加纳两个地区劳动年龄成年人健康保险参保决定因素的差异。
Differences in the determinants of health insurance enrolment among working-age adults in two regions in Ghana.
作者信息
Duku Stephen Kwasi Opoku
机构信息
Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, P. O. Box LG 581 Legon, Accra, Ghana.
Amsterdam Institute for Global health and Development, Amsterdam, The Netherlands.
出版信息
BMC Health Serv Res. 2018 May 29;18(1):384. doi: 10.1186/s12913-018-3192-9.
BACKGROUND
Ghana's National Health Insurance Scheme (NHIS) has achieved varying levels of enrolment within the regions with different rural-urban populations with associated income inequalities. This study sought to investigate the differences in the determinants of enrolment between the Greater Accra (GAR) and Western (WR) regions of Ghana to inform the NHIS reforms.
METHOD
Data from 4214 adults, 18 years and above from a household survey conducted in the two regions was analyzed. Bivariate analysis (t-test for continuous and Pearson chi-square for categorical) was performed to examine differences in respondents characteristics (socio-economic and insurance enrolment) between the two regions for the total, urban and rural samples. Logistic regression estimation was performed to establish differences in determinant of enrolment between the regions.
RESULTS
Age, sex, educational level, marital status, health status and travel time to nearest health facility were identified as determinants of enrolment in both regions and among the rural and urban residents within the regions. Although the rich and richest in both regions are more likely to enroll than the poor and poorest, the odds of enrolment for the urban richest in the WR is about twice that of GAR whiles the odds of enrolment for the rural richest in the GAR is also about twice that of the WR. Those who visit public facilities in the GAR are more likely to enroll than those in WR for the total and urban samples. However, those who visit private facilities in rural communities in both regions are more likely to enroll.
CONCLUSION
Differences in the NHIS enrolment between the regions is as a result of differences in socio-economic factors that are intrinsic in the regions and impact on the inhabitants' ability to afford insurance premium. Policymakers should determine NHIS premium differently at the district level based on socio-economic activities and income levels within the districts.
背景
加纳国家医疗保险计划（NHIS）在不同城乡人口及存在相关收入不平等的各地区实现了不同程度的参保率。本研究旨在调查加纳大阿克拉（GAR）地区和西部（WR）地区参保决定因素的差异，以为NHIS改革提供参考。
方法
分析了来自这两个地区一项家庭调查的4214名18岁及以上成年人的数据。进行双变量分析（连续变量用t检验，分类变量用Pearson卡方检验），以检查两个地区总体、城市和农村样本中受访者特征（社会经济和保险参保情况）的差异。进行逻辑回归估计以确定各地区参保决定因素的差异。
结果
年龄、性别、教育水平、婚姻状况、健康状况以及到最近医疗机构的出行时间被确定为两个地区以及各地区城乡居民参保的决定因素。尽管两个地区的富人和最富有的人比穷人和最贫穷的人更有可能参保，但WR地区城市最富有的人参保几率约为GAR地区的两倍，而GAR地区农村最富有的人参保几率也约为WR地区的两倍。对于总体和城市样本，在GAR地区就诊于公共医疗机构的人比在WR地区的人更有可能参保。然而，在两个地区农村社区就诊于私立医疗机构的人更有可能参保。
结论
各地区NHIS参保率的差异是由于各地区内在的社会经济因素不同，这些因素影响居民支付保险费的能力。政策制定者应根据各地区的社会经济活动和收入水平，在地区层面区别确定NHIS保险费。
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