The Impact of Community‐Based Health Insurance on Catastrophic Health Care Expenditure: A Cross‐Sectional Study From Ethiopia

ABSTRACT Background Achievement of an efficient and equitable health care system through coverage of health insurance is an important instrument to break up the vicious circle of poverty and ill health. This study sought to determine the impact of community‐based health insurance (CBHI) on catastrophic health care expenditure in Addis Ababa region of Ethiopia. Methods We conducted a cross‐sectional study on the impact of utilizing community‐based health insurance (CBHI) among patients who received care at a tertiary institution in Ethiopia over 2 months (April and May 2023). Data were collected using a structured questionnaire. Data were analyzed using SPSS version 20. Simple descriptive statistics, Chi‐squared test, and multivariate regression analysis were employed as appropriate. P ‐value less than 0.05 and Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI) were used to determine statistical significance. Results Among 260 study participants included in the study, two‐thirds (168, 64.6%) were enrolled in CBHI, while about one‐third were not (92, 35.4%). Compared to CBHI non‐members, members of CBHI had less catastrophic health care expenditure (68.8% vs. 53.5% CBHI for CBHI non‐members and CBHI members respectively, p ‐value = 0.039). Multivariate regression analysis revealed that community‐based health insurance (CBHI) members (AOR = 0.4, 95% CI = 0.25–0.83) were 60 percent less likely to have catastrophic health care expenditure compared to those that are CBHI non‐members. Conclusion In this study, utilization of community‐based health insurance was found to be protective against catastrophic health care expenditure to a certain extent, which requires further justification whether this is true at the country level by conducting a similar large multicenter study.