Alhassan Robert Kaba, Duku Stephen Opoku, Janssens Wendy, Nketiah-Amponsah Edward, Spieker Nicole, van Ostenberg Paul, Arhinful Daniel Kojo, Pradhan Menno, Rinke de Wit Tobias F
Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands; Department of Epidemiology, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Legon, Accra, Ghana; University of Amsterdam (UvA), Amsterdam, Netherlands.
Department of Epidemiology, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Legon, Accra, Ghana; Department of Development Economics, Vrije University (VU), Amsterdam, Netherlands.
PLoS One. 2015 Oct 14;10(10):e0140109. doi: 10.1371/journal.pone.0140109. eCollection 2015.
Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.
To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed.
This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.
Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities.
There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.
由于医疗机构的优质护理会影响客户参与医疗保险和使用医疗服务的决策，因此其对于可持续医疗保险系统至关重要。探索医疗质量的不同维度及其关联，将有助于确定更有效的质量改进干预措施和医疗保险可持续性战略，尤其是在非洲资源有限的国家，那里普及优质护理仍然是一项挑战。
研究客户和医护人员对优质医疗护理的认知差异，并确定这些认知是否与医疗机构的技术质量指标相关。还讨论了研究结果对加纳可持续国家医疗保险计划（NHIS）的影响。
这是一项在加纳两个南部地区开展的横断面研究，涉及64个初级卫生机构、1903户家庭和324名医护人员。数据收集于2012年3月至6月进行。采用Wilcoxon-Mann-Whitney检验来确定客户和医护人员对优质医疗护理的认知差异。使用Spearman秩相关检验来确定医疗机构中感知质量与技术质量指标之间的关联，并采用有序逻辑回归来预测客户和医护人员感知的优质医疗护理的决定因素。
发现技术质量与客户感知的医疗护理质量之间存在负相关（系数 = -0.0991，p<0.0001）。在所有医疗质量指标方面，医护人员与客户的认知存在显著差异，这表明在质量改进方面的投入存在一定程度的不平衡，以及客户与服务提供者之间可能存在信息不对称。总体而言，研究结果表明，仅在技术质量护理方面加大努力不一定会转化为客户对优质医疗护理的更好认知以及在NHIS认可的医疗机构中使用医疗服务的意愿。
有必要加强客户教育，并在技术质量改进和感知质量改进方面做出平衡的努力。这将有助于增强客户对加纳医疗系统的信心，促进其积极参与国家医疗保险，提高医疗服务利用率，并最终改善公共卫生结果。
