Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa.
Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa.
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DOI：
10.1186/s12889-021-11678-9
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发表时间：
2021-09-09
影响因子：
4.5
通讯作者：
Miot J
中科院分区：
文献类型：
--
作者：
Govender K;Girdwood S;Letswalo D;Long L;Meyer-Rath G;Miot J
拟议中的国民健康保险（NHI）系统旨在重新设计南非的初级医疗保健（PHC），设想私营部门提供者和公共部门诊所作为NHI基金的独立合同单位。2017年，南非16%的人口拥有私人医疗保险，主要使用私人提供者。然而，据估计，高达28%的人口获得私人初级保健服务，低收入、无保险的人口中有相当一部分自掏腰包支付这些服务。研究的目的是了解低收入人群的就医行为、在公共和私营部门获得初级保健服务的患者、患者在不同部门之间的流动以及影响其设施选择的因素。我们进行了一次过的病人采访随机抽样的153例患者在7个私人初级保健提供者（主要提供服务的低收入，大多数没有保险的病人人群）和他们匹配的公共初级保健诊所（7设施）。大多数参与者从事经济活动（96/153，63%），139/153（91%）没有医疗保险，104/153（68%）月收入高达621美元。一个多项回答的问题发现，负担能力（67%）和便利性（60%）被列为选择通常在公立诊所获得护理的最重要原因（48%）;而便利性（71%）和护理质量（59%）是选择私营部门的主要原因（32%）。不同部门之间存在流动：在私营设施接受采访的人中有23/76人（30%），在公共设施接受采访的人中有8/77人（10%）表示，通常在私营和公共设施混合使用初级保健服务。结果表明，私营和公共部门之间的自行车与不同的因素影响设施的选择。一旦通过国家医疗保险降低了支付能力，就必须了解对获得初级保健服务的地方的潜在影响，因为这对国家医疗保险下的服务规划和承包有影响。
The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities). The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.
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影响因子：
2.8
作者：
Agyepong IA;Abankwah DN;Abroso A;Chun C;Dodoo JN;Lee S;Mensah SA;Musah M;Twum A;Oh J;Park J;Yang D;Yoon K;Otoo N;Asenso-Boadi F
通讯作者：
Asenso-Boadi F
影响因子：
3.7
作者：
Beogo, Idrissa;Liu, Chieh-Yu;Huang, Nicole
通讯作者：
Huang, Nicole
影响因子：
2.6
作者：
Abaerei, Admas Abera;Ncayiyana, Jabulani;Levin, Jonathan
通讯作者：
Levin, Jonathan
影响因子：
5
作者：
ANDERSEN, RM
通讯作者：
ANDERSEN, RM
影响因子：
2.5
作者：
Skordis-Worrall, Jolene;Hanson, Kara;Mills, Anne
通讯作者：
Mills, Anne