Community-based health insurance beneficiaries' satisfaction with health service provision and its predictors at outpatient department of public health facilities in Ethiopia: findings from a cross-sectional study.

backgroundEthiopia's Community-based health insurance (CBHI) is currently providing financial protection to more than 54 million beneficiaries (64% of the target population). Beneficiaries' satisfaction with health service provision is among the important factors that influence the decision to enroll and renew. Despite the importance of satisfaction in influencing such important decisions, there is limited evidence on systematic studies conducted at a national level on CBHI beneficiaries' satisfaction with health care service provision. Hence, this study aimed to measure the level of CBHI beneficiaries' satisfaction with health service provision and identify its determinants in Ethiopia.

methodsThis study employed a health facility-based cross-sectional study design. A total of 1,836 patients who made OPD visits were sampled, yielding a 99.9% response rate. The mean value of a composite variable derived from satisfaction items, was used to measure the level of satisfaction. Factors determining patient satisfaction were measured using binary logistic regression model, and variables with p-values < 0.05 were considered the final predictors of satisfaction.

resultsOverall, 58% [(95% CI: 55.8, 60.4)] of the patients were satisfied with the health service they received. Factors associated with higher satisfaction include fully receiving prescribed medicines [AOR = 5.31, 95% CI; 3.74, 8.12], partially receiving prescribed medicines [AOR = 1.92, 95% CI; 1.27, 2.9], being informed about health problem [AOR = 1.84, 95% CI; 1.47, 2.31], being informed about recovery methods [AOR = 1.61, 95% CI; 1.28, 2.03], patient's perception about conformity of service with benefit package [AOR = 1.4, 95% CI; 1.12, 1.73], visiting urban health facility [AOR = 1.34, 95% CI; 1.07, 1.67], and being in older age group. The study revealed a lower satisfaction at hospitals (53%) compared with health centers (61%).

conclusionNotably, a substantial proportion of patients (42%) were not satisfied, a rate higher than reported in comparable studies. Dissatisfaction was predominantly associated with shortages of prescribed medicines, inadequate laboratory services, and exposure to out-of-pocket payments. These findings highlight the need for coordinated efforts among health authorities and service providers to ensure uninterrupted availability of prescribed medicines and diagnostic services in alignment with the CBHI benefit package. Addressing these gaps is critical to fostering trust and improving satisfaction among CBHI beneficiaries.