Factors affecting households' trust in the community based health insurance scheme in Ethiopia.

The trust that potentially community-based health insurance (CBHI) members have in the actual health insurance scheme is a crucial determinant for members who decided to enroll and continue being members of the scheme. While the literature on health insurance in low-income countries mentions the importance of trust in consumers' decision to insure, to date the association between trust and trust-building factors has not been researched in the Ethiopian context. Therefore, the objective of this study was to assess the factors affecting households' trust in the CBHI scheme in Ethiopia. A community-based cross-sectional study design was employed to collect data from 617 household heads from March 1-30, 2020. A multistage sampling technique was carried out and interviewer-administered questionnaires were used to collect data. Descriptive statistics and multivariable linear regression analyses were performed, and variables with a P-value < 0.05 were considered to have a statistically significant association with trust in the CBHI scheme. A household survey resulted in 617 households being interviewed making a response rate of 97.3%. The mean age of the respondents was 44.7 (SD°11.2) years and the majority of the respondents were Oromo 528(85.6%). Holding other covariant fixed, educational level of household head (ß = 0.17, 95% CI:0.14-0.32), members' satisfaction with past experience (ß = 0.40, 95%CI:0.41-0.57), favorable attitude toward CBHI (ß = 0.31, 95%CI:0.12-0.49), perceived quality of service (ß = 0.15, 95% CI:0.02-0.29) and dropout from CBHI (ß = -0.23, 95%CI:- 0.41-- 0.05) were covariant that had an association with trust in the CBHI scheme. This study found that the educational level of the household head, members' satisfaction with past experience, members' attitude toward CBHI, perceived quality of services and dropout from CBHI were covariant that were affecting trust in the CBHI scheme. Therefore, if the scheme wants to build trust and maintain membership, great attention should be given toward the improvement of the quality of service and attitude of members towards the CBHI scheme. These findings suggest that CBHI managers, different health insurance agencies, providers and policymakers need to think systematically about a wide range of initiatives that enhance trust and caring, and to design trust-building structures and practices that sustain the CBHI scheme.

Magnitude and Determinants of Dropout from Community-Based Health Insurance Among Households in Manna District, Jimma Zone, Southwest Ethiopia.

BACKGROUND: Community-based health insurance (CBHI) is a prepayment method of financial contributions for healthcare which aims to risk pooling, avoidance of catastrophic and impoverishing health expenditure. However, a high dropout from the scheme remains the biggest challenge to effective and sustainable progress towards universal financial protection in low- and middle-income countries. While large literature had examined initial enrollment and factors associated with it, only a few studies dealt with dropout. So the study aimed to assess the magnitude and determinants of dropout from community-based health insurance among households in Manna district, Jimma zone, Oromia Regional State, Ethiopia. METHODS: A community-based cross-sectional study design was employed to collect data from 634 household heads from March 1 to 30, 2020. A multistage sampling technique was carried out and interviewer-administered questionnaires were used to collect data. Descriptive statistics and multivariable logistic regression analyses were performed, and variables with a P-value<0.05 were considered as having a statistically significant association with the dropout from the CBHI. RESULTS: Magnitude of dropout from CBHI was 31.9% with 95% confidence interval (CI)=28.2-35.8% and relatively older age [adjusted odds ratio (AOR) (95% CI)=0.26 (0.10-0.78)], educational level [AOR (95% CI)=0.16 (0.06-0.41)], family size [AOR (95% CI)=0.36 (0.19-0.66)], poor perceived quality of service [AOR (95% CI)=5.7 (2.8-11.8)], trust in health facility [AOR (95% CI)=0.43 (0.3-0.61)], trust in the scheme [AOR (95% CI)=0.61 (0.45-0.84)], providers' attitude [AOR (95% CI)=10 (4.0-25.4)], and benefit package [AOR (95% CI)=4.9 (2.4-9.9)] were statistically significant determinants associated with dropout. CONCLUSION: Dropout from CBHI in this study area was high. Household heads' age, educational level, family size, perceived quality of service, providers' attitude, a benefits package, trust in the contracted health facility, and the scheme were the significant predictors of dropout. We strongly recommend that greater efforts should be made toward the providers' attitude, promised benefit package, and quality of services.