Households willingness to join and pay for community-based health insurance: implications for designing community-based health insurance based on economic Status in Ethiopia

Background: Despite the encouraging results achieved by community-based health insurance in Ethiopia, the program faces significant challenges. Among these challenges is the current practice where premium contributions to Community Based Health Insurance are either a flat rate or based solely on family size, rather than considering households’ socio-economic status The overall aim of this study was to assess households’ willingness to join and pay for Community Based Health Insurance in reference to socio-economic status to design sliding scale-based Community Based Health Insurance contributions in Ethiopia. Methods: A community based cross-sectional study was conducted in districts from two different contexts: urban areas and agrarian areas in two major regions in Ethiopia, namely Oromia, and Amhara. A double-bounded dichotomous contingent valuation method was used to determine households’ willingness to pay. Descriptive statistics were used to summarize the data. A chi-square test was used to assess background factors associated with willingness to join and pay for Community Based Health Insurance, and tobit regression analyses were conducted to identify factors that determine the amount of willingness to pay for Community Based Health Insurance. The statistical significance of all results was interpreted using an adjusted two-sided Type I error rate of 0.05. Result: A total of 786 households participated in this study. Overall, 532 (67.7%) study households have ever participated in the Community Based Health Insurance scheme. The reason for never participating was unaffordability of payment (30.3%), and they stated that the service was unsatisfactory (21.7%). Generally, 647 (82.3%) of the households were willing to join Community Based Health Insurance or renew their scheme membership in the future, with higher willingness among rural and urban residents and households with food insecurity (p