Self-referral status, associated factors and to explore challenges among community based health insured and noninsured beneficiaries at Debre Tabor Specialized Hospital, , Northwest Ethiopia : using mixed method Study

Abstract

Introduction: Even though the problem of self-referral is much exacerbated in Ethiopia, there is limited evidence. The purpose of this study therefore is to determine the magnitude and identify associated and challenging factors of selfreferral. Objective: To compare magnitude of self-referral status, to identify the associated factors and to explore the challenges among community based health insured and noninsured beneficiaries at Debre Tabor specialized hospital, Northwest Ethiopia. Methods: Concurrent nested mixed method study with consecutive sampling technique for quantitative data and homogenous purposeful with phenomenological approach for qualitative data were used. The data was analyzed using STATA version14.2. Binary logistic regression analysis was employed. P-value less than 0.05 and confidence interval were used to select significant variables. For qualitative data, audio recordings were transcribed and later translated to English; finally the data were thematically analyzed. Results: A total of 881 study participants (582 insured) and (299 non-insured). The magnitude of self-referral was 19.4% (113) and 30.1% (90) among insured and non-insured patients respectively. Factors which are significantly associated with self-referral among health insured patients were, patients who didn’t get any information given by health professionals ((AOR 10.67, 95%; CI; 5.04, 21.72)), living in semi-urban and rural areas ((AOR 0.37, 95%; CI; (0.15, 0.90)) and ((AOR 0.28, 95%; CI; (0.11, 0.72)), who didn’t have any information given by health professionals ((AOR 18.76, 95%; CI; 7.19, 48.90)), educational status of primary and secondary school ((AOR 0.19, 95%; CI; (0.07, 0.59)) and ((AOR 0.29, 95%; CI; (0.09, 0.91)), who didn’t know that getting services without referral is prohibited ((AOR 7.48, 95%; CI; (4.06,13.76). 7 participants for qualitative part were included based on information saturation. Conclusions and recommendations: in our study self-referral status is lower among insured patients than non-insured. Patients who didn’t get information about referral system given by health professionals, being having primary and secondary school, being live in rural and semi-urban areas and who didn’t know that prohibition of getting services without referral were factors significantly associated with insured whereas, who didn’t get information given by health professionals about referral status and who did not know that getting services without referral is prohibited were significantly associated with non-insured. Out of pocket expenditure, poor service at primary health facilities and physician referral of patients to their