Community-based health insurance coverage: Drop-out rates and associated factors among households in selected districts of West Shewa Zone, Ethiopia

Abstract

Background: In countries where governments are unable to subsidize health care coverage and large segments of the population cannot afford to purchase formal health insurance, community-based health insurance (CBHI) has been advanced as an alternative means of financial protection and a way to increase health care access for the poor. Objective: To examine community-based health insurance coverage, drop-out rates and associated factors among households in West Shewa zone, Ethiopia. Methods: We conducted a community-based, cross-sectional study. A multi-stage sampling technique was used to select 610 households. Data were collected using a structured questionnaire and bivariate and multivariate logistic regression analyses were employed to determine the associations between demand-side characteristics of study participants and outcome indicators of interest. Results: Thirty-three percent of the study participants had ever joined a community-based health insurance scheme, 22.1% were currently enrolled and 38% had dropped out. Sixty-nine percent of participants were willing to join a community-based health insurance scheme in the future. The main reason for dropping out was the limited benefits offered by the program. Coverage was positively associated with older age (AOR = 1.931, 95% CI = 1.225-3.044) and larger household size (AOR = 1.910, 95% CI = 1.212-3.011) and negatively associated with the absence of chronic illness in the household (AOR = 0.159, 95% CI = 0.100-0.252) and poor perceived health status of a household member with a chronic illness (AOR = 0.534, 95% CI = 0.312-0.914). Dropping out was negatively associated with the absence of chronic illness in the household (AOR = 0.266, 95% CI = 0.106-0.478). Conclusion: Our study showed that household coverage for community-based health insurance in West Shewa zone was low, with over a third of participants dropping out. We recommend that the Ethiopian Health Insurance Agency, the Federal Ministry of Health and regional and local health insurance agencies improve the benefits package to encourage greater participation.