Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?
Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?
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DOI：
10.3402/gha.v7.23848
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发表时间：
2014-01-01
影响因子：
2.6
通讯作者：
Oduro, Abraham
中科院分区：
文献类型：
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作者：
Dalaba, Maxwell Ayindenaba;Akweongo, Patricia;Oduro, Abraham
简介：加纳政府于 2003 年推出国家健康保险计划 (NHIS)，以取代自付费用 (OOP) 支付医疗服务，其内在目的是减少家庭治疗疾病的直接费用。目的：评估 NHIS 在降低加纳北部卡塞纳-南卡纳地区家庭治疗疟疾费用方面的效果。方法：我们在 2009 年 10 月至 10 月期间进行了一项横断面调查2011 年在卡塞纳-南卡纳地区。从 Navrongo 健康和人口监测系统家庭数据库中随机抽取了 4,226 个家庭样本，并进行了结构化访谈。从患者角度收集疟疾治疗费用。结果：在走访的 4,226 个家庭中，共有 1,324 名（31%）家庭成员报告发烧，51%（675 名）报告接受疟疾治疗，并提供了就诊地点的信息。大多数受访者 63% (424) 向正规医疗机构寻求疟疾治疗，其余受访者则使用化学商店的药物进行自我治疗，占 32% (217)，或使用剩余药物或草药进行自我治疗，占 5% (34)。大多数到正规医疗机构寻求治疗的人的保险率为 79% (334)。治疗疟疾的平均直接医疗费用为每例 GH(sic)3.2（2.1 美元），参保者每例支出（GH(sic)2.6/1.7 美元）低于未参保者（GH(sic)3.2/2.1 美元）。家庭每次疟疾治疗产生的总体平均费用（直接和间接）为 GH(sic)20.9（13.9 美元）。尽管参保者在医疗机构就诊的比例为 76% (31)，而未参保者占 24% (10)，但家庭在参保者身上的平均支出 (GH(sic)4/2.7 美元) 低于未参保者 (GH(sic)6.4/4.3 美元)。差异不具有统计显着性（p = 0.2330）。结论：尽管一些参保个人为直接医疗护理支付了 OOP 费用，但有证据表明 NHIS 对疟疾治疗费用（门诊和住院）具有保护作用。
Introduction: The Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households.Objective: To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana.Methods: We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective.Results: Of the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH(sic)3.2 (US$2.1) per case with the insured spending less (GH(sic)2.6/US$1.7) per case than the uninsured (GH(sic)3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH(sic)20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH(sic)4/US$2.7) than their uninsured counterparts (GH(sic)6.4/US$4.3). The difference was not statistically significant (p = 0.2330).Conclusion: Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost (outpatient and in-patient) of malaria treatment.