Willingness to join community based health insurance among households in South Wollo, Northeast Ethiopia: A community-based cross-sectional study

BACKGROUND: Poor health care financing remains a major challenge to health service utilization among the lower socioeconomic society. Consequently, countries have designed different health insurance programs to overcome financial barriers against health services utilization. Similarly, Ethiopia has been implementing community-based health insurance programs since 2011 to improve health care financing system. However, only a small number of people are enrolled which might be attributed to lack of willingness towards the program and the reasons for this remained under reported. This study was intended to examine willingness to join the community-based health insurance program and its associated factors in South Wollo, Northeast Ethiopia. METHOD: A community-based cross-sectional study was conducted among 421 households. A multistage systematic random sampling technique was employed to recruit the study households. Data were entered into EpiData version 3.1 and was exported into SPSS version 24.0 for analysis. Bivariable and multivariable logistic regression analysis with a backward elimination method was performed to identify the determinants of willingness to join community-based health insurance. Finally, a statistically significant level was declared at a p-value of less than 0.05. RESULTS: Two hundred and ninety-three [73.6% (95%CI:68.8%-77.9%)] households were willing to join community-based health insurance programs. Being male headed household (AOR:0.2, 95%CI: 0.07–0.58), being a member of Idir (AOR:0.46, 95%CI: 0.25-.84), absence of chronic illness in the household (AOR: 0.31, 95%CI: 0.13–0.77), and family size < 4 (AOR: 0.18, 95% CI:0.08–0.41) were barriers to join community-based health insurance program whereas rural residency (AOR:1.9, 95% CI: 1.09–3.32), perceived quality health services (AOR:2.96, 95%CI:1.4–6.24), and having positive attitude (AOR:4.1, 95%CI:2.32–7.22) and good knowledge to programs (AOR:2.62, 95%CI:1.43–4.8) were enabling factors. CONCLUSION: Nearly three-fourths of the households were willing to join community-based health insurance programs. However, different household and health service-related factors affected their willingness. The ministry of health with the regional and woreda health offices should work towards improving the quality of health services, conduct program advocacy and community sensitization towards the program, and build trust with the community.