Determinants of satisfaction with community-based health insurance schemes among beneficiaries with chronic diseases in selected public hospitals in Eastern Ethiopia: A multicenter study

Background: Community-based health insurance is a voluntary scheme where community members pool resources to cover healthcare costs. Assessing beneficiary satisfaction with chronic disease management is crucial for the program's long-term viability. Therefore, this study aimed to assess determinants of satisfaction with community-based health insurance among beneficiaries with chronic diseases in selected public hospitals in the Hararghe Zones of Eastern Ethiopia.

Methods: An institution-based cross-sectional study was conducted among randomly selected 416 chronic disease beneficiaries of community-based health insurance from 30 July to 30 August 2023. Data were collected through a pre-tested and structured face-to-face interview questionnaire. The data were entered into Epi-Data 3.1 and then exported to STATA 17.0 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify determinants of satisfaction with community-based health insurance. Significance was set at a p-value < 0.05.

Results: The mean age of the study participants was 48.10 ± 15.8 years. The study revealed that 55.1% (95% CI: 50.2%-59.8%) of beneficiaries with chronic diseases were satisfied with community-based health insurance. Beneficiaries aged over 55 years (AOR = 0.27; 95% CI: 0.08-0.91), experiencing delayed community-based health insurance opening times (AOR = 0.35; 95% CI: 0.17-0.73), preferring hospitals for future services (AOR = 4.13; 95% CI: 1.14-14.85), shorter waiting times (<60 min) (AOR = 8.8; 95% CI: 4.39-17.72), availability of drugs (AOR = 2.67; 95% CI: 1.30-5.45), availability of laboratory services (AOR = 5.5; 95% CI: 2.83-10.84), and knowledge of community-based health insurance benefit packages (AOR = 2.8; 95% CI: 1.47-5.43) were significant determinants associated with satisfaction to the community-based health insurance service.

Conclusion: About half of the community-based health insurance beneficiaries with chronic diseases were satisfied, indicating that a considerable number of them were dissatisfied with the services. The age of the participants, office opening time, waiting times, laboratory services, pharmacy services, and knowledge of community-based health insurance benefit packages were significant determinants of satisfaction with community-based health insurance schemes. Therefore, the government and other stakeholders need to enhance service quality, increase awareness, and address both supply and demand-side factors. These key strategies can lead to higher satisfaction with and ensure the sustainability of community-based health insurance schemes.