Hospitalized for fever? Understanding hospitalization for common illnesses among insured women in a low-income setting
Hospitalized for fever? Understanding hospitalization for common illnesses among insured women in a low-income setting
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DOI：
10.1093/heapol/czt032
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发表时间：
2014-07-01
影响因子：
3.2
通讯作者：
Mahal, Ajay
中科院分区：
文献类型：
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作者：
Sinha, Tara;Desai, Sapna;Mahal, Ajay
背景：健康小额保险是一种金融工具，增加了低收入者对医疗保健服务的利用。对被保险人住院治疗的疾病了解有限。对印度小额保险计划VimoSEWA的健康索赔进行的分析表明，在投保的成年妇女中，很大一部分住院治疗的是发烧、腹泻和疟疾等常见病，这些病可以在门诊治疗。本研究旨在了解导致常见疾病住院的因素。方法：本文采用混合方法的方法。定量数据是从印度古吉拉特邦816个城市低收入家庭的家庭调查中收集的。定性数据的基础上，10个深入的案例研究，保险妇女住院常见疾病和采访五个供应商。定量和定性的数据进行了补充，从保险计划的行政records.Results的数据：社会经济特征和发病率模式之间的投保和未投保的妇女是相似的发热最常见的疾病。虽然发烧是投保妇女住院的主要原因，但没有投保妇女因发烧住院。定性调查表明，10名住院妇女中有9人首先寻求门诊治疗。住院的危险因素是症状持续或恶化。促进住院治疗的因素包括有保险和医生的看法就需要住院治疗。结论：在没有高质量的初级保健，健康保险可以导致住院治疗非严重疾病。住院治疗的威慑力来自成员的道德风险;不能排除提供者的道德风险。这项研究强调，需要高质量的初级卫生保健，并更好地与健康小额保险计划相结合。
Background:Health microinsurance is a financial tool that increases utilization of health care services among low-income persons. There is limited understanding of the illnesses for which insured persons are hospitalized. Analysis of health claims at VimoSEWA, an Indian microinsurance scheme, shows that a significant proportion of hospitalization among insured adult women is for common illnesses-fever, diarrhoea and malaria-that are amenable to outpatient treatment. This study aims to understand the factors that result in hospitalization for common illnesses.Methods:The article uses a mixed methods approach. Quantitative data were collected from a household survey of 816 urban low-income households in Gujarat, India. The qualitative data are based on 10 in-depth case studies of insured women hospitalized for common illnesses and interviews with five providers. Quantitative and qualitative data were supplemented with data from the insurance scheme's administrative records.Results: Socioeconomic characteristics and morbidity patterns among insured and uninsured women were similar with fever the most commonly reported illness. While fever was the leading cause for hospitalization among insured women, no uninsured women were hospitalized for fever. Qualitative investigation indicates that 9 of 10 hospitalized women first sought outpatient treatment. Precipitating factors for hospitalization were either the persistence or worsening of symptoms. Factors that facilitated hospitalization included having insurance and the perceptions of doctors regarding the need for hospitalization.Conclusion: In the absence of quality primary care, health insurance can lead to hospitalization for non-serious illnesses. Deterrents to hospitalization point away from member moral hazard; provider moral hazard cannot be ruled out. This study underscores the need for quality primary health care and its better integration with health microinsurance schemes.