Abstract:
Background: Poor renewal rate is a key challenge facing the sustainability of community-based
health insurance (CBHI) schemes in low-income countries including Ethiopia.It is being scaled up in
the Tembaro district since 2016, but a significant dropout was observed. Nevertheless, determinants
of dropout with the scheme were not well studied in the area. Therefore, this study aimed to generate
evidence on determinants of CBHI dropout among households to enhance health service utilization in
the study area.
Objective: To identify determinants of community-based health insurance dropouts among
households in Tembaro District, Kembata Tembaro Zone, Southern Ethiopia.
Methods:A population-based case-control study was conducted from December 01-20, 2021 in
Tembaro district. A total of 350 households (175 cases (droped out) and 175 controls (renewed))
were included in the study. Face to face interview using structured questionnaire was used for
household survey to collect data.Descriptive statistics such as frequencies, mean, and standard
deviations were computed. Binary logistic regression analysis was fitted and variables with p-value
<0.25 in the bivariable logistic regression were entered into the multivariable logistic regression
model. The result of the final model was reported using Odds Ratio (OR) along with 95% confidence
intervals (CI). Statistical significance was declared at P-value less than 0.05.
Result:Three hundred fifty (175 cases and 175 controls) were employed in the anlysis. Male-headed
households[AOR=2.43; 95% CI: 1.02-5.76],households with no formal education and primary
education [AOR= 3.20; 95% C.I: 1.39-7.32] and [AOR= 3.16; 95% C.I: 1.39-7.32],good perceived
health status [AOR=2.98, 95% CI: 1.40-6.31], households visited the health facilities ≥7 times a year
[AOR=4.45, 95% CI: 2.05-9.67], absence of chronic disease[AOR=3.28; 95% CI: 1.59-6.76]and
premiumunaffordable[AOR: 2.37, 95% CI: 1.41-3.98]were significantlyassociated with CBHI dropout.
Conclusion:Sex of the HH head, educational status, perceived health status, frequency health facility
visits, having chronic diseaseand the CBHI affordabilitywereindependent predictors of CBHI dropout. Inter-sectorial collaboration is needed targeting the quality of care for CBHI
patients,challenge adverse selectionand male contribution for better adherence of CBHI
