Willingness to Pay for Community-Based Health Insurance Scheme and Associated Factors Among Rural Communities in Gemmachis District, Eastern Ethiopia

Abishu Kado · Bedasa Taye Merga · Hassen Abdi Adem · Yadeta Dessie · Biftu Geda

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Healthcare Systems and Reforms Healthcare Policy and Management Microfinance and Financial Inclusion

Abstract

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.

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2008Coping with out-of-pocket health payments: empirical evidence from 15 African countries 2009Borrowing And Selling To Pay For Health Care In Low- And Middle-Income Countries 2014Economic impacts of health shocks on households in low and middle income countries: a review of the literature 2015A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries 2008Impact of mutual health organizations: evidence from West Africa 1997Willingness to pay for health insurance in a developing economy. A pilot study of the informal sector of Ghana using contingent valuation 2002Willingness‐to‐pay for community‐based insurance in Burkina Faso 2016Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh

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