Client’s satisfaction with a community-based health insurance scheme and associated factors in Addis Ababa

Abstract

Many countries introduced CBHI as their health care financing system to ensure healthcare access. Understanding the level of satisfaction and factors associated with the level of satisfaction in Addis Ababa is essential to ensure the sustainability of the program. Therefore, this study assessed the level of satisfaction of CBHI members and its associated factors. Methodology: Institutional based cross- sectional study was conducted on a sample of 419 beneficiaries in the ten health centers found in the ten sub cities of Addis Ababa, which have deal with their respective scheme to give service to members. Both quantitative and qualitative methods were used. Data was collected using pretested structured questionnaire and FGD guide. Descriptive and binary logistic regression analysis was carried out to identify its associated factors. Odds ratio with 95% confidence interval was calculated using logistic regression analysis. Finally, variables with p-value of <0.05 has been considered as statistically significant. Data from the qualitative part was analyzed by using thematic analysis Result: In this study, the overall satisfaction level of households with the community-based health insurance was found to be 46.3%. Satisfaction of CBHI members was positively associated with CBHI management regulations (AOR= 1.96, 95% CI: 1.12, 3.46). In addition participants who received the right drug (AOR=1.77, 95% CI: 1.08, 2.93), households who got immediate care during the recent visit (AOR = 4.95, 95% CI: 2.72, 8.98), those who agreed with the adequacy of medical equipment at the permitted public health institutions (AOR = 1.65, 95% CI: 1.02, 2.69), and households who agreed on the adequacy and qualification of health personnel (AOR= 1.89, 95% CI: 1.12, 3.20) were more satisfied with the scheme than their counter parts. The challenges mentioned by the discussants were shortage of drugs, disrespect and poor attitude of health professionals, absence of kenema pharmacy in their nearby place, lack of laboratory and other diagnostic service, health professionals lacked awareness about CBHI scheme, and rigid premium payment modality. Conclusion and Recommendation: In this study, the satisfaction level of members of CBHI scheme was found to be low. In order to achieve a better result and ensure the sustainability of CBHI program the health bureau together with sub cities should do further investigations on the qualification and competency of health professionals, availability of medication and medical equipment and attitude of pharmacists at Kenema pharmacies towards CBHI members.