Factors that affect enrollment into a community-based health insurance scheme among households in Arba Minch Zuria District, Gamo Zone, Southern Ethiopia, 2023: A community-based, unmatched case-control Study

Background Many low-and middle-income countries are affected by catastrophic health expenditures as out-of-pocket payments exceed the World Health Organization’s (WHO) 10% threshold level. The government of Ethiopia has been working to reduce out-of-pocket payments from 37% to less than 15% in its health sector transformation plan II; however, the scheme was marked by a low membership and dropout rate. The aim of the study was to identify determinants of enrolment into a community-based health insurance scheme (CBHIS) in Arba Minch Zuria District of Gamo Zone, Southern Ethiopia. Methods Unmatched case-control study was employed from February 8, 2023, to March 9, 2023, among 327 participants (109 cases and 218 controls to community-based health insurance (CBHI) scheme) in a 1:2 proportions. Multi-stage sampling technique was used to draw the study participants. Data were collected by using structured interviewer administered questionnaire and then entered into Epi-data and exported to SPSS for analysis. Bivariable and multivariable analysis was carried out using binary logistic regression. Significance was declared by using an adjusted odds ratio (AOR) with 95% confidence interval (CIs) and a p value of <0.05. Results A total of 327 participants (109 enrolled and 218 non-enrolled) were interviewed, resulting in a response rate of 100%. Family size (AOR=1.66; 95% CI: 1.00–2.73), wealth index (AOR=2.29; 95% CI: 1.25–4.19), awareness level of the community based health insurance scheme (AOR=3.78; 95% CI: 1.09–13.18), and perceived quality of health care (AOR=1.67; 95% CI: 1.02-2.75) were found to be determinant factors of enrollment in the scheme. Conclusion Strengthening community awareness activities, focusing on families of poor households, and improving the quality of health service delivery are highly recommended to improve enrollment in the scheme.