Data were collected using pretested and structured questionnaires. The collected data were coded, entered into Epi Info (version 7), and analyzed using Statistical Package for the Social Sciences (SPSS version 25). Descriptive statistics were computed for key variables. Bi-variable and multivariable logistic regression analyses were performed to identify factors associated with CBHI dropout. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to assess the strength of these associations. A -value of < 0.05 was considered statistically significant. The results are presented as tables and graphs.
A total of 546 households participated in the study, yielding a response rate of 99.1%. The overall CBHI dropout rate was 36.1% (95% CI, 32-40%). Factors significantly associated with the CBHI dropout rate included family size (AOR = 1.94, 95% CI: 1.18-3.19), age ≥51 years (AOR = 0.39, 95% CI: 0.18-0.86), being unable to read and write (AOR = 5.58, 95% CI: 2.88-10.8), being able to read and write (AOR = 3.59, 95% CI: 1.76-7.33), attending primary education (AOR = 2.45, 95% CI: 1.25-4.81), being a paying member (AOR = 2.52, 95% CI: 1.31-4.86), no history of chronic illness in the family (AOR = 1.75, 95% CI: 1.09-2.8), leaving health facilities without receiving treatment (AOR = 3.9, 95% CI: 2.29-6.57), and insufficient or unavailable laboratory services (AOR = 1.95, 95% CI: 1.15-3.32).
More than one-third of the households in the study area dropped out of the CBHI scheme. This study identified several factors that are significantly associated with the CBHI dropout rate. These factors include family size, age of the household head, educational level, type of membership, absence of chronic illness in the household, experiences of leaving health facilities without treatment, and lack of adequate laboratory services. Therefore, we strongly recommend that the government and relevant stakeholders take action to address these factors in order to reduce dropout rates and improve the sustainability of the scheme.
尽管社区医疗保险（CBHI）计划的参保人数起初有激增，但在埃塞俄比亚，尤其是在研究区域，维持参保率仍是一项重大挑战。高辍学率危及该计划的有效性和长期可持续性。因此，本研究旨在评估埃塞俄比亚凯莱姆沃莱加省塞约区家庭中的社区医疗保险辍学率及其相关因素。
在塞约区8个社区中随机抽取551户家庭开展了一项基于社区的横断面研究。本研究采用多阶段抽样技术，于2023年8月1日至9月30日进行。使用经过预测试的结构化问卷收集数据。收集到的数据进行编码后录入Epi Info（7版），并使用社会科学统计软件包（SPSS 25版）进行分析。计算关键变量的描述性统计数据。进行双变量和多变量逻辑回归分析以确定与社区医疗保险辍学相关的因素。计算调整后的比值比（AOR）及95%置信区间（CI）以评估这些关联的强度。P值<0.05被认为具有统计学意义。结果以表格和图表形式呈现。
共有546户家庭参与研究，应答率为99.1%。社区医疗保险的总体辍学率为36.1%（95%CI：32 - 40%）。与社区医疗保险辍学率显著相关的因素包括家庭规模（AOR = 1.94，95%CI：1.18 - 3.19）、年龄≥51岁（AOR = 0.39，95%CI：0.18 - 0.86）、无法读写（AOR = 5.58，95%CI：2.88 - 10.8）、能够读写（AOR = 3.59，95%CI：1.76 - 7.33）、接受小学教育（AOR = 2.45，95%CI：1.25 - 4.81）、为付费成员（AOR = 2.52，95%CI：1.31 - 4.86）、家庭无慢性病病史（AOR = 1.75，95%CI：1.09 - 2.8）、未接受治疗就离开医疗机构（AOR = 3.9，95%CI：2.29 - 6.57）以及实验室服务不足或无法获得（AOR = 1.95，95%CI：1.15 - 3.32）。
研究区域内超过三分之一的家庭退出了社区医疗保险计划。本研究确定了几个与社区医疗保险辍学率显著相关的因素。这些因素包括家庭规模、户主年龄、教育水平、成员类型、家庭中无慢性病、未接受治疗就离开医疗机构的经历以及缺乏足够的实验室服务。因此，我们强烈建议政府和相关利益攸关方采取行动解决这些因素，以降低辍学率并提高该计划的可持续性。
