Assessments of Healthcare Service Utilization and Associated Factors Among Members and Non-members of Community-based Health Insurance in Addis Ababa Ethiopia

Background: Community-based health insurance is designed to provide financial protection and reduce out-of-pocket payments for health care. Direct out-of-pocket payments for health care restrict access to health services and compromise household wellbeing. Objective: To assess healthcare service utilization and associated factors among members and non-members of community-based health insurance in Addis Ababa, Ethiopia, in 2025. Method: A community-based comparative cross-sectional study was conducted from March 6 to April 8, 2021. Multistage sampling was used to select 366 households (183 insured, 183 uninsured). Data were collected through face-to-face interviews using a structured questionnaire. Data entry and analysis were performed using EPI INFO v7 and SPSS v25, respectively. Descriptive statistics, two-sample t-tests, and logistic regression were used. Results: A total of 354 households (178 insured, 176 uninsured) participated, yielding a response rate of 97.5%. Healthcare service utilization was significantly higher among CBHI members (73.6%) compared to non-members (55.7%) (t = –3.579, p < 0.05). For CBHI members, significant predictors included sex of household head and presence of illness episode. For non-members, sex, marital status, and chronic illness were significant predictors. Conclusion: CBHI membership is significantly associated with higher healthcare service utilization. Expanding CBHI coverage and addressing financial and perceptual barriers are recommended to improve healthcare access.