Household satisfaction with community-based health insurance scheme and associated factors in Addis Ababa, Ethiopia, a mixed method approach.

backgroundPatient satisfaction is a key indicator of health care quality and is often linked to better adherence to medical recommendations and increased utilization of health services. Despite its importance, evidence on satisfaction with community-based health insurance (CBHI) in Addis Ababa is limited. This study aimed to assess the level of satisfaction among CBHI members and identify associated factors at the household level in Addis Ababa, Ethiopia.

methodsA community-based cross-sectional study was conducted in Addis Ababa with mixed method. Data was collected on 630 households by using systematic random sampling method. Data was entered into Epi Data, and exported into SPSS version 25 for analysis. A bivariate binary logistic regression statistical analysis was used to identify potential candidate variables (p 0.25). The result was presented using COR and AOR with 95% CI and a p value less than 0.05 was considered significant in multivariate regression. In addition to the quantitative data, focus group discussions and key informant interviews with health professionals, CBHI office staff, and community leaders were conducted until data saturation. Semi-structured guides were used, and thematic analysis was applied.

resultThe study revealed that the level of satisfaction with the community-based health insurance scheme was found to be 51.6% (46.29-54.01). Marital status/divorced (AOR = 0.18, 95% CI (0.07-0.42)), knowledge of community-based health insurance benefit packages (AOR = 4.49, 95% CI=(2.19-9.21)), received correct prescribed drug (AOR = 4.52, 95% CI= (1.83-15.88)), participated on community-based health insurance related meetings (AOR = 11.04, 95% CI= (5.82-20.91)) and has qualified health professionals (AOR = 3.13, 95% CI=(1.72-5.71)), availability and sanitation of showers and toilets (AOR = 2.25, 95% CI=(1.10-4.63)) and satisfaction with the health facilities included in the CBHI scheme (AOR = 2.31, 95% CI =(1.02-5.23)) were significantly associated with household's satisfaction to community-based health insurance scheme. Qualitative findings from focus group discussions and key informant interviews revealed several barriers to effective CBHI implementation in Addis Ababa. Major challenges included limited awareness of CBHI services among members and health professionals, lack of compassionate and respectful care, shortages of medications, laboratory, and diagnostic services, and difficulties with premium payment modalities. These factors were consistent with the quantitative findings, highlighting their influence on household satisfaction with the CBHI scheme.

conclusionsAround half of households were satisfied with the community-based health insurance (CBHI) scheme. Household satisfaction was significantly associated with marital status, educational level, knowledge of CBHI benefit packages, receipt of correctly prescribed drugs, participation in CBHI-related meetings, presence of qualified health professionals, availability and sanitation of showers and toilets, and satisfaction with the permitted health institutions. Qualitative findings further highlighted barriers to satisfaction, including limited awareness of CBHI services, lack of respectful and compassionate care, shortages of medications, laboratory and diagnostic services, and difficulties with premium payment modalities. To enhance the sustainability of the community-based health insurance scheme, it is recommended to strengthen the supply chain for essential medicines, improve communication and awareness among CBHI members, and enhance the responsiveness and quality of care provided by health professionals.