Wang Wenjuan, Temsah Gheda, Mallick Lindsay
International Health and Development Division, ICF International, Rockville, MD, USA.
Avenir Health, Glastonbury, CT, USA.
Health Policy Plan. 2017 Apr 1;32(3):366-375. doi: 10.1093/heapol/czw135.
While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage-Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care.
虽然已有研究评估了医疗保险对医疗保健利用的影响，但很少有研究关注医疗保险对孕产妇保健利用的影响。本研究通过分析人口与健康调查（DHS）的全国代表性数据，估计了在加纳、印度尼西亚和卢旺达这三个医疗保险覆盖率相对较高的国家，医疗保险状况对孕产妇保健服务利用的影响。该分析采用倾向得分匹配法来调整医疗保险参保中的选择偏差，并评估医疗保险对孕产妇保健利用的四项指标的影响：至少进行一次产前检查；进行四次或更多次产前检查；在孕早期开始产前检查；以及在医疗机构分娩。尽管这三个国家的医疗保险计划大多旨在关注贫困人口，但覆盖率严重偏向富人，尤其是在加纳和卢旺达。印度尼西亚在覆盖率方面的财富状况差异较小。分析发现，在这三个国家中，医疗保险覆盖对孕产妇保健利用的四项指标中的至少两项产生了显著的积极影响。在所有四项指标上，印度尼西亚的医疗保险效应最为系统。医疗保险对基于医疗机构的分娩利用的积极影响似乎比对产前检查利用的影响更为一致。分析表明，扩大医疗保险范围，包括针对贫困人口的收入敏感型保费或豁免以及低自付额或无自付额，可以增加孕产妇保健的利用。
