Abuosi Aaron A, Domfeh Kwame Ameyaw, Abor Joshua Yindenaba, Nketiah-Amponsah Edward
Department of Public Administration and Health Services Management, University of Ghana Business School, P.O Box LG 78, Legon, Ghana.
Department of Finance, University of Ghana Business School, Legon, Ghana.
Int J Equity Health. 2016 May 12;15:76. doi: 10.1186/s12939-016-0365-1.
The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest.
A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care.
Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with.
It was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of care is a concern of both insured and uninsured patients.
2003年加纳引入医疗保险后，医疗服务利用率大幅提高。然而，人们对患者护理质量的担忧也在增加。其中一些担忧包括等待时间过长、医护人员对患者的言语辱骂、医生体格检查不充分以及对参保患者的歧视。该研究比较了加纳部分医院参保和未参保门诊患者对护理质量的看法，以确定在护理质量方面参保患者和未参保患者是否受到不平等对待，因为经验证据和传闻证据似乎都表明存在这种情况。
在加纳三个地区的17家综合医院对818名门诊患者进行了横断面调查。这三个地区分别是上东部地区、布朗阿哈福地区和中部地区。采用便利抽样法在患者出院访谈中选取患者。描述性统计，包括频率分布、均值和标准差，用于描述受访者的社会经济和人口特征。因子分析用于确定不同的护理质量结构；t检验统计量用于检验参保患者和未参保患者在质量认知上的差异；回归分析用于检验医疗保险与护理质量之间的关联。
总体而言，参保患者和未参保患者在质量认知上没有显著差异。然而，参保患者和未参保患者在获得医疗护理的经济能力方面存在显著差异。影响所有患者的主要护理质量问题是资源不足，特别是缺乏医生、药品以及其他基本用品和设备。
得出的结论是，总体而言，与普遍的传闻证据和经验证据相反，参保患者和未参保患者并未受到不平等对待。相反，护理质量是参保患者和未参保患者共同关心的问题。
