Health Service Utilization by Women Members and Non-Members of Community-Based Health Insurance Schemes in Sidama, Southern Ethiopia, 2024: A Comparative Cross-Sectional Study.

Abstract

Background: The community-based health insurance (CBHI) program was established in Ethiopia to enhance access to healthcare and protect vulnerable populations, including women, from financial risk.

Aim: This study analyzed healthcare utilization and its determinants between community-based health insurance members and nonmembers of women in Sidama's Central Zone, southern Ethiopia.

Methods: From January 19 to February 20, 2024, a community-based comparative cross-sectional study was conducted among 1280 women (640 insured and 640 uninsured). The study participants were selected using a multistage sampling technique, and data were collected through structured face-to-face interviews using the KoBo Toolbox.

Findings: The analysis revealed that CBHI membership was associated with a 77% higher frequency of health facility visits than non-members (APR = 1.77, 95% CI: 1.52-2.06; P < .001). For insured women, some individual and community-level factors were associated with the frequency of health facility visits. Age was positively associated with health facility visits, with each additional year leading to a 1.0% increase (APR = 1.01, 95% CI: 1.01-1.02; P < .001). Healthcare satisfaction also played a role, with a one-unit increase associated with a 4.0% increase in the frequency of healthcare visits (APR = 1.04, 95% CI: 1.03-1.05; P < .001). Geographical accessibility was a barrier, as women living farther from facilities experienced a 41.0% reduction in health facility visits (APR = 0.59, 95% CI: 0.48-0.73; P < .001). Community literacy and poverty levels were also significant determinants, with women from high-literacy communities having more than twice the visits (APR = 2.11, 95% CI: 1.60-2.80; P < .001) and those from low-poverty areas having higher visit rates (APR = 1.58, 95% CI: 1.24-2.01; P < .001). Family size was a determinant among uninsured women, with each additional household member associated with a 9.6% increase in health facility visits (APR = 1.10, 95% CI: 1.02-1.18; P = .015). Healthcare satisfaction had a positive association with the frequency of health facility visits (APR = 1.05, 95% CI: 1.04-1.05; P < .001). Geographical accessibility remained a barrier, with a 42% reduction in visits for those living farther from facilities (APR = 0.58, 95% CI: 0.44-0.77; P < .001). Community literacy was also a significant factor, with women from high-literacy areas having more than twice the frequency of health facility visits (APR = 2.12, 95% CI: 1.60-2.81; P < .001).

Conclusions: This analysis demonstrated that membership in CBHI substantially increased the frequency of health facility visits, resulting in a 77% rise relative to non-members. Among insured women, significant determinants included age, healthcare satisfaction, geographical accessibility, community literacy, and poverty levels. Conversely, for uninsured women, associated factors comprised family size, healthcare satisfaction, geographical accessibility, and community literacy, highlighting the necessity of addressing systemic barriers and community-level influences to enhance healthcare access and utilization in the region.