Table 3_Determinants of the decision to enroll in community-based health insurance among households in the West Guji Zone, Oromia State, southern Ethiopia, in 2022.pdf

BackgroundIn recent years, the Ethiopian government has introduced community-based health insurance (CBHI) schemes to increase healthcare accessibility and affordability. Despite these efforts, enrolment rates remain low, posing challenges to achieving universal health coverage. This study investigates the determinants influencing household enrolment decisions in community-based health insurance within the West Guji Zone, Oromia Regional State, southern Ethiopia, in 2022.
Methods and materialsA community-based, unmatched case-control study was conducted among 690 randomly selected households (345 cases and 345 controls) in the West Guji Zone from 15 April to 15 June 2022. Data were collected via a pretested and structured face-to-face interviewer-administered questionnaire. The data were entered into EpiData 3.1 and analyzed via SPSS Version 26. Bivariate and multivariate binary logistic regression models were used to identify the determinants of enrolment decisions in community-based health insurance. An adjusted odds ratio (AOR) with a 95% confidence interval and p-value <0.05 was used to declare statistically significant associations.
ResultsThe findings of this study revealed that factors such as no formal education (AOR = 2.885, 95% CI: 1.252, 6.648), negative perception (AOR = 0.067, 95% CI: 0.040, 0.112), poor and middle wealth index (AOR = 0.307, 95% CI: 0.166, 0.569), community solidarity practices (AOR = 4.266, 95% CI: 2.352, 7.736), trust in the CBHI scheme (AOR = 4.782, 95% CI: 2.926, 7.816), quality of service (AOR = 2.209, 95% CI: 1.324, 3.687), availability of prescribed drugs (AOR = 1.829, 95% CI: 1.102, 3.035), and satisfaction with services (AOR = 3.209, 95% CI: 1.937, 5.315) were identified as significant determinants of CBHI enrolment decisions.
ConclusionThis study revealed that a lack of formal education, negative perceptions, and a lower wealth index negatively impact CBHI enrolment. However, community solidarity practices, trust, quality of service, availability of prescribed drugs, and satisfaction positively influence CBHI enrolment. This study highlights the need for targeted interventions to increase community awareness, foster community solidarity at the local level, increase trust in the health system, and increase the affordability of premiums, thereby promoting community-based health insurance enrolment and achieving universal health coverage in Ethiopia.

研究背景
近年来，埃塞俄比亚政府推出了基于社区的健康保险（community-based health insurance, CBHI）计划，以提升医疗服务的可及性与可负担性。尽管采取了上述举措，该计划的参保率仍处于较低水平，为实现全民健康覆盖目标带来了挑战。本研究于2022年针对埃塞俄比亚南部奥罗米亚州西古吉地区，探究影响家庭参与基于社区的健康保险参保决策的决定因素。

研究方法与材料
本研究于2022年4月15日至6月15日期间，在西古吉地区开展基于社区的非匹配病例对照研究，共随机抽取690户家庭（病例组与对照组各345户）。数据通过经过预试验的结构化面对面访谈式问卷收集。研究数据录入至EpiData 3.1软件，并采用SPSS 26版本进行统计分析。本研究采用双变量与多变量二元logistic回归模型，以识别影响基于社区的健康保险参保决策的决定因素。以校正比值比（adjusted odds ratio, AOR）结合95%置信区间（confidence interval, CI），且p值<0.05作为判定统计学关联显著的标准。

研究结果
本研究结果显示，未接受正规教育（校正比值比=2.885，95%置信区间：1.252, 6.648）、负面认知（校正比值比=0.067，95%置信区间：0.040, 0.112）、贫困及中等财富指数（校正比值比=0.307，95%置信区间：0.166, 0.569）、社区团结实践（校正比值比=4.266，95%置信区间：2.352, 7.736）、对基于社区的健康保险计划的信任（校正比值比=4.782，95%置信区间：2.926, 7.816）、服务质量（校正比值比=2.209，95%置信区间：1.324, 3.687）、处方药可及性（校正比值比=1.829，95%置信区间：1.102, 3.035）以及服务满意度（校正比值比=3.209，95%置信区间：1.937, 5.315）等因素，均被确定为影响基于社区的健康保险参保决策的显著决定因素。

研究结论
本研究表明，未接受正规教育、负面认知以及较低的财富指数会对基于社区的健康保险参保产生负面影响；而社区团结实践、信任度、服务质量、处方药可及性以及服务满意度则会对参保行为产生积极促进作用。本研究强调，需开展针对性干预措施，以提升社区认知水平、培育地方层面的社区团结氛围、增强公众对医疗体系的信任，并提高保费的可负担性，从而推动埃塞俄比亚基于社区的健康保险参保率提升，助力实现全民健康覆盖目标。