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

This study revealed a strong willingness among community members to participate in or renew their membership in the Community Based Health Insurance scheme, with a clear preference for a socio-economic-based sliding scale approach over current flat rate or family size-dependent premium systems. This preference highlights the potential for transforming towards more equitable citizen contributions. Policymakers should therefore consider household economic status, alongside factors like household food security and family size, in determining Community Based Health Insurance membership fees. Furthermore, enhancing the quality of healthcare services is essential to boosting Community Based Health Insurance member satisfaction and ensuring the program's long-term sustainability. This comprehensive approach not only improves health outcomes but also strengthens community trust and support for the Community Based Health Insurance initiative.