High out-of-pocket costs coupled with limited health care insurance are the key features of developing countries including Ethiopia. This study explored factors that derive households’ health insurance decision-making behavior by taking the Community-Based Health Insurance (CBHI) scheme in purposively selected four woredas from high and low enrollment rates in North Shoa zone, Amhara, Ethiopia. Both quantitative and qualitative research approaches were utilized.. The study used primary data collected from purposively selected 384 representative households using a semi-structured questionnaire. The study primarily applied a binary logistic regression along with descriptive analysis. Findings revealed that age and education of the head of the household, size of the household, previous year’s estimated annual health expenditure, household’s perception toward the quality and adequacy of public health service, awareness, and trust in the scheme were positively influencing households’ decision to enroll in the CBHI scheme while the distance to the nearest health institution was negatively affecting households enrollment decision. In the same vein, the qualitative analysis also implies that shortage of medicine, limited range of services, and prolonged refunding procedures are critical constraints of the scheme. The findings of this study suggests that the government and stakeholders should implement contemporary strategies to foster the participation of households in the CBHI scheme by raising awareness, building community trust to the scheme, improving administrative procedures, and instigating public-private partnerships to enhance the accessibility of healthcare services and foster health equity within the community thereby reducing households’ health care financial risk.
Muhammed et al. (Thu,) studied this question.