Effect of Community-Based Health Insurance On Utilization of Outpatient Health Care Service In Addis Ababa, Ethiopia: A Comparative Cross Sectional Study

Abstract

Abstract Background: Community-based health insurance schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Ethiopia has been implementing community-based health insurance across all the regional states and city administrations, especially in all woredas of Addis Ababa since 2011 EC. However, in Addis Ababa, the positive impact of insured households from non-insured ones was not well described and not justified with evidence concerning the status of outpatient utilization. Objective: To assess the effects of the community-based health insurance scheme on the utilization of healthcare services in Addis Ababa, Ethiopia. Methods: The study was done using a comparative cross-sectional study design through a mixed approach. 664 (332 insured and 332 non-insured) households were recruited for the quantitative part. Concerned stakeholders were identified and focus group discussions were used, for the qualitative part of the study. Pearson Chi-square (χ2) test and multivariable logistic regression were used to have in mind the effect of community-based health insurance on healthcare utilization and to identify the independent factors by controlling the confounders, respectively. Result: The evidence from Pearson Chi-square (χ2) test shows that there is a significant difference in the utilization of outpatient health care services between CBHI –insured and non-insured households (χ2=47.776, P<0.001). The study reveals that insured households were about 4.4 times more likely to utilize outpatient healthcare than their noninsured counterparts [AOR: 4.41;95% CI: (2.59,7.49)]. In all the focus group discussions participants assured that the mobilization and the message delivered by community health workers during the time of the scheme registration had an impact on health facility visits for their illness. Conclusion: Community-based health insurance is an effective tool to enhance the utilization of healthcare services since the study remarks that the scheme has had a positive effect on the utilization of outpatient healthcare services. Key Words: Community-Based Health Insurance; Utilization of Outpatient Health care; Comparative Cross-Sectional Study.