Assessment of utilization of fee waiver system among beneficiaries in Addis Ababa, Ethiopia, 2017.

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Addis Abeba University


Back-ground: Fee waiver system is one component of health care financing reform; it is a system for granting access to health services for those who are unable to pay. Evidence shows that the implementation of fee waiver system have slower progress rates, and lack sufficient information on the privileges that come with the utilization of fee waivers. As a result, studying the utilization and factors that influencing implementation of waiver system is found to be crucial. Objective: The main objective of the study is to assess utilization and factors that influence the utilization and implementation of waiver system in Addis Ababa 2017. Method: A community based cross-sectional study design using both quantitative and qualitative methods, was conducted on 578 waiver beneficiaries and 15 key informants found in Addis Ababa from March to April 2017. The data were collected by using a structured interviewer based questionnaire for beneficiaries. Participants were selected using simple random sampling technique. Data were entered using EPI info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics were used to summarize the data bi-variable and multivariable logistic regression was used to examine the relationship between outcome variable and independent variables. A cut of point P-value<0.05 was used to show the level of significance. Qualitative data were collected by using semi structured open ended questionnaire for key informants. Transcription and translation of each record were made by principal investigator using MS word and translated data were analyzed and categorized by triangulation by using thematic approach. Results: Among 578 beneficiaries who responded to the questionnaire, 438 (76%) of them had a health problem after being introduced to waiver privileges. Out of the latter, 367 (84%) had visited health facility. Of those who visited health facility, 273 (74%) utilized waiver privilege. The study showed that age, marital status, educational status, family size and visiting private health facility were significantly associated with utilization of waiver privilege. The key informant indicated that, fee waiver system implemented in public health institution but the system showed lack of effectiveness, because of lack of similar criteria, lack of training about the xii implementation and beneficiary identification, leakage, under-coverage and service related factor such as unavailability of medication, laboratory service and other resources. Conclusion; - Utilization of waiver privilege was seventy four percent. Among those who were utilizing the waiver system, availability of medication and other resources were found to be questionable. The system is also prone to the possibility of leakage and under-coverage. Addis Ababa city Administrators, Woreda administrators, and health facility medical directors monitor and evaluate the system. In addition, further public studies are needed. Key words; - fee waiver, waiver beneficiaries, utilization, under-coverage, leakage



fee waiver, waiver beneficiaries, utilization, under-coverage, leakage