Factors to Perceived Quality of Community Based Health Insurance Utilization among Admitted Patients at St. Paul’s Hospital Millennium Medical College and AaBET Hospital, Addis Ababa, Ethiopia

Author(s):

Dessalegn Keney Guddu*, Yared Lasebew Asres, Abriham Getachew Dullo and Tefaye Getachew Shawel

Background: Community Based Health Insurance (CBHI) was introduced by the Ethiopian government in 2011 with the aim to improve access and quality of health care to the poor informal workers. But studies show that CBHI scheme based service quality is also reported to be low. On the other hand, there has been scarcity of data on barriers to quality of service utilized particularly at hospital level by the insured patients. Objective: The aim of this study was to identify the barriers to good quality of community based health insurance utilization among admitted patients at St. Paul’s Hospital Millenium Medical College and AaBET Hospital, Ethiopia. Methods: Cross sectional mixed design implementing quantitative from chart review as well as qualitative study using phenomenological design using focused group discussion and in depth interview involving the concerned CBHI stake holders was conducted from June 1-July 15,2023. Open Data Kit (ODK) was used for quantitative data collection and SPSS V25 and NVIVO V12 were used for data analysis. Results: Total of 396 clients participated in the study. The mean age of study participants was 43.64 ± 14.3 years. Overall, 72.7% of admitted patients have got good quality community-based health insurance services. Factors significantly affecting quality of CBHI utilization were a clean and attractive hospital environment (AOR=2.77: 95% CI (1.24–6.165)), satisfied with community based health insurance (AOR=2.45: 95% CI (1.11– 5.39)) at enrollment, good knowledge of the CBHI scheme (AOR=1.97: 95% CI (1.2–3.23)), adequate availability of information on CBHI services in hospital (AOR=2.37: 95% CI (1.34–4.21)), higher family monthly income between 5251 and 7800 (AOR=1.97: 95% CI (1.2–3.23)), income more than 7801 birr (AOR=5.3: 95% CI (2.32–10.23)) respectively. The barriers to good quality utilization identified with qualitative exploration include difficulty in accessing hospital service areas(inconvenient) and information, limitation on the type of service provided by the scheme, poor knowledge of patients, overcrowding, long waiting times for chart activation, shortage of drugs and inpatient beds. Conclusion and recommendation: This study determined that the magnitude of good quality community-based health insurance services utilization was moderate compared to previous studies. Policymakers and stakeholders should improve monitoring of quality of CBHI services and further multicenter studies are necessary to improve service quality in public hospitals of Addis Ababa.