Disparities in modern health service utilization between community-based health insurance member and non-member households in Ethiopia: a meta-analysis

Abstract

Despite the long-standing implementation of Ethiopia’s community-based health insurance (CBHI) program and numerous original studies, no national pooled data exist regarding disparities in modern health service utilization (MHSU) between insured and uninsured households within CBHI. Therefore, this meta-analysis aimed to ascertain the extent of MHSU disparities between CBHI member and non-member households in Ethiopia. We searched Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar on March 22, 2024. The Joanna Briggs Institute (JBI) critical appraisal tools were used to assess the risk of bias, and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines were followed to structure the review. Data analysis was conducted using Stata 17. Heterogeneity was examined through sensitivity and subgroup analyses. Publication bias was initially assessed using the Luis Furuya-Kanamori (LFK) index, which indicated major asymmetry; therefore, a random-effects model was applied, which resolved the asymmetry and was used to estimate pooled effects at a significant level of p less than 0.05 with 95% CIs. We also performed Egger’s test, which was non-significant (p = 0.440), indicating the absence of small-study effects and suggesting that publication bias did not influence the results of the meta-analysis. The meta-analysis revealed that the prevalence of MMHSU among CBHI member households was 63%, compared with 44% among non-members, reflecting a 19% gap in MMHSU between insured and uninsured families. The comparison generally showed that the insured households were 3.26 times more likely to use modern health services than their uninsured counterparts (OR = 3.26, 95% CI = 2.41–4.11). The analysis revealed that households participating in the CBHI scheme accessed modern health services more often than those not enrolled. This difference suggests that people without CBHI may face barriers to accessing care. This difference suggests that people without CBHI may face barriers to accessing care. The finding highlights an opportunity for policymakers to expand CBHI coverage to include more households and to improve the benefit packages for current members, with the goal of achieving universal access to healthcare. https://www.crd.york.ac.uk/PROSPERO/view/CRD42022355972