Abstract
Community-Based Health Insurance (CBHI) programs are vital in improving healthcare accessibility and providing financial protection, especially in resource-limited settings such as Dangila Wereda, Awi Zone, Ethiopia. This study evaluates the impact of CBHI on health service utilization and out-of-pocket healthcare expenditures while identifying key factors influencing enrollment and assessing program effectiveness. A cross-sectional study was conducted among 419 households. Binary logistic regression was applied to determine factors affecting CBHI enrollment. Likert scale analysis was used to assess household attitudes, and propensity score matching (PSM) was employed to measure the impact of CBHI on healthcare utilization and financial burden reduction. Significant predictors of CBHI enrollment included family size, tropical livestock units, income level, sickness occurrence in the past year, awareness of CBHI, presence of functional health centers in the village, and trust in the CBHI scheme. Household perceptions reflected cautious optimism regarding CBHI's ability to enhance service quality and alleviate financial burdens. PSM analysis showed an average annual reduction of 1444.60 ETB in healthcare expenditures and a 3.24-fold increase in healthcare utilization among CBHI members. CBHI has a positive impact on reducing healthcare costs and improving utilization in Dangila Wereda. However, addressing concerns about service quality, strengthening awareness campaigns, and enhancing trust in the program are essential to maximizing its effectiveness. Ongoing evaluation and targeted interventions are recommended to sustain and improve CBHI's impact on healthcare access and financial security.