Community Based Health Insurance Utilization and Associated Factors among Informal Workers in Gida Ayana District, Oromia Region, West Ethiopia

Abstract

Background: Health insurance reduces impoverishment, inequitable access, and utilization of healthcare attributed to out of pocket healthcare expenditure. However, the available evidence on the magnitude and the factors associated with the utilization by households is rare, which makes it difficult to take remedial action for its sustainability and effectiveness. Therefore, the aim of this study was to assess community based health insurance utilization and the associated factors among informal workers in Gida Ayana district, east Wollega Zone, west Ethiopia. Methods: A community based cross-sectional study was conducted on 644 households in February 2018. Multistage sampling technique was used to select households. Data were collected using pretested and structured questioner and analyzed using SPSS Version 22. Bivariate and multivariable logistic regressions were computed to identify the factors associated with community based health insurance utilization. A p-value of < 0.05 with 95% confidence interval was used to declare the level of statistical significance. Results: The magnitude of community based health insurance utilization was 27.5% (95% CI: 23.8, 31.2). Older ages (41-50) (AOR=3.26; 95% CI:1.80, 5.90), having formal education (AOR=5.8; 95% CI: 3.38, 10.00), being farmer (AOR= 2.9; 95% CI:1.40, 6.00), households with better wealth status (AOR=2.40; 95% CI:1.40, 4.26), disagreement on affordability of premium (AOR=0.50; 95% CI:0.27,0.97), good knowledge (AOR=2.30; 95% CI:1.40, 3.85), selfassessed health status as poor (AOR=4.2; 95% CI:2.20, 8.00) and being neutral on trustworthiness of officials (AOR=0.43; 95% CI:0.20, 0.76) had statistically significant association with community based health insurance utilization. Conclusion: The magnitude of community based health insurance utilization in this study was low. Older ages, having formal education, better wealth status, being farmer, having good knowledge about community based health insurance utilization, self-assessed health status as poor and being neutral on trustworthiness of officials were significantly associated with community based health insurance utilization. The district’s health office should disseminate information, deeply discuss the working principles and reduce premiums payments of community based health insurance to enhance the utilization.

Keywords: Gida Ayana; Informal Workers; Health Insurance; Utilization, West Ethiopia.