Dalinjong Philip Ayizem, Wang Alex Y, Homer Caroline S E
Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
PLoS One. 2018 Feb 1;13(2):e0184830. doi: 10.1371/journal.pone.0184830. eCollection 2018.
The free maternal health policy was implemented in Ghana in 2008 under the National Health Insurance Scheme (NHIS). The policy sought to eliminate out of pocket (OOP) payments and enhance the utilisation of maternal health services. It is unclear whether the policy had altered OOP payments for services. The study explored views on costs and actual OOP payments during pregnancy. The source of funding for payments was also explored.
A convergent parallel mixed methods design, involving quantitative and qualitative data collection approaches. The study was set in the Kassena-Nankana municipality, a rural area in Ghana. Women (n = 406) who utilised services during pregnancy were surveyed. Also, 10 focus groups discussions (FGDs) were held with women who used services during pregnancy as well as 28 in-depth interviews (IDIs) with midwives/nurses (n = 25) and insurance managers/directors (n = 3). The survey was analysed using descriptive statistics, focussing on costs from the women's perspective. Qualitative data were audio recorded, transcribed and translated verbatim into English where necessary. The transcripts were read and coded into themes and sub-themes.
The NHIS did not cover all expenses in relation to maternal health services. The overall mean for OOP cost during pregnancy was GH¢17.50 (US$8.60). Both FGDs and IDIs showed that women especially paid for drugs and ultrasound scan services. Sixty-five percent of the women used savings, whilst twenty-two percent sold assets to meet the OOP cost. Some women were unable to afford payments due to poverty and had to forgo treatment. Participants called for payments to be eliminated and for the NHIS to absorb the cost of emergency referrals. All participants admitted the benefits of the policy.
Women needed to make payments despite the policy. Measures should be put in place to eliminate payments to enable all women to receive services and promote universal health coverage.
2008年，加纳在国家医疗保险计划（NHIS）下实施了免费孕产妇健康政策。该政策旨在消除自付费用（OOP）并提高孕产妇健康服务的利用率。目前尚不清楚该政策是否改变了服务的自付费用。本研究探讨了关于孕期费用和实际自付费用的观点。还探讨了支付费用的资金来源。
采用收敛平行混合方法设计，涉及定量和定性数据收集方法。该研究在加纳农村地区的卡塞纳-南卡纳市进行。对孕期使用过服务的406名妇女进行了调查。此外，还与孕期使用过服务的妇女进行了10次焦点小组讨论（FGD），并对助产士/护士（25人）和保险经理/董事（3人）进行了28次深入访谈（IDI）。使用描述性统计方法对调查进行分析，重点是从妇女角度看的费用。定性数据进行了音频记录、转录，并在必要时逐字翻译成英文。对转录本进行阅读并编码为主题和子主题。
NHIS并未涵盖与孕产妇健康服务相关的所有费用。孕期自付费用的总体平均值为17.50加纳塞地（8.60美元）。FGD和IDI均显示，妇女尤其要支付药品和超声扫描服务的费用。65%的妇女动用储蓄，22%的妇女出售资产以支付自付费用。一些妇女因贫困无力支付，不得不放弃治疗。参与者呼吁取消支付费用，并要求NHIS承担紧急转诊的费用。所有参与者都承认该政策的益处。
尽管有该政策，妇女仍需支付费用。应采取措施消除支付费用，以使所有妇女都能获得服务并促进全民健康覆盖。
