The association between health insurance status and utilization of health services in rural Northern Ghana: evidence from the introduction of the National Health Insurance Scheme
The association between health insurance status and utilization of health services in rural Northern Ghana: evidence from the introduction of the National Health Insurance Scheme
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DOI：
10.1186/s41043-017-0128-7
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发表时间：
2017-12-13
影响因子：
1.9
通讯作者：
Goudge, Jane
中科院分区：
文献类型：
--
作者：
Dalinjong, Philip Ayizem;Welaga, Paul;Goudge, Jane
背景：低收入和中等收入国家的许多家庭因支付医疗费用而面临经济困难，而另一些家庭则陷入贫困。风险分担和预付机制有助于减轻护理费用的影响，并有助于实现全民健康覆盖(UHC)。加纳实施了国家健康保险计划，以促进所有加纳人获得医疗服务。本文研究了加纳北部卡塞纳-南卡纳地区农村贫困社区医疗保险状况与门诊、住院卫生服务利用之间的关系。我们对11,175个家庭进行了访谈，收集了55,992个家庭成员的数据。多因素Logistic回归模型被用来确定与门诊和住院健康服务利用相关的因素。因变量为门诊和住院卫生服务利用情况。结果：显著地，参保者利用门诊和住院医疗服务的几率分别增加2.51(95%可信区间2.3~2.8)和2.78(95%可信区间2.2~3.6)。有近期疾病或伤害病史[32.4(95%可信区间29.4-35.8)和5.72(95%可信区间4.6-7.1)]且自我报告健康状况较差或非常差的受访者[2.08(95%可信区间1.7-2.5)和2.52(95%可信区间1.9-3.4)]，以及长期服药的受访者[2.79(95%可信区间2.2-3.5)和3.48(95%可信区间2.5-4)]。8)]也增加了分别利用门诊和住院健康服务的几率。在参保者中，最贫穷的人使用以社区为基础的卫生规划和服务(CHPS)院落，而最不贫穷的人使用私立诊所和公立医院提供门诊卫生服务。未参保的人主要使用药房或有执照的化学品商店(LCS)。在住院卫生服务方面，参保者主要使用公立医院，未参保者使用私人诊所或公共卫生中心。结论：参保对象与研究地区门诊和住院卫生服务利用率的提高有关。总体而言，NHIS可以成为实现普遍人权的有效工具，因此应该做出务实的努力来维持这一工具。
Background: Many households in low-and middle-income countries face financial hardships due to payments for health care, while others are pushed into poverty. Risk pooling and prepayment mechanisms help to lessen the impact of the costs of care as well as assisting to achieve universal health coverage (UHC). Ghana implemented the National Health Insurance Scheme (NHIS) for the promotion of access to health services for all Ghanaians. In this paper, we examined the association between health insurance status and utilization of outpatient and inpatient health services in rural poor communities.Methods: The study was a cross-sectional household survey conducted in the Kassena-Nankana districts of Northern Ghana. We conducted interviews in 11,175 households and collected data on 55,992 household members. Multiple logistic regression models were used to identify factors associated with the utilization of outpatient and inpatient health services. The dependent variables were the utilization of outpatient and inpatient health services. We adjusted for several potential socio-demographic factors associated with utilization and health insurance status.Results: Significantly, the insured had 2.51 (95% CI 2.3-2.8) and 2.78 (95% CI 2.2-3.6) increased odds of utilizing outpatient and inpatient health services respectively. Respondents with a history of recent illness or injury [32.4 (95% CI 29.4-35.8) and 5.72 (95% CI 4.6-7.1)] and poor or very poor self-reported health status [2.08 (95% CI 1.7-2.5) and 2.52 (95% CI 1.9-3.4)] and those on chronic medication [2.79 (95% CI 2.2-3.5) and 3.48 (95% CI 2.5-4.8)] also had increased odds of utilizing both outpatient and inpatient health services respectively. Among the insured, the poorest use the Community-based Health Planning and Services (CHPS) compounds, while the least poor use private clinics and public hospitals for outpatient health services. The uninsured predominately use pharmacies or licensed chemical shops (LCSs). For inpatient health services, the insured largely use public hospitals, with the uninsured using private clinics or public health centres.Conclusion: The findings suggest that being insured with the NHIS is associated with increased utilization of outpatient and inpatient health services in the study area. Overall, the NHIS can be an effective tool for achieving UHC and hence pragmatic efforts should be made to sustain it.