DETERMINANTS OF COMMUNITY-BASED HEALTH INSURANCE DROPOUT AMONG HOUSEHOLDS IN TEMBARO DISTRICT, KEMBATA TEMBARO ZONE, SOUTHERN ETHIOPIA.

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