Duku Stephen Kwasi Opoku, Nketiah-Amponsah Edward, Janssens Wendy, Pradhan Menno
Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
Faculty of Economics and Business Administration, Free University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2018 Jan 16;13(1):e0190911. doi: 10.1371/journal.pone.0190911. eCollection 2018.
This study's objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare for both the insured and uninsured.
本研究的目的是通过分析参保者和未参保者对医疗保健非技术质量的认知差异，为加纳医疗保险参保率低提供另一种解释。它进一步探讨了保险状况与医疗保健质量认知之间的关联，以确定保险状况在医疗保健质量认知中是否重要。分析使用了对居住在64个医疗中心集水区的1903户家庭进行调查的数据。采用两个独立样本t检验来比较参保者和未参保者对医疗保健非技术质量七个指标的平均认知。使用广义有序logit回归，控制社会经济特征并在医疗机构层面进行聚类，检验保险状况与医疗保健质量认知之间的关联。结果发现，参保者的认知明显比未参保者更负面，而曾经参保者的认知比从未参保者更负面。参保与对医疗保健质量的认知显著降低有关。因此，一旦人们参保，与未参保者相比，他们往往会认为自己接受的医疗保健质量较差。本研究表明，医疗保险状况在医疗保健质量认知中很重要。研究结果还意味着，医疗保健质量的认知可能受到在医疗机构的个人经历的影响，在那里参保者和未参保者可能受到不同的对待。由于对为参保个人提供的医疗保健质量认知不佳，医疗保险的吸引力降低，导致加纳对医疗保险的需求较低。加纳的政策制定者应考虑重新设计、重组和改造国家医疗保险计划，以确保为参保者和未参保者提供更高质量的医疗保健。
