The impact of community-based health insurance on health-related quality of life and associated factors in Ethiopia: a comparative cross-sectional study

Quality of life can be used to measure the effect of intervention on health related conditions. Health insurance contributes positive effect on availability of medical supplies and empowerment of women and children on financial healthcare. Therefore, the study was aimed to measure the impact of Community-Based Health Insurance on HRQoL and associated socio-demographic factors.

A comparative community based cross-sectional study was employed. Data was collected by trained enumerators using World Health Organization QoL-BREF tool from a sample of 1964 (982 CBHI insured and 982 un-insured) household heads selected by probability proportional to size. A descriptive summery, simple and multiple linear regression analysis was applied to describe the functional predictors of HRQoL. The study was ethically approved by IRB of Wolkite University.

The HRQoL score among CBHI insured family heads was 63.02 and 58.92 for un-insured family heads. The overall variation in HRQoL was explained due to; separated marital condition which reduced the HRQoL by 4.30% than those living together [^β = − 0.044, 95% CI (− 5.67, − 0.10)], daily laborer decreased HRQoL by 7.50% [^β = − 0.078, 95% CI (− 12.91, − 4.10)], but employment increased by 5.65% than farmers [^β = 0.055, 95% CI (2.58, 17.59)]. QoL increased by 6.4 and 6.93% among primary and secondary level educated household heads than those household heads who could not read and write [^β = 0.062, 95% CI (0.75, 4.31)] and [^β = 0.067, 95% CI (1.84, 7.99)], respectively. As family size increased by one households’ head, HRQoL decreased by 18.21% [^β = − 0.201, 95% CI (− 2.55, − 1.63)], as wealth index increased by one unit, HRQoL decreased by 32.90% [^β = − 0.306, 95% CI (− 5.15, − 3.86)] and QoL among CBHI insured household heads increased by 12.41% than those un-insured family heads [^β = 0.117, 95% CI (2.98, 6.16)].

The study revealed that significant difference in quality of life was found among the two groups; health insurance had positive effect on quality of life. Triggered, the government shall expand the scheme into other similar areas’ and further efforts should be made on the scheme service satisfaction to ensure its continuity.