Health Service Utilization Among Out-of-Pocket Payers and Fee-Wavier Users in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia: A Comparative Cross-Sectional Study

Abstract

Background Health service utilization among out-of-pocket payers and fee-wavier users and factors associated with it in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia. Methods A comparative community-based cross-sectional study was conducted in Northern Ethiopia. Households with at least one person who experienced illness during the last six months were included in the study. Data were collected using a structured and interviewer-administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the HSU. Results In this study, 652 individuals (489 OOP payers and 163 fee waiver users) participated with overall response rate of 98%. The overall HSU among the participants was 44.3% (41.9 for OOP users and 51.5% for fee waiver users). The study revealed that educational status (AOR = 0.35; 95% CI: 0.21, 0.59), family size (AOR = 0.60; 95% CI: 0.37, 0.97) and income level (AOR = 2.09; 95% CI: 1.12, 3.90, and AOR = 4.12; 95% CI: 2.41, 7.53) were factors significantly associated with the HSU among OOP payers. The study also revealed that educational status (AOR = 0.65; 95% CI: 0.21, 0.59), family size (AOR = 0.4; 95% CI: 0.37, 0.97), income level (AOR = 1.12; 95% CI: 1.21, 4.87), and payment mechanism (AOR = 2.21; 95% CI = 1.34, 4.67 were significantly associated with the HSU among all study participants. Conclusion This study shows that the level of the HSU is low. Educational status, family size, economic status, and payment mechanism were significantly associated with the HSU. Therefore, improving the community’s educational level, promoting family planning, devising income-generating strategies, and strengthening the fee waiver mechanism may enhance the HSU.

Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis

“…For instance, households with chronic diseases within their family members purposely enrolled on the CBHI scheme associated with their disease status [ 47 ] •Premium load for CBHI is only decided based on family size without considering their income level [ 48 ] •High premium contribution, unclear benefit packages, high cost of living and burden of other deductions from salary for SHI [ 49 , 50 ] •High SHI contribution might lead us to further crisis and illness associated with being unable to wear clean clothes and eat right [ 49 ] •Low contract renewal rate related to the inability to afford the premiums and expected returns from the insurance [ 51 , 52 ] •Free health care services for healthcare providers from their employer health care institution [ 53 ] Strategic purchasing of services Revenue retention and utilisation •Increase resource availability for service provision [ 11 ] •Use of retained revenue for procurement of drugs and medical supplies, and oversight implementation [ 27 ] •Improve infrastructures, utilities, procure medical equipment, supplies, medical supplies, drugs, information systems, management procedures, and training to enhance services quality [ 26 , 29 , 54 ] •Avail of essential medicines; reduce stock-outs of essential drugs; improve the diagnostic capacity of health facilities; maintain continual quality of care; improve water supply, electricity to health facilities; and health infrastructures [ 27 , 54 ] •Lack of understanding of the working procedures and fear of accountability led health facilities to be reluctant to use the retained revenues. This led to health facilities being reluctant to use the retained revenues and demonstrated the loss of efficiency in health service delivery [ 11 ] Systematising fee-waivers •Provide free of charge to the poorest segments of the population to access the full range of health services [ 29 ] •Access free health care for poor households [ 27 ] •Contribute to increasing financial protection and ensuring UHC for all in Ethiopia [ 43 ] •Reduce inequities in access to health care services [ 29 ] •Increase healthcare service utilisation for the poor [ 55 …”

“…Access to healthcare services free health care for poor households through fee waiver systems increases financial protection and ensures UHC for all [ 27 , 43 ]. Fee waiver systems increase healthcare service utilisation and reduce inequalities in accessing healthcare services for the poor [ 29 , 55 ]. Private wing at hospitals can raise the motivation of medical professionals, staffs’ sense of hospitals ownership and a decline the turnover rate could help offer more choices and quality of care [ 27 – 30 ].…”

“…Successes of healthcare financing initiatives in Ethiopia include generating an additional income for health facilities, promoting cost sharing between Government and users, risk-sharing for the non-predicted illness, providing special assistance mechanisms for those who can not afford to pay, and purchasing healthcare services [ 11 , 26 , 27 ]. Ethiopia's healthcare financing initiatives have made significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial risk protection, and healthcare services [ 27 , 29 , 55 ]. On the contrary, poor access to equitable quality healthcare services was the major challenges associated with low healthcare funding and high OOP payments in Ethiopia [ 17 , 23 , 75 , 76 ].…”

Health services utilization and associated factors among fee waiver beneficiaries’ in Dessie city administration, Northeast Ethiopia: a cross-sectional study design

“…The fee waiver system is used to ensure that health-care services are available to those in society who cannot afford them [ 8 , 9 ]. Since the implementation of the fee waiver, an increasing number of poor households have experienced better access to health services compared with out-of-pocket (OOP) payers [ 10 ]. The government allocated a budget, usually at the district level, for reimbursement, and the health facilities were reimbursed on the basis of a fee for service [ 5 ].…”

“…The fee waiver system still lacks financial security for the poor and exposes them to OOP expenses in Ethiopia [ 6 ]. According to studies conducted in different parts of Ethiopia, the highest level of health service utilization among fee waiver beneficiaries was in Gondar town (61.8%) [ 13 ], Daunt (60.98%) [ 14 ], Gamo Gofa (59.6%) [ 15 ], and Tigray (51.5%) [ 10 ].…”