What role does community-based health insurance play in the utilisation of health services among households in Ethiopia? A community-based comparative cross-sectional study.

Objective: In Ethiopia, despite increased health service coverage, health service utilisation remains very low. However, evidence on the level of health service utilisation between insured and non-insured households in the study area was scanty. Therefore, this study aimed to assess health service utilisation and its predictors among insured and non-insured households of community-based health insurance in the East Wallaga Zone, Oromia region, Ethiopia, in 2022.

Methods: A community-based comparative cross-sectional study was employed. Data were collected using semi-structured interviewer-administered pretested questionnaire by face-to-face interviewing of heads of the households or spouse from 1 January 2022 to 30 January 2022, on 900 (450 insured and 450 non-insured). Epi-Data V.3.1 and Statistical Package for Social Science V.26 were used for data entry and analysis, respectively. The association between dependent (health service utilisation) and independent variables was analysed first using binary logistic regression. Multivariable logistic regression was used to identify potential predictor variables at a p<0.05.

Results: About 60.5% (95% CI 55.7% to 64.8%) of insured households had used health services compared with 45.9% (95% CI 41.4% to 50.9%) of non-insured households in the last 6 months. Family health status (Adjusted Odd Ratio (AOR) and 95% CI=2.74 (1.37 to 5.45), AOR and 95% CI=1.62 (1.01 to 3.14)); family with chronic disease (AOR and 95% CI=8.33 (5.11 to 13.57), AOR and 95% CI=4.90 (2.48 to 9.67)); perceived availability of drugs (AOR and 95% CI=0.34 (0.15 to 0.79), AOR and 95% CI=3.97 (1.69 to 9.34)); perceived transportation cost (AOR and 95% CI=0.44 (0.21 to 0.90), AOR and 95% CI=1.71 (1.00 to 2.93)); participated in indigenous community insurance (AOR and 95% CI=3.82 (1.96 to 7.45), AOR and 95% CI=0.13 (0.06 to 0.29)) and >10 km travel distance from nearby health facilities (AOR and 95% CI=1.52 (1.02 to 2.60), AOR and 95% CI=8.37 (4.54 to 15.45)) among insured and non-insured households, respectively, were predictors of health service utilisation.

Conclusion: Insured households were more likely to utilise health services compared with non-insured households. Family health status, family with chronic disease, perceived availability of drugs, perceived transportation cost, participation in indigenous community insurance and >10 km travel were predictors of health service utilisation among insured and non-insured households. Hence, the greatest emphasis should be given to enhancing enrolment in the community-based health insurance scheme to achieve universal health coverage.