Were Lawrence P O, Were Edwin, Wamai Richard, Hogan Joseph, Galarraga Omar
Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA.
School of Public Health, Brown University, Providence, RI, USA.
BMC Health Serv Res. 2017 Jul 3;17(1):454. doi: 10.1186/s12913-017-2397-7.
Healthcare financing through health insurance is gaining traction as developing countries strive to achieve universal health coverage and address the limited access to critical health services for specific populations including pregnant women and their children. However, these reforms are taking place despite limited evaluation of impact of health insurance on maternal health in developing countries including Kenya. In this study we evaluate the association of health insurance with access and utilization of obstetric delivery health services for pregnant women in Kenya.
Nationally representative data from the Kenya Demographic and Health Survey 2008-09 was used in this study. 4082 pregnant women with outcomes of interest - Institutional delivery (Yes/No - delivery at hospital, dispensary, maternity home, and clinic) and access to skilled birth attendants (help by a nurse, doctor, or trained midwife at delivery) were selected from 8444 women ages 15-49 years. Linear and logistic regression, and propensity score adjustment are used to estimate the causal association of enrollment in insurance on obstetric health outcomes.
Mothers with insurance are 23 percentage points (p < 0.01) more likely to deliver at an institution and 20 percentages points (p < 0.01) more likely have access to skilled birth attendants compared to those not insured. In addition mothers of lower socio-economic status benefit more from enrollment in insurance compared to mothers of higher socio-economic status. For both institutional delivery and access to skilled birth attendants, the average difference of the association of insurance enrollment compared to not enrolling for those of low SES is 23 percentage points (p < 0.01), and 6 percentage points (p < 0.01) for those of higher SES.
Enrolling in health insurance is associated with increased access and utilization of obstetric delivery health services for pregnant women. Notably, those of lower socio-economic status seem to benefit the most from enrollment in insurance.
随着发展中国家努力实现全民健康覆盖，并解决包括孕妇及其子女在内的特定人群获得关键医疗服务机会有限的问题，通过医疗保险进行医疗融资正变得越来越普遍。然而，尽管包括肯尼亚在内的发展中国家对医疗保险对孕产妇健康的影响评估有限，但这些改革仍在进行。在本研究中，我们评估了医疗保险与肯尼亚孕妇获得产科分娩医疗服务及利用情况之间的关联。
本研究使用了2008 - 2009年肯尼亚人口与健康调查的全国代表性数据。从8444名15 - 49岁的女性中选取了4082名有相关结果的孕妇——机构分娩（是/否——在医院、诊所、产院和医务室分娩）以及获得熟练接生人员（分娩时有护士、医生或经过培训的助产士协助）的情况。使用线性和逻辑回归以及倾向得分调整来估计参保与产科健康结果之间的因果关联。
与未参保的母亲相比，参保母亲在机构分娩的可能性高23个百分点（p < 0.01），获得熟练接生人员协助的可能性高20个百分点（p < 0.01）。此外，社会经济地位较低的母亲比社会经济地位较高的母亲从参保中受益更多。对于机构分娩和获得熟练接生人员协助这两个方面，社会经济地位低的人群参保与未参保相比，关联的平均差异为23个百分点（p < 0.01），社会经济地位高的人群为6个百分点（p < 0.01）。
参保与孕妇增加获得产科分娩医疗服务及利用情况相关。值得注意的是，社会经济地位较低的人群似乎从参保中受益最大。
