Factors to Perceived Quality of Community Based Health Insurance Utilization Among Admitted Patients at St. Pauls Hospital Millennium Medical College and AaBET Hospital, Addis Ababa, Ethiopia

BackgroundCommunity based health insurance(CBHI) was introduced by the Ethiopian government in 2011 with the aim to improve access and quality of health care to the poor informal workers. But studies show that CBHI scheme based service quality is also reported to be low.On the other hand, there has been scarcity of data on barriers to quality of service utilized particularly at hospital level by the insured patients. ObjectiveThe aim of this study was to identify the barriers to good quality of community based health insurance utilization among admitted patients at St. Pauls Hospital Millenium Medical College and AaBET Hospital, Ethiopia. MethodsCross sectional mixed design implementing quantitative from chart review as well as qualitative study using phenomenological design using focused group discussion and indepth interview involving the concerned CBHI stake holders was conducted from June1-July15,2023. Opendata kit (ODK) was used for quantitatie data collection and SPSS V25 and NVIVO V12 were used for data analysis. ResultsTotal of 396 clients participated in the study. The mean age of study particiapnts was 43.64{+/-} 14.3 years. over all, 72.7% of admitted patients have got good quality community-based health insurance services.Factors significantly affecting quality of CBHI utilization were a clean and attractive hospital environment [AOR = 2.77:95% CI (1.24-6.165)], satisfied with community based health insurance [AOR = 2.45:95% CI (1.11-5.39)] at enrollment, good knowledge of the CBHI scheme [AOR = 1.97:95% CI (1.2- 3.23)], adequate availability of information on CBHI services in hospital [AOR = 2.37:95% CI (1.34-4.21)], higher family monthly income between 5251 and 7800 [AOR = 1.97:95% CI (1.2-3.23)], income more than 7801 birr [AOR = 5.3:95% CI (2.32-10.23)] respectively. The barriers to good quality utilization identified with qualitative exploration include difficulty in accessing hospital service areas(inconvenient) and information, limitation on the type of service provided by the scheme, poor knowledge of patients, overcrowding, long waiting times for chart activation, shortage of drugs and inpatient beds Conclusion and recommendationThis study determined that the magnitude of good quality community-based health insurance services utilization was moderate compared to previous studies.Policymakers and stakeholders should improve monitoring of quality of CBHI services and further multicenter studies are necessary to improve service quality in public hospitals of Addis Ababa.