Ameyaw Edward Kwabena, Ahinkorah Bright Opoku, Baatiema Linus, Seidu Abdul-Aziz
School of Public Health, Faculty of Health, University of Technology Sydney, PMB University Private Mail Bag, Sydney, NSW, Australia.
Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.
BMC Pregnancy Childbirth. 2021 Mar 12;21(1):201. doi: 10.1186/s12884-021-03651-6.
Increasing the use of healthcare is a significant step in improving health outcomes in both the short and long term. However, the degree of the relationship between utilization of health services and health outcomes is affected by the quality of the services rendered, the timeliness of treatment and follow-up care. In this study, we investigated whether the National Health Insurance Scheme (NHIS) is helping pregnant women in accessing health services in Ghana.
Data for the study were obtained from the women's file of the 2014 Ghana Demographic and Health Survey. All women with birth history and aged 15-49 constituted our sample (n = 4271). We employed binary logistic regression analysis in investigating whether the NHIS was helping pregnant women in accessing health service. Statistical significance was set at <0.05.
Most women had subscribed to the NHIS [67.0%]. Of the subscribed women, 78.2% indicated that the NHIS is helping pregnant women in accessing healthcare. Women who had subscribed to the NHIS were more likely to report that it is helping pregnant women in accessing health service [aOR = 1.70, CI = 1.38-2.10]. We further noted that women who had at least four antenatal visits were more likely to indicate that NHIS is helping pregnant women in accessing health services [aOR = 3.01, CI = 2.20-4.14]. Women with secondary level of education [aOR= 1.42; CI: 1.04-1.92] and those in the richest wealth quintile [aOR = 3.51; CI = 1.94-6.34] had higher odds of indicating that NHIS is helping pregnant women in accessing healthcare. However, women aged 45-49 [aOR = 0.49; CI = 0.26-0.94], women in the Greater Accra [aOR = 0.29; CI = 0.16-0.53], Eastern [aOR = 0.12; CI = 0.07-0.21], Northern [aOR = 0.29; CI = 0.12-0.66] and Upper East [aOR = 0.17; CI = 0.09-0.31] regions had lower odds of reporting that NHIS is helping pregnant women in accessing health services.
To enhance positive perception towards the use of health services among pregnant women, non-subscribers need to be encouraged to enrol on the NHIS. Together with non-governmental organizations dedicated to maternal and child health issues, the Ghana Health Service's Maternal and Child Health Unit could strengthen efforts to educate pregnant women on the importance of NHIS in maternity care.
增加医疗保健的使用是改善短期和长期健康结果的重要一步。然而，卫生服务利用与健康结果之间的关系程度受到所提供服务的质量、治疗及时性和后续护理的影响。在本研究中，我们调查了国家健康保险计划（NHIS）是否有助于加纳的孕妇获得卫生服务。
本研究的数据来自2014年加纳人口与健康调查的女性档案。所有有生育史且年龄在15 - 49岁的女性构成我们的样本（n = 4271）。我们采用二元逻辑回归分析来调查NHIS是否有助于孕妇获得卫生服务。统计学显著性设定为<0.05。
大多数女性已加入NHIS[67.0%]。在已参保的女性中，78.2%表示NHIS有助于孕妇获得医疗保健。已加入NHIS的女性更有可能报告其有助于孕妇获得卫生服务[aOR = 1.70，CI = 1.38 - 2.10]。我们还注意到，至少进行过四次产前检查的女性更有可能表示NHIS有助于孕妇获得卫生服务[aOR = 3.01，CI = 2.20 - 4.14]。受过中等教育的女性[aOR = 1.42；CI：1.04 - 1.92]以及最富裕财富五分位数组的女性[aOR = 3.51；CI = 1.94 - 6.34]更有可能表示NHIS有助于孕妇获得医疗保健。然而，45 - 49岁的女性[aOR = 0.49；CI = 0.26 - 0.94]、大阿克拉地区的女性[aOR = 0.29；CI = 0.16 - 0.53]、东部地区的女性[aOR = 0.12；CI = 0.07 - 0.21]、北部地区的女性[aOR = 0.29；CI = 0.12 - 0.66]以及上东部地区的女性[aOR = 0.17；CI = 0.09 - 0.31]报告NHIS有助于孕妇获得卫生服务的可能性较低。
为了增强孕妇对使用卫生服务的积极认知，需要鼓励未参保者加入NHIS。加纳卫生服务局的母婴健康部门可以与致力于母婴健康问题的非政府组织共同加强努力，向孕妇宣传NHIS在孕产妇护理中的重要性。
