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.rnObjective: 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.rnMethod: 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