Assessment of Health Insurance’s Role in Reducing Financial Barriers to Health Service Access: Perspective from a Resource Limited Setting

In Ethiopia, Community-Based Health Insurance (CBHI) schemes aim to enhance healthcare accessibility and reduce financial barriers to health care access by providing protection against out-of-pocket (OOP) expenses. However, evidence on the institutional experience of insured patients remains limited. This study explores the financial implications of CBHI membership among inpatients at St. Paul's Hospital Millenium Medical College. A cross-sectional study was conducted in St. Paul's Hospital Millenium Medical College Inpatient Departments. After stratifying across different wards, the study participants were chosen by systematic random sampling. Data on socio-demographics and payment related factors were collected with a structured questionnaire. Ethical approval and informed consent were obtained. About 260 respondents, of whom 168 (64.6%) were CBHI members and 92 (35.4%) were non-members, had participated in the study. The result reveals that both CBHI members and non-members continue to bear OOP expenses, undermining the financial protection intended by the scheme. Among CBHI members, self-sponsored out-of-pocket payments along with health insurance (65, 38.7%) were the major source of financing. The significant reduction in reported difficulty in paying for basic necessities among CBHI members compared to non-members (<i>P</i> = .034) does suggest that the insurance offers some level of financial relief. While CBHI provides some financial relief, gaps in coverage need more in-depth exploration.