Factors Contributing to Low Adherence to Community-Based Health Insurance in Rural Nyanza District, Southern Rwanda
Factors Contributing to Low Adherence to Community-Based Health Insurance in Rural Nyanza District, Southern Rwanda
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DOI：
10.1155/2018/2624591
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发表时间：
2018-01-01
影响因子：
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通讯作者：
Yamuragiye, Assumpta
中科院分区：
文献类型：
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作者：
Mukangendo, Mecthilde;Nzayirambaho, Manasse;Yamuragiye, Assumpta
背景基于社区的健康保险计划是一种新兴的机制，为防止与健康有关的贫困提供财政保护。在卢旺达，CBHI正在全国范围内实施，它基于Ubudehe系统的四个社会经济类别：第一类的保费由政府全额补贴，第二和第三类成员支付3000 frw，第四类成员支付7000 frw作为保费。然而，自2011年以来，社区对该计划的遵守程度较低，这一点尚未得到充分研究。Objective.本研究旨在确定导致卢旺达南部农村地区尼扬扎地区CBHI依从性低的因素。方法论2017年5月至2017年6月，在尼扬扎农村地区的9个卫生中心进行了一项横断面研究。基于5%的误差范围和95%的置信区间，计算了495例入组CBHI或未入组CBHI方案的门诊患者的样本量。Logistic回归用于确定CBHI依从性低的决定因素。结果该研究显示，医疗保健提供者的长等待时间和医疗保健服务提供与CBHI计划的低依从性之间存在显著关联（P值< 0.019）（CI：0.09107至0.80323）。结果显示，负担不起保险费（P < 0.050）（CI：0.94119 ~ 9.8788）和不方便的保险费支付方式（P < 0.001）（CI：0.16814 ~ 0.59828）与CBHI方案依从性低显著相关。有证据表明，通过Ubudehe类别测量的社会经济地位（P值< 0.005）（CI：1.4685至8.93406）增加了对CBHI计划的低依从性。结论本研究的结论是，属于第二类的Ubudehe系统，等待时间长的医疗保健提供者和服务之间，保费负担不起，保费支付模式不方便的显着预测低坚持CBHI计划。
Background. Community-based health insurance (CBHI) schemes are an emerging mechanism for providing financial protection against health-related poverty. In Rwanda, CBHI is being implemented across the country, and it is based on four socioeconomic categories of the Ubudehe system: the premiums of the first category are fully subsidized by government, the second and third category members pay 3000frw, and the fourth category members pay 7000frw as premium. However, low adherence of community to the scheme since 2011 has not been sufficiently studied. Objective. This study aimed at determining the factors contributing to low adherence to the CBHI in rural Nyanza district, southern Rwanda. Methodology. A cross-sectional study was conducted in nine health centers in rural Nyanza district from May 2017 to June 2017. A sample size of 495 outpatients enrolled in CBHI or not enrolled in the CBHI scheme was calculated based on 5% margin of error and a 95% confidence interval. Logistic regression was used to identify the determinants of low adherence to CBHI. Results. The study revealed that there was a significant association between long waiting time to be seen by a medical care provider and between health care service provision and low adherence to the CBHI scheme (P value < 0.019) (CI: 0.09107 to 0.80323). The estimates showed that premium not affordable (P value < 0.050) (CI: 0.94119 to 9.8788) and inconvenient model of premium payment (P value < 0.001) (CI: 0.16814 to 0.59828) are significantly associated with low adherence to the CBHI scheme. There was evidence that the socioeconomic status as measured by the category of Ubudehe (P value < 0.005) (CI: 1.4685 to 8.93406) increases low adherence to the CBHI scheme. Conclusion. This study concludes that belonging to the second category of the Ubudehe system, long waiting time to be seen by a medical care provider and between services, premium not affordable, and inconvenient model of premium payment were significant predictors of low adherence to CBHI scheme.