Factors affecting the uptake of community-based health insurance in Ethiopia: a systematic review

Abstract

<p class="abstract">The goal of health care financing in Ethiopia is achieving universal health care coverage by community-based health insurance which was expected to cover more than eighty percent of the population. The aim was to minimize catastrophic out-of-pocket health service expenditure. We systematically reviewed factors affecting the uptake of community-based health insurance in Ethiopia. We searched various databases by 09 to 10 March 2019. We included articles regardless of their publication status with both quantitative and qualitative approaches. The factors determining the uptake of community-based health insurance in Ethiopia were found to be demographic and socio-economic, and health status, and health service-related issues. Among demographic and socio-economic factors, the report of the studies regarding gender and age was not consistent. However, income, education, community participation, marriage, occupation, and family size were found to be significant predictors and were positively related to the uptake of the scheme.<strong> </strong>Concerning health status and health service-related factors; illness experience, benefit package, awareness level, previous out of pocket expenditure for health care service, and health service status (quality, adequacy, efficiency, and coverage) were significantly and positively related but the premium amount, self-rated health status and bureaucratic complexity were found to be negative predictors. To achieve universal health care coverage through community-based health insurance, special attention should be given to community-based intervention.</p>

The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia

“…This study was in line with the previous study [ 18 , 26 , 27 ], which indicates the age of household age significantly positively affected CBHI enrollment. This study contradicted the previous study [ 28 ], age is not a significant predictor of CBHI scheme enrollment. This may be due to the fact that older people are more afraid of impending illness than younger people.…”

“…This finding is consistent with those from other settings elsewhere [ 29 – 31 ], which shows the richest households were more likely to use the CBHI program when compared the poorest households. In addition, it is in line with the previous studies [ 26 , 28 , 32 , 33 ], which show income significantly positively affected CBHI enrollment. This study was not in line with the previous studies [ 34 ], poor wealth status households were more likely willing to pay/enroll for CBHI than rich household heads.…”

“…This study also revealed that households with 4 up to 6 members were more likely to enroll in the CBHI scheme than households with 1 up to 3. This study was consistent with the previous studies [ 28 , 38 ], which show family size had a significant positive effect on dropout of households from the CBHI scheme This study contradicts the previous study [ 26 , 32 , 39 ], which shows family size had a significant negative effect on CBHI enrollment. Moreover, this study was not in line with the study [ 31 ], which shows the number of family sizes in the household had no significant effect on CBHI enrollment.…”

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

“…To do so, many developing countries have introduced CBHI since the 1990s to strengthen healthcare financing and improve access to healthcare by reducing costly risk-coping strategies ( 28 ). However, its uptake has been challenged by a variety of factors, including satisfaction ( 29 ), demographic, socio-economic, health status, and health services issues ( 30 ). Moreover, treatment outcome and patient satisfaction are inseparable ( 31 ).…”

“…So, to ensure equitability, the premiums should be based on income levels ( 37 ). On the other hand, as livestock size increased with income, the farmers’ interest in implementing the scheme decreased because the livestock were considered to be reserved assets ( 30 ). Despite the far distance, this study showed that rural respondents were more satisfied than urban dwellers, which did not deter households from joining the scheme ( 12 ); i.e., the rural and informal sectors, in particular, benefited from this program ( 32 ).…”