医疗保险对泰国南部女性分娩护理利用和感知延迟及障碍的影响。
Effect of health insurance on delivery care utilization and perceived delays and barriers among southern Thai women.
机构信息
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
出版信息
BMC Public Health. 2011 Jun 28;11:510. doi: 10.1186/1471-2458-11-510.
BACKGROUND
Financial reform aims to overcome the problems of financial barriers and utilization of health services. However, it is unclear whether financial reforms or health insurance can reduce delays and/or barriers or if there are still other important obstacles for preventing pregnant women accessing delivery care. This study aimed to assess the effect of health insurance and other factors on delivery care utilization and the perception of delays and barriers to delivery care among women living in Songkhla province, Thailand.
METHODS
A cross-sectional study was conducted from November 2007 to December 2008. Women who delivered at hospital or home in the areas of participating hospitals in four districts were interviewed at 24- or 48-hours postpartum. The impact of health insurance and other factors on outcomes of interest was assessed using multivariate logistic regression.
RESULTS
Of 2,847 women, 2,822 delivered at a hospital and 25 at home, of which 80% and 40% had health insurance for delivery care, respectively. Muslims, low educated women, those who thought they could not use health insurance for delivery care and those less willing to seek care at their delivery place were more likely to give birth at home. Perception of delays to seeking care, reaching a hospital and receiving care was reduced in women insured by civil servant medical benefit. Women insured by universal coverage and social security perceived a lower delay in reaching a hospital but a higher delay in receiving care. Low education, unwillingness to seek care, out-of-pocket payment, worry about cost of delivery care, transportation difficulties, low perception of receiving good care or a perception of being treated badly were also associated with delays and barriers to health care. Almost all (93%) agreed that health insurance could reduce financial barriers for accessing services. However, having health insurance influenced them to seek care, reach a hospital, and receive care quickly in 50%, 32%, and 23% of the women, respectively.
CONCLUSIONS
Health insurance has a significant impact on perceived delays and barriers, but not place of delivery. Socio-economic determinants continue to play an important role for place of delivery and perceived delays and barriers.
背景
金融改革旨在克服金融障碍和卫生服务利用方面的问题。然而，目前尚不清楚是金融改革还是医疗保险能够减少延迟和/或障碍，或者是否仍然存在其他重要障碍，阻碍孕妇获得分娩护理。本研究旨在评估医疗保险和其他因素对分娩护理利用的影响，以及在泰国宋卡府生活的妇女对分娩护理延迟和障碍的认知。
方法
本研究采用横断面研究设计，于 2007 年 11 月至 2008 年 12 月进行。在参与医院所在的四个区的医院或家中分娩的妇女在产后 24 或 48 小时内接受访谈。使用多变量逻辑回归评估医疗保险和其他因素对感兴趣结局的影响。
结果
在 2847 名妇女中，2822 名在医院分娩，25 名在家分娩，其中分别有 80%和 40%的人有医疗保险来支付分娩费用。穆斯林、受教育程度较低的妇女、认为自己无法使用医疗保险支付分娩费用的妇女以及不太愿意在分娩地寻求护理的妇女更有可能在家中分娩。有公务员医疗福利保险的妇女认为寻求护理、到达医院和接受护理的延迟减少了。有全民医疗保险和社会保险的妇女认为到达医院的延迟较低，但接受护理的延迟较高。受教育程度低、不愿意寻求护理、自费、担心分娩费用、交通困难、对接受良好护理的低感知或对被虐待的感知，也与医疗保健的延迟和障碍有关。几乎所有（93%）的人都同意医疗保险可以减少获得服务的经济障碍。然而，医疗保险对 50%、32%和 23%的妇女的护理寻求、到达医院和接受护理的速度产生了显著影响。
结论
医疗保险对感知延迟和障碍有显著影响，但对分娩地点没有影响。社会经济决定因素继续对分娩地点和感知延迟和障碍起着重要作用。
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