用户费用豁免政策显著提高了埃塞俄比亚西北部巴赫达尔市孕产妇保健服务的利用率：一项比较横断面研究。
User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.
作者信息
Marye Demlie Mekonnen, Debalkie Atnafu Desta, Belayneh Melesse, Takele Alemu Ayenew
机构信息
Department of Health System Management and Health Economics, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia.
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.
出版信息
Clinicoecon Outcomes Res. 2023 Dec 11;15:775-785. doi: 10.2147/CEOR.S431488. eCollection 2023.
BACKGROUND
Increasing free and skilled delivery is a top priority in the global effort to reduce maternal and newborn mortality. Reducing user-fees through exemption policy has contributed to universal health coverage. However, there is scant evidence regarding the effect of exempted maternal services on adherence to utilization in Ethiopia. Thus, this study aimed to assess the effect of fee exemption policy on adherence to maternal health service utilization and its predictors.
METHODS
A community-based comparative cross-sectional study was conducted in Bahir Dar City. A two-stage multistage sampling was employed; 497 women participated. Data were collected by face-to-face interview; entered and cleaned using Epi-Data 3.1. SPSS version 25 was used for further analysis. Bivariable and multivariable logistic regression models were computed to assess the association between explanatory and outcome variables. An adjusted odds ratio with a 95% confidence interval was used to interpret the degree of association. The effect of fee exemption policy on adherence to maternal health service utilization was measured by propensity score matching.
RESULTS
The overall adherence to maternal service utilization was 54.2%. Factors associated with adherence to maternal health service utilization were pregnancy complications [AOR: 4.1, 95% CI (2.32, 7.28)], secondary and above education [AOR: 4.6, 95% CI (1.38, 15.08)], early ANC booking [AOR: 3.1, 95% CI (1.83, 5.16)], autonomous women [AOR: 2.1, 95% CI (1.02, 4.39)], user fee exemption [AOR: 2.3, 95% CI (1.20, 4.47)] and high parity [AOR: 0.39, 95% CI (0.2, 0.75)]. User fee exemption induced a 22.7% increment in adherence to maternal service utilization (ATET=0.227, t=2.13).
CONCLUSION
User fee exemption policy significantly improved adherence to maternal health service utilization. Promoting a fee exemption policy through third-party financing can enhance maternal health service utilization adherence in hard-to-reach settings of Ethiopia by targeting mothers with higher pregnancies, no complications, no autonomy, and less education.
背景
增加免费且专业的分娩服务是全球降低孕产妇和新生儿死亡率努力中的首要任务。通过豁免政策降低用户费用有助于实现全民健康覆盖。然而，关于埃塞俄比亚豁免孕产妇服务对服务利用依从性的影响，证据很少。因此，本研究旨在评估费用豁免政策对孕产妇保健服务利用依从性及其预测因素的影响。
方法
在巴赫达尔市开展了一项基于社区的比较性横断面研究。采用两阶段多阶段抽样；497名妇女参与。通过面对面访谈收集数据；使用Epi-Data 3.1录入和清理数据。使用SPSS 25版进行进一步分析。计算双变量和多变量逻辑回归模型以评估解释变量和结果变量之间的关联。使用调整后的比值比及95%置信区间来解释关联程度。通过倾向得分匹配来衡量费用豁免政策对孕产妇保健服务利用依从性的影响。
结果
孕产妇服务利用的总体依从率为54.2%。与孕产妇保健服务利用依从性相关的因素有妊娠并发症[AOR：4.1，95%CI（2.32，7.28）]、中学及以上教育程度[AOR：4.6，95%CI（1.38，15.08）]、早期产前检查预约[AOR：3.1，95%CI（1.83，5.16）]、自主女性[AOR：2.1，95%CI（1.02，4.39）]、用户费用豁免[AOR：2.3，95%CI（1.20，4.47）]和高胎次[AOR：0.39，95%CI（0.2，0.75）]。用户费用豁免使孕产妇服务利用的依从性提高了22.7%（平均治疗效果=0.227，t=2.13）。
结论
用户费用豁免政策显著提高了孕产妇保健服务利用的依从性。通过第三方融资推广费用豁免政策，可以通过针对妊娠次数较多、无并发症、无自主权且教育程度较低的母亲，提高埃塞俄比亚难以到达地区的孕产妇保健服务利用依从性。
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