Healthcare satisfaction and associated factors between insured and uninsured women in the Sidama region, Ethiopia

Abstract Ethiopia’s community-based health insurance (CBHI) improves financial protection and access to healthcare for women. This study compared satisfaction between 1060 insured and uninsured women in Central Sidama (February to April 2024). Data were analyzed using a zero-truncated negative binomial multilevel model with adjusted prevalence ratios (APR), 95% confidence intervals (CI), and p-values. CBHI membership was associated with increased satisfaction (APR = 1.04; 95% CI: 1.01–1.07; p = 0.012). Higher community autonomy raised satisfaction for insured (APR = 1.10; 95% CI: 1.03–1.16; p = 0.003) and uninsured women (APR = 1.07; 95% CI: 1.00–1.14; p = 0.037). High community poverty decreased satisfaction among insured (APR = 0.90; 95% CI: 0.84–0.97; p = 0.007). Non-governmental facilities increased satisfaction (APR = 1.18; 95% CI: 1.10–1.28; p < 0.001), while disability after treatment lowered it (APR = 0.53; 95% CI: 0.31–0.90; p = 0.019). Richest women reported lower satisfaction than poorest (insured: APR = 0.82; 95% CI: 0.76–0.89; p < 0.001; uninsured: APR = 0.80; 95% CI: 0.74–0.86; p < 0.001). Policies should reduce economic inequalities and enhance healthcare access to improve satisfaction.