Community-Based Health Insurance Dropout Rate and Associated Factors among households in Seyo District, Kellem Wollega Zone, Oromia, Ethiopia: Community-Based Cross-sectional study

Segni Mulugeta Tafasa^1,2*Yonas Etana³Firezer Belay Keno²Worku Fikedu²Dejene Seyoum²

• ¹Wollega University, Nekemte, Ethiopia
• ²Department of Epidemiology and Biostatistics, College of Medical and Health Sciences, Wollega University, Nekemte, Oromia Region, Ethiopia
• ³Dambi Dollo University, Dambi Dollo, Ethiopia

Despite initially high enrollment in the Community-Based Health Insurance (CBHI) scheme, sustaining membership remains a significant challenge in Ethiopia, particularly in the study area. High dropout rates threaten the program's effectiveness and long-term sustainability. Therefore, this study aimed to assess the CBHI dropout rate and its associated factors among households in the Seyo district, Kellem Wollega, Ethiopia.A community-based cross-sectional study was conducted among 551 randomly selected households from eight kebeles in the Seyo district, using a multistage sampling technique, from August 1 to September 30, 2023. Data were collected through pretested and structured questionnaires. The data were coded, entered into Epi Info version 7, and analyzed using SPSS version 25. Descriptive statistics were computed for key variables. Bi-variable and multivariable logistic regression analyses were performed to identify factors associated with CBHI dropout. Adjusted odds ratios with 95% CI were calculated to assess the strength of associations. A p-value of less than 0.05 was considered statistically significant. A total of 546 households participated in the study, yielding a response rate of 99.1%. The overall CBHI dropout rate was 36.1% (95% CI: 32-40%). Factors significantly associated with CBHI dropout rate included family size [AOR = 1.94, 95% CI: 1.18-3.19], age ≥51 years [AOR = 0.39, 95% CI: 0.18-0.86], being unable to read and write [AOR = 5.58, 95% CI: 2.88-10.8], being able to read and write [AOR = 3.59, 95% CI: 1.76-7.33], attending primary education [AOR = 2.45, 95% CI: 1.25-4.81], being a paying member [AOR = 2.52, 95% CI: 1.31-4.86], no history of chronic illness in the family [AOR = 1.75, 95% CI: 1.09-2.8], leaving health facilities without receiving treatment [AOR = 3.9, 95% CI: 2.29-6.57], and unavailable laboratory services [AOR = 1.95, 95% CI: 1.15-3.32].Nearly more than one-third of the households dropped from CBHI scheme in the study area. This study identified factors significantly associated with CBHI dropout rate, including family size, age of household head, educational level, type of membership, absence of chronic illness, leaving health facilities without treatment, and lack of adequate laboratory services. Therefore, we recommend concerned body to address these factors to reduce dropout.