Level of Satisfaction and Associated Factors Among Clients Enrolled In The Community Based Health Insurance Scheme At Asella Referral And Teaching Hospital, Ethiopia

Abstract

Abstract Background: Client satisfaction is a key indicator of healthcare quality and a determinant of the sustainability of Community-Based Health Insurance (CBHI) schemes. Evidence on satisfaction levels and associated factors remains limited in Ethiopia, particularly in referral hospital settings. Objective: To assess the level of client satisfaction and identify associated factors among CBHI-enrolled clients at Asella Referral and Teaching Hospital (ARTH), Arsi Zone, Ethiopia. Methods: An institution-based cross-sectional study was conducted from August 11 to November 30, 2025, among 402 CBHI-enrolled clients. Data were collected using a structured interviewer-administered questionnaire, with satisfaction measured on a 5-point Likert scale. Binary and multivariable logistic regression analyses were performed. Variables with p < 0.20 in bivariate analysis were included in the multivariable model, and statistical significance was set at p < 0.05. Results: The overall client satisfaction level was 75.9% (mean score = 3.84 ± 0.59). Most respondents intended to renew CBHI membership (99.3%) and reported high satisfaction with staff courtesy and hospital cleanliness (> 95%). However, major service gaps were identified: 69.2% of clients did not receive all prescribed medications, and 71.4% did not obtain all requested laboratory services, resulting in the lowest satisfaction score for out-of-pocket payments (mean = 2.90 ± 1.32). Clients aged 18 – 29 years (AOR = 0.33; 95% CI: 0.12 – 0.90) and 30 – 44 years (AOR = 0.38; 95% CI: 0.15 – 0.95) were less likely to be satisfied compared to those aged ≥ 60 years. Lower educational status, longer CBHI enrollment (≥5 years), and participation in CBHI meetings (AOR = 1.70; 95% CI: 1.00 – 2.91) were associated with higher satisfaction. Conclusion: Although overall satisfaction and intention to renew CBHI membership were high, significant dissatisfaction related to the availability of essential drugs and diagnostic services persisted. Client satisfaction was influenced by age, education level, duration of enrollment, and scheme engagement. Improving the availability of medicines and laboratory services, strengthening communication, and addressing the expectations of younger and more educated clients may enhance satisfaction and support the sustainability of the CBHI program. Keywords: community based health insurance, client satisfaction, associated factors, hospital services, ethiopian cbhi scheme