Community-based health insurance dropout rate and associated factors in Tembaro District, Ethiopia: a community-based cross-sectional study

Abstract

Dropout from community-based health insurance (CBHI) membership showed an increasing trend. The reasons for the dropout rate vary with local factors including insurance managers' commitment, community literacy, presence of chronic illness, and availability of medicines and diagnostics. This study assessed the CBHI membership dropout rate and associated factors among people living in Tembaro district, Kembata Tembaro Zone, Ethiopia. A community-based cross-sectional study was conducted among 590 households. Data entry and analysis were performed using Epi-data Version 3.1 and SPSS Version 21. Multivariable logistic regression analysis was used to identify factors associated with the dropout rate. The overall CBHI dropout rate was 31.5% (95% CI, 27.6, 35.4). Household monthly income < 1000 Ethiopian birr (AOR = 2.26, 95% CI: (1.38, 3.70)), paying members (AOR = 5.28, 95% CI: (3.43, 8.13)), not participating in CBHI related meetings (AOR = 1.99, 95%CI: (1.34, 2.95)), and households who did not seek treatment recently (AOR = 1.73, 95% CI: (1.18, 2.54)) were positively associated with CBHI dropout-rate. However, households with members who had suffered from a chronic disease (AOR = 0.30, 95%CI: (0.17, 0.56)), and households with any illness encountered during the past 12 months (AOR = 0.45, 95% CI: (0.30, 0.67)) were negatively associated with dropout-rate. The district CBHI dropout rate was high. Therefore, understanding contributing factors by all relevant stakeholders and addressing them will have multiple health system benefits. For future researchers, it is imperative to use more robust methods to comprehensively examine cases of CBHI dropout rate from policy, payer, provider, and members perspective.