Determinants of Household Enrollment in to Community-Based Health Insurance Scheme in Hawassa City, Ethiopia: A Case-Control Study, 2023

Background: Ethiopia has been implementing community-based health insurance (CBHI) since 2011. This innovative financing method aims to improve domestic resource mobilization and sustainable health financing. This study examined the factors influencing CBHI enrollment among households in Hawassa, Ethiopia. Objective: To identify the key factors for enrollment in the community-based health insurance scheme in Hawassa city, Ethiopia. Methods: A community-based, unmatched 1:3/2 case-control study was conducted from December 1 to December 30, 2023, among 400 households (160 cases and 240 controls). Cases were chosen from households that registered for CBHI and are currently using it. Controls were selected from households that did not register for CBHI membership. Data was gathered using a semi-structured interview-administered questionnaire. We used multivariable logistic regression analysis with SPSS version 26. We considered variables statistically significant at a p-value less than 0.05, with a 95% confidence interval. Results: We collected data from 400 respondents (160 cases and 240 controls), achieving a 100% response rate. Participants with secondary education or higher, primary education, and those who can read and write showed statistically significantly higher odds of CBHI enrollment. The adjusted odds ratios (AOR) were 4.825 (95% CI: 1.592, 14.623), 3.900 (95% CI: 1.283, 11.852), and 3.129 (95% CI: 1.046, 9.355), respectively. Family size also had a significant impact, with an AOR of 2.302 (95% CI: 1.439, 3.693). Households with good knowledge of CBHI had higher odds of enrollment (AOR=2.959, 95% CI: 1.597, 5.482). Additionally, a perception of respectful care was notably linked, with an AOR of 1.819 (95% CI: 1.166, 2.835). Conclusion and recommendation: Education level, family size, knowledge, and perception of respectful care were significant factors for CBHI enrollment. Therefore, responsible organizations should enhance community education on the benefits of CBHI.