Community‐Based Health Insurance Membership Renewal Rate and Associated Factors among Households in Gedeo Zone, Southern Ethiopia

Abstract

Background. Community-based health insurance (CBHI) scheme is an emerging strategy to achieve universal health coverage and protect communities in developing countries from catastrophic financial expenditure at the service delivery point. However, high membership discontinuation from the CBHI scheme remained the challenge to progress toward universal financial protection in resource-constrained countries. Therefore, this study assessed the community-based health insurance membership renewal rate and associated factors in the Gedeo zone, Southern Ethiopia. Methods. We conducted a community-based cross-sectional study among households in the Yirga Chafe district, Gedeo zone, Southern Ethiopia, from September 10 to 30, 2021. We used a multistage simple random sampling to recruit 537 respondents. We entered data into Epi-Info 7 and exported it to SPSS version 25 for analysis. We used a logistic regression model to determine factors associated with the CBHI scheme membership renewal. Variables with a P value of <0.05 and a 95% confidence level were considered to be significantly associated with the outcome variable. Results. We found the respondents’ CBHI membership renewal rate was 82.68%. Those who enrolled in the CBHI scheme >3years ( AOR = 3.12 ; 95% CI: 1.40–6.97), having illnesses in the last three months ( AOR = 2.97 ; 95% CI: 1.47–5.99), the CBHI premium affordability ( AOR = 12.64 ; 95% CI: 3.25–49.38), good knowledge of the CBHI scheme ( AOR = 21.11 ; 95% CI: 10.63–41.93), perceived quality of health service ( AOR = 4.21 ; 95% CI: 1.52–11.68), and favorable attitude towards the CBHI scheme ( AOR = 3.89 , 95% CI: 1.67–9.04) were significantly associated with the CBHI program membership renewal rate. Conclusion. In our study, we found the magnitude of CBHI members who discontinued their CBHI scheme membership was high. Besides, we found that the affordability of the CBHI premium, respondents’ attitude, and knowledge of the CBHI program were predictor factors for dropout from the CBHI membership. Therefore, the government should consider the economic status of communities during setting the CBHI program contribution. Moreover, awareness creation through health education should be provided to improve participants’ knowledge and perception of the CBHI program.

Assessing the Determinants of Compliance with Contribution Payments to the National Health Insurance Scheme among Informal Workers in Indonesia

“…Informal workers who had little knowledge of the program were 4.94 times (p = 0.004) more likely than those who knew the program well to not make the required NHI contribution payments. Similar results from previous studies support this finding [38,42]. Those who are knowledgeable about the NHI plan have a deeper awareness of its guiding principles, its benefits package, and the advantages of maintaining membership in a health insurance system [38].…”

“…Similar results from previous studies support this finding [38,42]. Those who are knowledgeable about the NHI plan have a deeper awareness of its guiding principles, its benefits package, and the advantages of maintaining membership in a health insurance system [38]. Another argument could be that a thorough understanding of the NHI will improve their comprehension of the NHI notion of risk sharing [32].…”

“…This was based on the consideration of the possibility that another family member's health status might affect the decision to pay the contribution, given that the contribution payment is family-based. Second, seven scaled statements, modified from Kaso et al [38], were used to measure the perceived quality of service received from providers, with a Cronbach's alpha of 0.89. Lastly, attitude toward NHI comprised six Likert scale statements, adapted from a previous study [38], with a Cronbach's alpha of 0.91.…”

“…Second, seven scaled statements, modified from Kaso et al [38], were used to measure the perceived quality of service received from providers, with a Cronbach's alpha of 0.89. Lastly, attitude toward NHI comprised six Likert scale statements, adapted from a previous study [38], with a Cronbach's alpha of 0.91. The medians of the total score were used to categorize both variables.…”

“…Ability factors have two subsections. Knowledge of the NHI program was assessed with 10 questions related to the program covering the domains of the basic principle of the NHI's implementation, the aim of the NHI, the contribution amount, the inpatient fine charge, the benefit package, the cost-sharing payment concept, and the risk-sharing concept, which were all adapted from previous studies [38,42]. A correct answer obtained a score of 1, and an incorrect answer obtained a score of 0.…”