参保是否会提高农村老年居民的医疗服务利用率？来自加纳国家健康保险计划的证据。
Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana.
作者信息
van der Wielen Nele, Channon Andrew Amos, Falkingham Jane
机构信息
Centre for Research on Ageing, University of Southampton, Southampton, UK.
Department of Social Statistics and Demography Social Sciences, University of Southampton, Southampton, UK.
出版信息
BMJ Glob Health. 2018 Feb 15;3(1):e000590. doi: 10.1136/bmjgh-2017-000590. eCollection 2018.
INTRODUCTION
This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed.
METHODS
Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over.
RESULTS
The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled.
CONCLUSION
The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.
引言
本文探讨了加纳农村地区老年人的国家医疗保险参保情况与住院和门诊医疗服务利用之间的关系。加纳国家医疗保险计划（NHIS）旨在提高医疗服务的可承受性并增加其利用率。然而，该系统因未能满足老年人的需求而受到批评。加纳的大多数老年人生活在农村地区，那里获得医疗服务的机会很差。随着人口老龄化，需要对该计划是否使老年人受益以及这种受益是否公平进行具体评估。
方法
本文利用2012年至2013年的加纳生活水平调查，采用倾向得分匹配法来估计加入NHIS对50岁及以上老年人住院和门诊医疗服务利用的影响。
结果
原始结果显示NHIS成员的医疗服务利用率更高，匹配后这种情况依然存在。NHIS成员使用住院和门诊医疗服务的可能性分别比非成员高6%和9%。在对门诊医疗服务的增加情况进行分类时，发现非贫困者和女性比贫困者和男性受益更多。对于住院医疗服务，参保的受益情况在贫困状况和性别方面是相同的。然而，总体而言，贫困老年人即使参保，其使用医疗服务的频率也远低于非贫困老年人。
结论
结果表明，NHIS覆盖确实提高了农村老年人的医疗服务利用率，但不平等现象仍然存在。穷人在总体使用医疗服务方面仍然处于极大劣势，并且在门诊医疗参保方面受益较少。即使保险应消除临时自付费用的经济负担，但获得医疗服务仍受到一系列辅助性障碍的显著影响。
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