Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries
Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries
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DOI：
10.1136/bmjgh-2019-002205
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发表时间：
2020-08-01
影响因子：
8.1
通讯作者：
Kruk, Margaret
中科院分区：
文献类型：
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作者：
Roder-DeWan, Sanam;Gage, Anna;Kruk, Margaret
人们对卫生系统的信任和认可是衡量系统绩效的关键指标，但在低收入和中等收入国家却没有得到充分衡量。我们探讨了这些措施在12个国家的流行程度和预测因素。方法我们在阿根廷、中国、加纳、印度、印度尼西亚、肯尼亚、黎巴嫩、墨西哥、摩洛哥、尼日利亚、塞内加尔和南非进行了一项网络调查，收集人口统计数据、质量评级以及对卫生系统的信心和认可。我们使用多变量逻辑回归来评估信心/认可与近期医疗保健自我报告质量之间的关系。结果在13489名答复者中，62%报告在过去一年中进行过健康访问。应用人口权重，32%的这些用户非常有信心，如果他们“明天病得很重”，他们可以得到有效的护理；30%的人支持卫生系统，也就是说，他们认为它“运行得很好，只需要微小的改变”。在最后一次访问中报告高质量与4.48和2.69更高的置信度（95% CI 3.64至5.52）和认可（95% CI 2.33至3.11）相关。拥有健康保险与信心和认可呈正相关（调整优势比（AOR） 1.68, 95% CI 1.49至1.90；调整优势比（AOR） 1.34, 95% CI 1.22至1.48），而在医疗保健中遭受歧视则呈负相关（AOR 0.67, 95% CI 0.56至0.80;AOR 0.63, 95% CI 0.53至0.76）。结论12个中低收入国家对卫生系统的信心和认可程度较低。这可能会阻碍为全民健康覆盖争取支持的努力。积极的患者体验与对卫生系统的信心和认可密切相关。
Introduction People's confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries. Methods We conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system. We used multivariable logistic regression to assess the association between confidence/endorsement and self-reported quality of recent healthcare. Results Of 13 489 respondents, 62% reported a health visit in the past year. Applying population weights, 32% of these users were very confident that they could receive effective care if they were to 'become very sick tomorrow'; 30% endorsed the health system, that is, agreed that it 'works pretty well and only needs minor changes'. Reporting high quality in the last visit was associated with 4.48 and 2.69 greater odds of confidence (95% CI 3.64 to 5.52) and endorsement (95% CI 2.33 to 3.11). Having health insurance was positively associated with confidence and endorsement (adjusted odds ratio (AOR) 1.68, 95% CI 1.49 to 1.90 and AOR 1.34, 95% CI 1.22 to 1.48), while experiencing discrimination in healthcare was negatively associated (AOR 0.67, 95% CI 0.56 to 0.80 and AOR 0.63, 95% CI 0.53 to 0.76). Conclusion Confidence and endorsement of the health system were low across 12 LMICs. This may hinder efforts to gain support for universal health coverage. Positive patient experience was strongly associated with confidence in and endorsement of the health system.