title: Knowledge of and preferences for health insurance among formal sector employees in Addis Ababa: a qualitative study.
abstract: BACKGROUND
  The Ethiopian health system has been undergoing through reforms. One of the reforms stipulated in policy documents is the introduction of health insurance at national level. Having the majority of the population without any experience of health insurance, investigating preferences and knowledge of the essence of health insurance among potential enrolees will provide vital information for policy makers. This formative study seeks to explore the knowledge and the preference for health insurance among formal sector employees in Addis Ababa.
  
  
  METHODS
  Six focus group discussions with formal sector employees and five key informant interviews were conducted in Addis Ababa. A thematic analysis is used to analyse the results.
  
  
  RESULTS
  The findings suggest that there is little knowledge about the concept and elements of health insurance. Some concepts such as, risk pooling and sharing are not well understood. The participants of the study considered health insurance as only a prepayment mechanism without risk sharing among members of the scheme. Regarding preference for health insurance, they have revealed quality of care as the most important factor. Comprehensiveness of benefit packages and the amount of premium level are also found to be concerns related to health insurance. However, a trade-off is also observed among premium level, comprehensive benefit packages, and healthcare facilities.
  
  
  CONCLUSIONS
  Improvements on availability and quality of services need to precede the introduction of social health insurance. There is also a need to work on awareness creation regarding concepts of health insurance. Further studies may explore if the knowledge gap is real or appeared due to reservations of the participants on the introduction of health insurance.
authors.affiliation: School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethopia. g.amarech@gmail.com.
authors.forename: Amarech
authors.initials: A
authors.lastname: Obse
authors.affiliation: School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethopia. damen_h@hotmail.com.
authors.forename: Damen
authors.initials: D
authors.lastname: Hailemariam
authors.affiliation: Centre for Global Health, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland. normandc@tcd.ie.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
mesh_terms: D000288:Administrative Personnel; D003258:Consumer Behavior; D005002:Ethiopia; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics; D008297:Male; D036301:Qualitative Research