Community-Based Health Insurance Membership Renewal Rate and Associated Factors among Households in Gedeo Zone, Southern Ethiopia

Abstract

Background. Community-based health insurance (CBHI) scheme is an emerging strategy to achieve universal health coverage and protect communities in developing countries from catastrophic financial expenditure at the service delivery point. However, high membership discontinuation from the CBHI scheme remained the challenge to progress toward universal financial protection in resource-constrained countries. Therefore, this study assessed the community-based health insurance membership renewal rate and associated factors in the Gedeo zone, Southern Ethiopia. Methods. We conducted a community-based cross-sectional study among households in the Yirga Chafe district, Gedeo zone, Southern Ethiopia, from September 10 to 30, 2021. We used a multistage simple random sampling to recruit 537 respondents. We entered data into Epi-Info 7 and exported it to SPSS version 25 for analysis. We used a logistic regression model to determine factors associated with the CBHI scheme membership renewal. Variables with a $P$ value of <0.05 and a 95% confidence level were considered to be significantly associated with the outcome variable. Results. We found the respondents’ CBHI membership renewal rate was 82.68%. Those who enrolled in the CBHI scheme >3years ( $\text{AOR}=3.12$ ; 95% CI: 1.40–6.97), having illnesses in the last three months ( $\text{AOR}=2.97$ ; 95% CI: 1.47–5.99), the CBHI premium affordability ( $\text{AOR}=12.64$ ; 95% CI: 3.25–49.38), good knowledge of the CBHI scheme ( $\text{AOR}=21.11$ ; 95% CI: 10.63–41.93), perceived quality of health service ( $\text{AOR}=4.21$ ; 95% CI: 1.52–11.68), and favorable attitude towards the CBHI scheme ( $\text{AOR}=3.89$ , 95% CI: 1.67–9.04) were significantly associated with the CBHI program membership renewal rate. Conclusion. In our study, we found the magnitude of CBHI members who discontinued their CBHI scheme membership was high. Besides, we found that the affordability of the CBHI premium, respondents’ attitude, and knowledge of the CBHI program were predictor factors for dropout from the CBHI membership. Therefore, the government should consider the economic status of communities during setting the CBHI program contribution. Moreover, awareness creation through health education should be provided to improve participants’ knowledge and perception of the CBHI program.