Boachie Micheal Kofi
Department of Economics, Annamalai University, Annamalai Nagar, TN, India.
Int J Health Policy Manag. 2015 Oct 20;5(3):155-63. doi: 10.15171/ijhpm.2015.191.
In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP.
Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome.
Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level.
Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels by ensuring constant availability of essential drugs, doctors, and shorter waiting time. However, individual enrolees may value each criterion differently. Thus, not all enrolees may be motivated by same concerns. This requires providers to be circumspect regarding the factors that may attract enrolees. The National Health Insurance Authority (NHIA) should also ensure timely release of funds to help providers procure the necessary medical supplies to ensure quality service.
2012年初，阿散蒂地区的国家医疗保险计划（NHIS）成员被允许选择自己的初级医疗服务提供者。本文调查了阿散蒂地区参保人在选择首选初级医疗服务提供者（PPPs）时考虑的因素，以及这些因素与PPPs选择之间的关联方向。
采用横断面研究设计，该研究在库马西市区和夸布雷东区对600名NHIS参保人进行了抽样。抽样方法是在不同阶段结合简单随机抽样和系统抽样技术。使用描述性统计分析人口统计学信息和选择PPPs的标准。采用多项逻辑回归技术，以公立PPPs作为基础结果，确定因素与PPPs选择之间的关联方向。
在发放的600份问卷中，保留了496份用于进一步分析。结果显示，基本药物的可及性（53.63%）、医生的可及性（39.92%）、距离或接近程度（49.60%）、提供者声誉（39.52%）、等待时间（39.92%）、额外收费（37.10%）和推荐（48.79%）是参保人选择PPPs时采用的主要标准。在回归分析中，收入（-0.0027）、医生的可及性（-1.82）、额外收费（-2.14）和声誉（-2.09）在1%的水平上对选择政府PPPs具有统计学显著影响。就私立PPPs而言，药物的可及性（2.59）、等待时间（1.45）、居住地（-2.62）、性别（-2.89）和声誉（-2.69）在1%的水平上具有统计学显著意义。额外收费的存在（-1.29）在5%的水平上具有统计学显著意义。
参保人根据医生和基本药物的可及性、声誉、等待时间、收入和居住地等因素选择他们的PPPs。基于这些发现，医疗服务提供者需要通过确保基本药物和医生的持续可及性以及缩短等待时间来提高其质量水平。然而，个体参保人可能对每个标准的重视程度不同。因此，并非所有参保人都受到相同问题的激励。这要求提供者在可能吸引参保人的因素方面谨慎行事。国家医疗保险管理局（NHIA）也应确保及时发放资金，以帮助提供者采购必要的医疗用品，确保优质服务。
