Health service utilization among fee waiver beneficiaries versus out-of-pocket payers in Farta District, Ethiopia

A fee waiver program has been implemented in Ethiopia to increase health service utilization; however, evidence is still scant regarding its effect. Hence, this study aimed to assess the effect of fee waiver system on health service utilization and associated factors among households in Farta District, Northwest Ethiopia. A community-based comparative cross-sectional study was conducted from October 1 to November 14, 2022 among 1351 randomly selected households. The data were collected by face-to-face interviews using electronic epi-collect5 tool. Binary logistics regression and propensity score matching were computed to identify associated factors and to determine effect of fee-waiving system on health service utilization, respectively. The overall health service utilization was 52.7% (58.1% for fee waiver users and 47.2% for out-of-pocket payers). College and above education (AOR = 4.9 at 95% CI: 2.91, 8.23), large family size (AOR = 0.54; 95% CI: 0.41, 0.72), long distance to health facilities (AOR = 2.09; 95%CI: 1.64, 2.67), no cost of traveling (AOR = 4.22; 95% CI: 2.8, 6.37), chronic disease (AOR = 1.5; 95% CI: 1.11, 2.02) and fee waiver beneficiary (AOR = 1.65; 95% CI: 1.25, 2.18) were associated with overall health service utilization. Fee waiver users were 14.9% points more likely to utilize health services than matched out-of-pocket payers (t = 4.19). Health service utilization in the study area was relatively low. Fee waiver program significantly increased health service utilization, implying that financial protection interventions are crucial to improving access to healthcare. Improving education, reducing accessibility barriers, strengthening support to the low-income households may further increase service utilization. Hence, expanding fee waiver program, providing targeted health education, reducing physical and transportation barriers, and implementing financial support strategies are imperative to enhance health service utilization.