基于社区的健康保险对埃塞俄比亚西北部阿姆哈拉州东戈贾姆区阿内德德地区农村母亲儿童疾病就医行为的影响
Effect of Community-Based Health Insurance on Healthcare-Seeking Behavior for Childhood Illnesses Among Rural Mothers in Aneded District, East Gojjam Zone, Amhara Region, Northwest Ethiopia.
作者信息
Simieneh Muluye Molla, Yitayal Mezgebu, Gelagay Abebaw Addis
机构信息
Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
Risk Manag Healthc Policy. 2021 Apr 21;14:1659-1668. doi: 10.2147/RMHP.S298658. eCollection 2021.
BACKGROUND
Community-based health insurance (CBHI) schemes have been implemented in developing countries to facilitate modern medical care access. However, studies conducted on the effect of CBHI on healthcare-seeking behavior (HSB) have been limited and revealed inconsistent results. Therefore, this study aimed to assess the effect of CBHI on mothers' HSB for common under-five childhood illnesses.
METHODS
A community-based comparative cross-sectional study was conducted among 410 rural mothers (205 insured and 205 non-insured), and a multistage random sampling technique was used to select the study participants. Binary logistic regression and propensity score matching were used to identify factors associated with the mothers' HSB, and estimate the effect of CBHI on mothers' HSB, respectively.
RESULTS
The overall mother's HSB for childhood illnesses was 48.8% (200/410). From those mothers who visited healthcare, 92.0% were married, 86.0% were unable to read and write, 94.5% were farmers, and 54.5% were from low wealth status, 58.50% had a family size of ≤5, 54.0% had children less than 24 months of age. Besides, 63.0% were members of CBHI, 37.0% perceived their child's illness as severe, 78.0% made a shared decision to visit a health facility, and 67.5% lived within less than five Kms from the nearby health facilities. Being a member of CBHI, the child's age, decision to visit a health facility, and perceived disease severity were predictors of HSB. The CBHI had a significant effect on the HSB for childhood illnesses with ATT of 28.7% (t = 3.959).
CONCLUSION
The overall mothers' HSB for common childhood illnesses was low though the CBHI has a significant effect. CBHI should be strengthened to improve the mothers' HSB. It is also crucial to strengthen awareness creation regarding joint decision-making and educate mothers to visit the health facilities regardless of children's age and disease severity.
背景
发展中国家已实施基于社区的医疗保险（CBHI）计划，以促进获得现代医疗服务。然而，关于CBHI对就医行为（HSB）影响的研究有限，且结果不一致。因此，本研究旨在评估CBHI对母亲针对五岁以下儿童常见疾病的就医行为的影响。
方法
对410名农村母亲（205名参保和205名未参保）进行了一项基于社区的比较横断面研究，并采用多阶段随机抽样技术选择研究参与者。二元逻辑回归和倾向得分匹配分别用于确定与母亲就医行为相关的因素，并估计CBHI对母亲就医行为的影响。
结果
母亲针对儿童疾病的总体就医行为发生率为48.8%（200/410）。在那些就医的母亲中，92.0%已婚，86.0%不识字，94.5%是农民，54.5%来自低财富状况家庭，58.50%家庭规模≤5人，54.0%的孩子年龄小于24个月。此外，63.0%是CBHI成员，37.0%认为孩子的病情严重，78.0%共同决定前往医疗机构就诊，67.5%居住在距离附近医疗机构不到5公里的范围内。作为CBHI成员、孩子的年龄、前往医疗机构就诊的决定以及感知到的疾病严重程度是就医行为的预测因素。CBHI对儿童疾病的就医行为有显著影响，平均治疗效果（ATT）为28.7%（t = 3.959）。
结论
尽管CBHI有显著影响，但母亲针对常见儿童疾病的总体就医行为发生率较低。应加强CBHI以改善母亲的就医行为。加强关于共同决策的意识并教育母亲无论孩子年龄和疾病严重程度如何都前往医疗机构就诊也至关重要。
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