调查加纳非传染性疾病患儿家长/照料者的护理经济负担。
Investigating parents/caregivers financial burden of care for children with non-communicable diseases in Ghana.
作者信息
Abuosi Aaron A, Adzei Francis A, Anarfi John, Badasu Delali M, Atobrah Deborah, Yawson Alfred
机构信息
Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana.
Regional Institute of Population Studies, University of Ghana, Legon, Ghana.
出版信息
BMC Pediatr. 2015 Nov 16;15:185. doi: 10.1186/s12887-015-0504-7.
BACKGROUND
The introduction of the Ghana national health insurance scheme (NHIS) has led to progressive and significant increase in utilization of health services. However, the financial burden of caring for children with non-communicable diseases (NCDs) under the dispensation of the NHIS, especially during hospitalization, is less researched. This paper therefore sought to assess the financial burden parents/caregivers face in caring for children hospitalized with NCDs in Ghana, in the era of the Ghana NHIS.
METHODS
We conducted a cross-sectional survey of 225 parents or caregivers of children with NCDS hospitalized in three hospitals. Convenience sampling was used to select those whose children were discharged from hospital after hospitalization. Descriptive statistics such as frequencies and chi-square and logistic regression were used in data analysis. The main outcome variable was financial burden of care, proxied by cost of hospitalization. The independent variable included socio-economic and other indicators such as age, sex, income levels and financial difficulties faced by parents/caregivers.
RESULTS
The study found that over 30 % of parents/caregivers spend more than Gh¢50 (25$) as cost of treatment of children hospitalized with NCDs; and over 40 % of parents/caregivers also face financial difficulties in providing health care to their wards. It was also found that even though many children hospitalized with NCDs have been covered by the NHIS, and that the NHIS indeed, provides significant financial relief to parents in the care of children with NCDs, children who are insured still pay out-of-pocket for health care, in spite of their insurance status. It was also found that there is less support from relatives and friends in the care of children hospitalized with NCDs, thus exacerbating parents/caregivers financial burden of caring for the children.
CONCLUSIONS
Even though health insurance has proven to be of significant relief to the financial burden of caring for children with NCDs, parents/caregivers still face significant financial burden in the care of their wards. Stakeholders in health care delivery should therefore ensure that all children with NCDs including those excluded from the NHIS should be covered by NHIS. A special effort focusing on identifying children with NCDs within the lower income groups, especially from rural areas, in order to exempt them from any form of payment for their health care is recommended.
背景
加纳国家医疗保险计划（NHIS）的推出使得医疗服务利用率逐步显著提高。然而，在NHIS体系下，照顾患有非传染性疾病（NCDs）儿童的经济负担，尤其是住院期间的负担，研究较少。因此，本文旨在评估在加纳NHIS时代，父母/照顾者在照顾因非传染性疾病住院儿童时所面临的经济负担。
方法
我们对三家医院中225名患有非传染性疾病的住院儿童的父母或照顾者进行了横断面调查。采用便利抽样法选取那些孩子住院后已出院的家长。数据分析中使用了频率、卡方检验和逻辑回归等描述性统计方法。主要结果变量是护理的经济负担，以住院费用为代表。自变量包括社会经济和其他指标，如年龄、性别、收入水平以及父母/照顾者面临的经济困难。
结果
研究发现，超过30%的父母/照顾者为患有非传染性疾病的住院儿童支付超过50加纳塞地（25美元）的治疗费用；超过40%的父母/照顾者在为其病房提供医疗护理时也面临经济困难。研究还发现，尽管许多因非传染性疾病住院的儿童已被NHIS覆盖，并且NHIS确实为照顾患有非传染性疾病儿童的父母提供了显著的经济缓解，但参保儿童尽管有保险，仍需自掏腰包支付医疗费用。研究还发现，在照顾因非传染性疾病住院的儿童方面，亲戚和朋友的支持较少，从而加剧了父母/照顾者照顾孩子的经济负担。
结论
尽管医疗保险已被证明能显著减轻照顾患有非传染性疾病儿童的经济负担，但父母/照顾者在照顾其病房时仍面临重大经济负担。因此，医疗服务的利益相关者应确保所有患有非传染性疾病的儿童，包括那些被排除在NHIS之外的儿童，都能被NHIS覆盖。建议特别努力识别低收入群体，尤其是农村地区患有非传染性疾病的儿童，以便免除他们任何形式的医疗费用支付。
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