Willingness to Pay for Community-Based Health Insurance Scheme and Associated Factors Among Rural Communities in Gemmachis District, Eastern Ethiopia
Received 6 June 2020
Accepted for publication 30 September 2020
Published 23 October 2020 Volume 2020:12 Pages 609—618
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Samer Hamidi
Abishu Kado,1 Bedasa Taye Merga,2 Hassen Abdi Adem,2 Yadeta Dessie,2 Biftu Geda3
1West Hararghe Zonal Health Department, Chiro, Ethiopia; 2School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 3Colleges of Health and Medical Sciences, Arsi University, Asella, Ethiopia
Correspondence: Bedasa Taye Merga
School of Public Health, College of Health and Medical Sciences, Haramaya University, P.O.Box. 235, Harar, Ethiopia
Background: In sub-Saharan Africa, out-of-pocket expenditures constitute approximately 40% of total healthcare expenditures, imposing huge financial burdens on the poor. To tackle the effects of out-of-pocket payment for healthcare services, Ethiopia has been focusing on implementation and expansion of a community-based health insurance (CBHI) program since 2011. This study assessed willingness to pay for CBHI scheme and associated factors among rural communities in Gemmachis district, eastern Ethiopia.
Methods: Community-based cross-sectional study was conducted among 446 randomly selected participants in Gemmachis district from April 1 to April 30, 2019. Data were collected from participants using pretested structured questionnaires through face-to-face interview. Data were entered into EpiData version 3.1 and analyzed using SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with willingness to pay for CBHI.
Results: A total of 440 (98.7%) participants were involved in the study. Three in every four (74.8%) participants were willing to pay for CBHI (95% CI: 70.7%, 78.9%). Primary education (AOR=5.1, 95% CI: 2.4, 11.1), being merchant (AOR=0.23, 95% CI: 0.10, 0.51), housewife (AOR=3.8, 95% CI: 1.3, 11.0), poor (AOR=2.5, 95% CI: 1.3, 4.7), illness in the last one year (AOR=3.1, 95% CI, 1.9, 5.2), good knowledge about CBHI (AOR=2.3, 95% CI: 1.5, 3.6) and access to public health facility (AOR=2.0,95% CI: 1.1, 3.7) were all significantly associated with willingness to pay for CBHI.
Conclusion: A significant proportion of participants were willing to pay for CBHI scheme. Education, occupation, wealth status, illness in the last one year, knowledge about CBHI and access to healthcare facility were factors significantly associated with willingness to pay for CBHI. If the scheme is to serve as a means to provide access to health service, the premium for membership should be tailored and customized by individual socioeconomic factors.
Keywords: willingness to pay, community-based health insurance, associated factors, Ethiopia
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