Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.
Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.
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DOI：
10.1371/journal.pone.0140109
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Rinke de Wit TF
中科院分区：
文献类型：
--
作者：
Alhassan RK;Duku SO;Janssens W;Nketiah-Amponsah E;Spieker N;van Ostenberg P;Arhinful DK;Pradhan M;Rinke de Wit TF
卫生设施中的优质保健对可持续的健康保险制度至关重要，因为它影响到客户参加健康保险和使用健康服务的决定。探索医疗质量的不同层面及其关联将有助于确定更有效的质量改进干预措施和医疗保险可持续性战略，特别是在资源有限的非洲国家，在那里普遍获得高质量的医疗服务仍然是一项挑战。检查客户和卫生工作人员对高质量医疗保健的认知差异，并确定这些认知是否与医疗机构中的技术质量代理有关。还讨论了研究结果对加纳可持续国家健康保险计划(NHIS)的影响。这是一项在加纳南部两个地区进行的横断面研究，涉及初级卫生机构：1903户家庭和324名卫生工作人员。数据收集从2012年3月持续到6月。进行了Wilcoxon-Mann-Whitney测试，以确定客户和卫生工作人员对高质量医疗保健的看法的差异。使用Spearman的等级相关检验来确定卫生设施中感知的和技术的质量护理代理之间的关联，并使用有序Logistic回归来预测客户和工作人员感知的质量卫生保健的决定因素。在技术质量和客户感知的质量护理之间发现负相关(coef。=-0.0991，p<；0.0001)。在所有医疗质量代理中发现了显著的员工-客户感知差异，这表明客户和服务提供商之间对质量改进的承诺在一定程度上不平衡，以及潜在的信息不对称。总体而言，研究结果表明，仅仅加大对技术质量护理的努力并不一定会转化为客户认为的更好的质量护理，以及在NHIS认证的卫生设施中利用卫生服务的意愿。有必要加强客户教育，平衡地致力于技术和感知到的质量改进努力。这将有助于增强客户对加纳医疗保健系统的信心，刺激积极参与国家医疗保险，提高医疗保健利用率，并最终改善公共卫生结果。
Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman’s rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana’s healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.