Determinants of enrollment into community-based health insurance among households in Chora District, Southwest Ethiopia: Unmatched Case Control Study

BackgroundCommunity-based health insurance (CBHI) has emerged with exciting ideas in accessing reliable health care services for low and middle-income countries. Despite increasing effort, empirical evidence shows enrolment has remained low in Ethiopia. Therefore, this study aimed identifies determinants of enrollment into CBHI in Southwest Ethiopia. MethodsCommunity based unmatched case-control study was conducted in Chora district, Bunno Beddele Zone Southwest Ethiopia from 17th May-14th June 2021. About 245 cases and 245 controls (1: 1 ratio) were selected by simple random sampling technique, and participated in the study. Data were collected using face-to-face interview techniques with pre-tested questionnaire, and entered to Epi-data 4.6, then exported to SPSS version 25 for analysis. Logistic regression analyses were conducted to identify risk factors associated with enrolment into CBHI. The strength of association was measured using odds ratio. The findings were presented along with their corresponding 95%CI. Variables with p-values <0.05 were considered as determinants of CBHI enrolment. ResultsThe study revealed that female-headed households [AOR:10.86, 95%CI: 3.005-39.16], age of household head, being 35-50 years old [AOR:3.81, 95%CI:1.61-9.02], and being above50 years [AOR: 3.59, 95%CI: 1.23-10.47], having 4-5 family sizes [AOR:7.3, 95%CI: 2.08-25.84] and [&ge;]6 family sizes [AOR:13.31, 95%CI: 3.86-45.92], distance from health facility of [&le;]30 minutes [AOR:8.35, 95%CI: 3.22-21.65], favorable perception toward providers technical competencies [AOR:7.62, 95%CI:2.2-26.4], fully trusted on CBHI scheme [AOR:10.82, 95%CI:2.37-45.17] and moderate trust towards CBHI scheme managements [AOR:4.91, 95%CI:1.9-12.65] and positive attitudes towards CBHI scheme [AOR:4.34, 95%CI: 1.525, 12.32] were determinants among households for CBHI enrollment. ConclusionAvailability of contractual health-facility at nearest distances, being households head aged above 35years, being female-headship, large family-size, favorable perception towards health care providers technical competencies, trust towards scheme management, and positive attitudes toward scheme were determined CBHI scheme enrollment.