BACKGROUND: Understanding healthcare facility preferences—public versus private—is essential for formulating policies that promote universal health coverage (UHC). Various sociodemographic factors influence these preferences. This study examines healthcare facility preferences within the ADDIS-HDSS population in Addis Ababa, Ethiopia.

Methods: This analysis is based on the ADDIS-HDSS baseline census conducted in Yeka sub-city, Addis Ababa. We focused on respondents' preferred healthcare facility when household members are ill, and the reasons behind their choice. Multivariable logistic regression was used to analyze the factors influencing preferences.

Results: Most households (82.81%) preferred public healthcare facilities, citing affordability as the primary reason (59.31%). The remaining 17.19% preferred private healthcare, mainly due to perceived quality of care (43.06%) and timeliness (37.04%). Larger family size was associated with a reduced likelihood of preferring private facilities (AOR = 0.579, 95% CI: 0.522–0.642), while higher education (AOR = 2.573, 95% CI: 2.194–3.017) and wealthier households (AOR = 16.925, 95% CI: 14.705–19.481) were more likely to prefer private care.

Conclusion: The majority of households prefer public healthcare facilities, with affordability, quality, and timeliness as key factors. To achieve UHC in low-income countries, improving service quality and timeliness in public healthcare is critical.

KEYWORDS: Addis HDSS, Healthcare preference, Universal Health Coverage, Private versus Public healthcare facilities, Healthcare seeking, LMICs