Evaluating the effectiveness of the National Health Insurance Fund in providing financial protection to households with hypertension and diabetes patients in Kenya.
Evaluating the effectiveness of the National Health Insurance Fund in providing financial protection to households with hypertension and diabetes patients in Kenya.
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DOI：
10.1186/s12939-023-01923-5
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发表时间：
2023-06-01
影响因子：
4.8
通讯作者：
Barasa, Edwine
中科院分区：
文献类型：
--
作者：
Oyando, Robinson;Were, Vincent;Koros, Hillary;Mugo, Richard;Kamano, Jemima;Etyang, Anthony;Murphy, Adrianna;Hanson, Kara;Perel, Pablo;Barasa, Edwine
在缺乏有效的财务风险保护机制的情况下，非传染性疾病会给家庭带来沉重的财务负担。国家健康保险基金已将非传染性疾病服务纳入其国家计划。我们评估了NHIF为肯尼亚高血压和/或糖尿病患者家庭提供财务风险保护的有效性。我们进行了一项前瞻性队列研究，跟踪了888个至少有一名高血压和/或糖尿病患者的家庭12个月。暴露组包括参加NHIF国家计划的家庭，而对照组包括未参加NHIF的家庭。研究参与者来自肯尼亚的两个县。我们使用灾难性卫生支出（CHE）的发生率作为关注的结果。我们使用粗精确匹配和条件Logistic回归模型来分析与未登记的家庭相比，登记在NHIF的家庭中CHE的几率。CHE的社会经济不平等使用集中曲线和指数进行了研究。我们发现强有力的证据表明，与未登记的家庭（23.2%）相比，NHIF登记的家庭在医疗保健方面的家庭预算比例较低（12.4%）（p = 0.004）。虽然参加NHIF的家庭不太可能发生CHE，但我们没有发现强有力的证据表明，与没有NHIF的家庭相比，他们更好地保护了CHE（OR = 0.67; p = 0.47）。CHE的浓度指数（CI）显示出有利穷人的分布（CI：-0.190，p < 0.001）。近一半（46.9%）的家庭报告在基线时积极参加了NHIF，但一年后这一比例降至10.9%，表明NHIF的自然减员率为76.7%。NHIF覆盖的深度（即，在有活跃的NHIF的家庭中，NHIF支付的自付医疗费用的比例为29.6%。我们没有发现强有力的证据表明，NHIF国家计划在为肯尼亚高血压和/或糖尿病患者家庭提供财务风险保护方面是有效的。这在一定程度上是由于国家保健保险基金国家计划覆盖面较低，而且流失率较高。为了提高国家医疗保险基金的有效性，有必要修订国家医疗保险基金的一揽子福利计划，以包括原发性高血压和/或糖尿病服务，审查现有的提供者支付机制，以明确偿还这些服务，并扩大现有的保险补贴方案，以包括非正规劳动力市场的个人。
Non-communicable diseases (NCDs) can impose a substantial financial burden to households in the absence of an effective financial risk protection mechanism. The national health insurance fund (NHIF) has included NCD services in its national scheme. We evaluated the effectiveness of NHIF in providing financial risk protection to households with persons living with hypertension and/or diabetes in Kenya. We carried out a prospective cohort study, following 888 households with at least one individual living with hypertension and/or diabetes for 12 months. The exposure arm comprised households that are enrolled in the NHIF national scheme, while the control arm comprised households that were not enrolled in the NHIF. Study participants were drawn from two counties in Kenya. We used the incidence of catastrophic health expenditure (CHE) as the outcome of interest. We used coarsened exact matching and a conditional logistic regression model to analyse the odds of CHE among households enrolled in the NHIF compared with unenrolled households. Socioeconomic inequality in CHE was examined using concentration curves and indices. We found strong evidence that NHIF-enrolled households spent a lower share (12.4%) of their household budget on healthcare compared with unenrolled households (23.2%) (p = 0.004). While households that were enrolled in NHIF were less likely to incur CHE, we did not find strong evidence that they are better protected from CHE compared with households without NHIF (OR = 0.67; p = 0.47). The concentration index (CI) for CHE showed a pro-poor distribution (CI: -0.190, p < 0.001). Almost half (46.9%) of households reported active NHIF enrolment at baseline but this reduced to 10.9% after one year, indicating an NHIF attrition rate of 76.7%. The depth of NHIF cover (i.e., the share of out-of-pocket healthcare costs paid by NHIF) among households with active NHIF was 29.6%. We did not find strong evidence that the NHIF national scheme is effective in providing financial risk protection to households with individuals living with hypertension and/diabetes in Kenya. This could partly be explained by the low depth of cover of the NHIF national scheme, and the high attrition rate. To enhance NHIF effectiveness, there is a need to revise the NHIF benefit package to include essential hypertension and/diabetes services, review existing provider payment mechanisms to explicitly reimburse these services, and extend the existing insurance subsidy programme to include individuals in the informal labour market.
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影响因子：
3.2
作者：
Elwell-Sutton, Timothy M.;Jiang, Chao Qiang;Schooling, C. M.
通讯作者：
Schooling, C. M.
影响因子：
8.1
作者：
Barasa, Edwine;Nguhiu, Peter;McIntyre, Di
通讯作者：
McIntyre, Di
影响因子：
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作者：
Barasa, Edwine W;Mwaura, Njeri;Andrawes, Ledia
通讯作者：
Andrawes, Ledia
影响因子：
2.8
作者：
Choi JW;Choi JW;Kim JH;Yoo KB;Park EC
通讯作者：
Park EC
影响因子：
1.8
作者：
Manji, Imran;Manyara, Simon M.;Pastakia, Sonak D.
通讯作者：
Pastakia, Sonak D.