Community-based health insurance (CBHI) is one of the ways to provide health insurance for the informal sector and the rural populace. CBHI, in spite of its problems relating to the extent of resource pooling, has been shown to facilitate and improve access to healthcare services especially among children, pregnant women and the elderly.
The overall aim of this study was to assess the willingness of CBHI uptake and associated factors among the informal sector workers in urban towns. The proportion of willingness of CBHI uptake was 86.3%. Educational status, family size, easiness of getting money to pay for health care services; the time it took to reach the nearest health facility and frequency at which the respondents want to pay the yearly premium were the associated factors for the willingness of CBHI uptake.
Age of the respondents, wealth, knowing the benefits package of CBHI and ability to pay 500 ETB (USD $17.9) as annual premium were variables having a statistically significant association with the willingness of CBHI uptake in crude; but have no association when adjusted. Age with 45–54 categories was 4.51 (COR = 4.51: 95%CI, 1.5–13.58) times more likely willing to uptake CBHI than 15–24 age category. Those able to raise 200 ETB (USD $7.14) during the emergency were 2.02 times more likely to enroll in CBHI than their counterparts (COR = 2.02: 95%CI, 1.35–3.03). Knowing the benefits package of CBHI make the respondents wish to join CBHI (COR = 2.49: 95%CI, 1.61–3.83). And an ability to pay 500 ETB (USD $17.9) as annual premium made them will to uptake CBHI (COR = 21.62: 95%CI, 7.62–61.32).
The willingness of CBHI uptake of this survey is similar to a previously conducted survey in Cameroon 86.2% [12]. This proportion finding is higher than research conducted in Ecuador 69.3% [13]. This high discrepancy may be related to methodological issues and differences in the study areas. But, the current finding is less than that found in 2004 in Ethiopia, in which the probability of willingness to join the scheme was 94.7% [14]. The reason may be attributed to differences in the study areas and time of the study.
Having an educational level of a certificate/diploma were 3.38 times more likely to uptake CBHI, (AOR = 3.38: 95% CI, 1.27–8.98). This finding is supported by another study, in which persons having higher education level were willing to uptake CBHI [15]. It is also supported by a study conducted in Osun State, Nigeria where people with low level of education were less willing to join CBHI [16].
In this finding, respondents with 3–6 family sizes were about two times more likely willing to join CBHI than with less than three family sizes. This finding was also supported by other findings, in which respondents having a large family had a positive association with willingness to uptake CBHI [17, 18].
Different researches showed that, the wealth or socioeconomic standing of households and individuals is associated with the uptake of CBHI [11, 17]. A similar finding was also observed in India that; wealth was associated with uptake of CBHI [18]. Our study supported the above finding in which a respondent with difficulty in paying for the health care was 82% less likely to uptake CBHI compared to those with no difficulty. From this premise, it is conceivable to find that the poor are unwilling to uptake the scheme.
In terms of time taken to reach the nearest health facility within 20 min was also found to affect enrolment to CBHI. This finding was supported by other studies conducted in low and middle-income countries [16].
Limitation of the study
The Contingent Valuation Method has the limitation of testing consumers’ demand; that means CVM cannot approve whether the consumer actually pays the number of premiums that they said for the study and the study only shows the temporal link between dependent and independent variables.
Double-bounded dichotomous choice contingent valuation method may result in inflated value because respondents may say “yes” for the amount of money they will be asked to pay and it has starting point bias.
As the study employed an interviewer administered questionnaire that might result social desirability and recall bias.