家庭观念是否会影响坦桑尼亚社区医疗保险计划的参保决策？
Do household perceptions influence enrolment decisions into community-based health insurance schemes in Tanzania?
机构信息
Department of Health Management and Health Economics, University of Oslo, P.O. Box 0315, Oslo, Norway.
Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
出版信息
BMC Health Serv Res. 2021 Feb 19;21(1):162. doi: 10.1186/s12913-021-06167-z.
BACKGROUND
Several countries including Tanzania, have established voluntary non-profit insurance schemes, commonly known as community-based health insurance schemes (CBHIs), that typically target rural populations and the informal sector. This paper considers the importance of household perceptions towards CBHIs in Tanzania and their role in explaining the enrolment decision of households.
METHODS
This was a cross-sectional household survey that involved 722 households located in Bahi and Chamwino districts in the Dodoma region. A three-stage sampling procedure was used, and the data were analyzed using both factor analysis (FA) and principal component analysis (PCA). Statistical tests such as Bartlett's test of sphericity, Kaiser-Meyer-Olkin (KMO) for sampling adequacy, and Cronbach's alpha test for internal consistency and scale reliability were performed to examine the suitability of the data for PCA and FA. Finally, multivariate logistic regressions were run to determine the associations between the identified factors and the insurance enrolment status.
RESULTS
The PCA identified seven perception factors while FA identified four factors. The quality of healthcare services, preferences (social beliefs), and accessibility to insurance scheme administration (convenience) were the most important factors identified by the two methods. Multivariate logistic regressions showed that the factors identified from the two methods differed somewhat in importance when considered as independent predictors of the enrollment status. The most important perception factors in terms of strength of association (odds ratio) and statistical significance were accessibility to insurance scheme administration (convenience), preferences (beliefs), and the quality of health care services. However, age and income were the only socio-demographic characteristics that were statistically significant.
CONCLUSION
Household perceptions were found to influence households' decisions to enroll in CBHIs. Policymakers should recognize and consider these perceptions when designing policies and programs that aim to increase the enrolment into CBHIs.
背景
包括坦桑尼亚在内的一些国家已经建立了自愿性非营利性保险计划，通常被称为社区为基础的健康保险计划（CBHIs），这些计划主要针对农村人口和非正规部门。本文考虑了坦桑尼亚家庭对 CBHIs 的看法的重要性，以及它们在解释家庭参保决策中的作用。
方法
这是一项横断面家庭调查，涉及位于多多马地区巴希和钱温诺区的 722 户家庭。采用了三阶段抽样程序，使用因子分析（FA）和主成分分析（PCA）对数据进行分析。进行了巴特利特球形检验、Kaiser-Meyer-Olkin（KMO）用于样本充分性的检验、Cronbach's alpha 检验用于内部一致性和量表可靠性的统计检验，以检查 PCA 和 FA 对数据的适用性。最后，进行了多变量逻辑回归分析，以确定识别因素与保险参保状态之间的关联。
结果
PCA 确定了七个感知因素，而 FA 确定了四个因素。医疗服务质量、偏好（社会信仰）和保险计划管理的可及性（便利性）是这两种方法识别的最重要因素。多变量逻辑回归表明，从这两种方法中识别出的因素在作为参保状态的独立预测因素时，其重要性略有不同。就关联强度（优势比）和统计学意义而言，最重要的感知因素是保险计划管理的可及性（便利性）、偏好（信仰）和医疗服务质量。然而，年龄和收入是唯一具有统计学意义的社会人口特征。
结论
家庭的看法被发现会影响家庭参加 CBHIs 的决定。政策制定者在设计旨在增加 CBHIs 参保率的政策和方案时，应该认识到并考虑这些看法。
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