Determinants for non-enrolment in community based health insurance scheme in South Ari District, South Omo Zone, Southern Ethiopia 2022.

Abstract

Community-Based Health Insurance is an emerging concept in Ethiopia for providing financial protection against the cost of illness and improving access to quality health services for low-income rural households who are excluded from formal insurance. To reduce out of pocket expenditure the different countries introduce different health insurance scheme however a big challenge is non-enrolment in scheme. Hence, this study aimed to identify determinants for non-enrollment in community based health insurance scheme in South Ari District, South Omo Zone, Southern Ethiopia.

Methods: Community based unmatched Case-Control study design was employed with 1:1 ratio from April 20 to May 20 2022 among 448 household heads (224 Non enrolled and 224 enrolled. Structured and pretested questionnaire were used for data collection.   Bi-variable and multivariable logistic regression analyses were carried out using SPSS version 25. The significance of the statistical association was determined based on p<0.05.  

Result: A total of 438 respondents (219 Non-enrolled and 219 enrolled) in scheme were employed in the study with overall response rate of 98% among case (Non-enrolled) and control (enrolled). No drug availability in Health facility (AOR=2.56; 95% CI: 1.12-5.83), disagree with CBHI regular payment affordable to household (AOR=6.13; 95% CI: 2.75-13.66), disagree with time of premium payment convenient to households (AOR=4.23; 95% CI: 1.68-9.60) and disagree with trustworthiness of CBHI managers (AOR=6.73; 95% CI: 3.09-14.63) were significant factors for non-enrolment in the community-based health insurance.

Conclusion: Society’s non-enrolment decision in community based health insurance scheme was determined by: no availability of prescribed drug in health facility, lack of trustworthiness of in CBHI managers, disagree with convenience of premium collection period and disagree affordable of premium to households. Providing appropriate drug to health facilities, adjust the premium collection time, made affordable premium by considering the societies households’ income level and trustily serve the community increase enrollment.