埃塞俄比亚阿姆哈拉地区社区医疗保险对弱势家庭卫生服务利用的影响。
Impact of community-based health insurance on health services utilisation among vulnerable households in Amhara region, Ethiopia.
机构信息
UNICEF Office of Research-Innocenti, Via Degli Alfani 58, Florence, 50121, Italy.
Department of Agricultural Economics, University of Gondar, Gondar, Ethiopia.
出版信息
BMC Health Serv Res. 2023 Jan 19;23(1):55. doi: 10.1186/s12913-023-09024-3.
BACKGROUND
Ethiopia piloted community-based health insurance in 2011, and as of 2019, the programme was operating in 770 districts nationwide, covering approximately 7 million households. Enrolment in participating districts reached 50%, holding promise to achieve the goal of Universal Health Coverage in the country. Despite the government's efforts to expand community-based health insurance to all districts, evidence is lacking on how enrolment in the programme nudges health seeking behaviour among the most vulnerable rural households. This study aims to examine the effect of community-based health insurance enrolment among the most vulnerable and extremely poor households participating in Ethiopia's Productive Safety Net Programme on the utilisation of healthcare services in the Amhara region.
METHODS
Data for this study came from Amhara pilot integrated safety net programme baseline survey in Ethiopia and were collected between December 2018 and February 2019 from 5,398 households. We used propensity score matching method to estimate the impacts of enrolment in community-based health insurance on outpatient, maternal, and child preventive and curative healthcare services utilisation.
RESULTS
Results show that membership in community-based health insurance increases the probabilities of visiting health facilities for curative care in the past month by 8.2 percentage points (95% CI 5.3 to 11.1), seeking care from a health professional by 8.4 percentage points (95% CI 5.5 to 11.3), and visiting a health facility to seek any medical assistance for illness and check-ups in the past 12 months by 13.9 percentage points (95% CI 10.5 to 17.4). Insurance also increases the annual household per capita health facility visits by 0.84 (95% CI 0.64 to 1.04). However, we find no significant effects of community-based health insurance membership on utilisation of maternal and child healthcare services.
CONCLUSIONS
Findings that community-based health insurance increased outpatient services utilisation implies that it could also contribute towards universal health coverage and health equity in rural and informal sectors. The absence of significant effects on maternal and child healthcare services may be due to the free availability of such services for everyone at the public health facilities, regardless of insurance membership. Outpatient services use among insured households is still not universal, and understanding of the barriers to use, including supply-side constraints, will help improve universal health coverage.
背景
埃塞俄比亚于 2011 年试行社区医疗保险，截至 2019 年，该计划在全国 770 个地区运行，覆盖约 700 万户家庭。参与地区的参保率达到了 50%，有望实现该国全民健康覆盖的目标。尽管政府努力将社区医疗保险扩大到所有地区，但缺乏证据表明该计划的参保率如何促使最脆弱的农村家庭寻求医疗服务。本研究旨在考察在埃塞俄比亚生产安全网计划中，最脆弱和极度贫困家庭参加社区医疗保险对阿姆哈拉地区医疗服务利用的影响。
方法
本研究的数据来自埃塞俄比亚阿姆哈拉试点综合安全网计划基线调查，于 2018 年 12 月至 2019 年 2 月期间从 5398 户家庭收集。我们使用倾向评分匹配法估计参加社区医疗保险对门诊、产妇和儿童预防和治疗保健服务利用的影响。
结果
结果表明，参加社区医疗保险增加了过去一个月因疾病接受治疗的卫生机构就诊的可能性，增加了 8.2 个百分点（95%CI 5.3 到 11.1），增加了 8.4 个百分点（95%CI 5.5 到 11.3），以及增加了 13.9 个百分点（95%CI 10.5 到 17.4），在过去 12 个月中因疾病和检查前往卫生机构寻求任何医疗援助的可能性。保险还增加了每户家庭人均每年前往卫生机构就诊的次数，增加了 0.84 次（95%CI 0.64 到 1.04）。然而，我们没有发现社区医疗保险参保对产妇和儿童保健服务利用的显著影响。
结论
社区医疗保险增加门诊服务利用的发现意味着它也可以为农村和非正规部门的全民健康覆盖和健康公平做出贡献。对产妇和儿童保健服务没有显著影响可能是由于公共卫生机构免费向所有人提供此类服务，而不论其是否参保。参保家庭的门诊服务利用仍未普及，了解利用方面的障碍，包括供应方的限制，将有助于改善全民健康覆盖。
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