Barriers to Perccived Quality of Community Based Health Insurance Utilization Among Admitted Patients at St. Paul’s Hospital Millenium Medical College and AaBET Hospitals ,Ethiopia:

Abstract

Abstract Background: Community based health insurance(CBHI) scheme is introduced by the Ethiopian government in 2011 with the aim to improve access and quality of health care to the poor informal workers. But studies show that the CBHI utilization among the candidate patients is much lower(33-45%) than the target (80% of population) and CBHI scheme based service quality is also reported to be low.How ever, there has been scarcity of data on barriers to quality of service utiized particularly at hospital level by the insured patients. Objective: The aim of this study was to identify the barriers to good quality of community based health insurance utilization among admitted patients at St. Paul’s Hospital Millenium Medical College and AaBET Hospitals ,Ethiopia Methods: Cross sectional mixed design implementing quantitative from patient interview and chart review as well as qualitative study using with phenomenological design using focused group discussion and indepth interview involving the concerned health care workers , CBHI commitee members and patients’attendants was conducted from June1-July15,2023 .Opendata kit (ODK) was used for data collection and SPSS V25 and NVIVO V12 were used for data analysis. Results: Total of 396 clients participated in the study .The mean age of study particiapnts was 43.64± 14.3yearsb.The study found that 72.7% of admitted patients at SPHMMC and AaBET hospitals used good quality community-based health insurance services.Factors significantly affecting quality CBHI utilization were a clean and attractive hospital environment [AOR = 2.77:95% CI (1.24–6.165)], satisfied with community-based health insurance [AOR = 2.45:95% CI (1.11–5.39)] at enrollment, very satisfied [AOR = 8.79:95% CI (2.12–36.44)], good knowledge of the CBHI scheme [AOR = 1.97:95% CI (1.2–3.23)], adequate availability of information on CBHI services in hospital [AOR = 2.37:95% CI (1.34–4.21)], family monthly income between 5251 and 7800 [AOR = 1.97:95% CI (1.2–3.23)], income more than 7801 birr [AOR = 5.3:95% CI (2.32–10.23)] respectively. The barriers to good quality utilization identified with qualitative exploration include difficulty in accessing hospital service areas(inconvenient) and information, limitation on the type of service provided by the scheme, poor knowledge of patients, overcrowding, long waiting times for chart activation, and some services, shortage of drugs and inpatient beds and lack of reimbursement. Conclusion and recommendation: This study determined that the magnitude of good quality community based health insurance services utilization was moderate compared to previous studies.Policymakers and stakeholders should improve monitoring of quality of CBHI services, addressing the a forementioned challenges and further multicenter studies are warranted to improve quality in public hospitals of Addis Ababa. Keywords: quality ,community, health insurance, barriers, utilization