Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?
Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?
复制标题
DOI：
10.1016/j.socscimed.2010.10.025
复制
发表时间：
2011-01-01
影响因子：
5.4
通讯作者：
Baltussen, Rob
中科院分区：
文献类型：
--
作者：
Jehu-Appiah, Caroline;Aryeetey, Genevieve;Baltussen, Rob
为了提高医疗保健提供的公平性并为贫困家庭提供风险保护，低收入国家越来越多地转向社会医疗保险。本研究利用 2009 年对 3301 个家庭进行的家庭调查数据，旨在评估加纳国民健康保险计划 (NHIS) 的入学公平性，并评估各个社会经济群体的需求决定因素。具体来说，通过观察不同的倾向（年龄、性别、教育、职业、家庭规模、婚姻状况、同伴压力和健康信念等）、促成（收入、居住地）、需求（健康状况）和社会因素（观念）如何影响家庭加入和留在 NHIS 的决定。通过比较消费五分位数之间的入学情况来评估入学公平性。在使用 PCA 评估受访者对计划、提供者和社区健康“信念和态度”的看法后，使用多项 Logit 模型评估加入和退出 NHIS 的决定因素。我们发现了 NHIS 入学不平等的证据，以及社会经济五分位数当前和以前入学的决定因素存在显着差异。当前和以前的入学都受到倾向性、有利性和社会因素的影响。然而，富人和穷人之间的入学决定因素存在明显差异。政策制定者需要认识到，扩大入学率需要在设计刺激入学的干预措施时认识到所有这些复杂因素。 (C) 2010 Elsevier Ltd. 保留所有权利。
To improve equity in the provision of health care and provide risk protection to poor households, low-income countries are increasingly moving to social health insurance. Using data from a household survey of 3301 households conducted in 2009 this study aims to evaluate equity in enrollment in the National Health Insurance Scheme (NHIS) in Ghana and assess determinants of demand across socio-economic groups. Specifically by looking at how different predisposing (age, gender, education, occupation, family size, marital status, peer pressure and health beliefs etc) enabling (income, place of residence) need (health status) and social factors (perceptions) affect household decision to enrol and remain in the NHIS. Equity in enrollment is assessed by comparing enrollment between consumption quintiles. Determinants of enrolling in and dropping out from NHIS are assessed using a multinomial logit model after using PCA to evaluate respondent's perceptions relating to schemes, providers and community health 'beliefs and attitudes'. We find evidence of inequity in enrollment in the NHIS and significant differences in determinants of current and previous enrollment across socio-economic quintiles. Both current and previous enrollment is influenced by predisposing, enabling and social factors. There are, however, clear differences in determinants of enrollment between the rich and the poor. Policy makers need to recognize that extending enrollment will require recognition of all these complex factors in their design of interventions to stimulate enrollment. (C) 2010 Elsevier Ltd. All rights reserved.