Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia.
School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia.
PLoS One. 2024 Feb 9;19(2):e0293513. doi: 10.1371/journal.pone.0293513. eCollection 2024.
BACKGROUND: The provision of equitable and accessible healthcare is one of the goals of universal health coverage. However, due to high out-of-pocket payments, people in the world lack sufficient health services, especially in developing countries. Thus, many low and middle-income countries introduced different prepayment mechanisms to reduce large out-of-pocket payments and overcome financial barriers to accessing health care. Though many studies were conducted on willingness to pay for social health insurance in Ethiopia, there is no aggregated data at the national level. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of willingness to pay for social health insurance and its associated factors among public servants in Ethiopia. METHOD: Studies conducted before June 1, 2022, were retrieved from electronic databases (PubMed/Medline, Science Direct, African Journals Online, Google Scholar, and Web of Science) as well as from Universities' digital repositories. Data were extracted using a data extraction format prepared in Microsoft Excel and the analysis was performed using STATA 16 statistical software. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for cross-sectional studies. To evaluate publication bias, a funnel plot, and Egger's regression test were utilized. The study's heterogeneity was determined using Cochrane Q test statistics and the I2 test. To determine the pooled effect size, odds ratio, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region, sample size, and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. RESULT: To estimate the pooled magnitude of willingness to pay for the Social Health insurance scheme in Ethiopia, twenty articles with a total of 8744 participants were included in the review. The pooled magnitude of willingness to pay for Social Health Insurance in Ethiopia was 49.62% (95% CI: 36.41-62.82). Monthly salary (OR = 6.52; 95% CI:3.67,11.58), having the degree and above educational status (OR = 5.52; 95%CI:4.42,7.17), large family size(OR = 3.69; 95% CI:1.10,12.36), having the difficulty of paying the bill(OR = 3.24; 95%CI: 1.51, 6.96), good quality of services(OR = 4.20; 95%CI:1.97, 8.95), having favourable attitude (OR = 5.28; 95%CI:1.45, 19.18) and awareness of social health insurance scheme (OR = 3.09;95% CI:2.12,4.48) were statistically associated with willingness to pay for Social health insurance scheme. CONCLUSIONS: In this review, the magnitude of willingness to pay for Social Health insurance was low among public Civil servants in Ethiopia. Willingness to pay for Social Health Insurance was significantly associated with monthly salary, educational status, family size, the difficulty of paying medical bills, quality of healthcare services, awareness, and attitude towards the Social Health Insurance program. Hence, it's recommended to conduct awareness creation through on-the-job training about Social Health Insurance benefit packages and principles to improve the willingness to pay among public servants.
背景:提供公平和可及的医疗保健是全民健康覆盖的目标之一。然而,由于自付费用高,世界上的人们缺乏足够的卫生服务,特别是在发展中国家。因此,许多低收入和中等收入国家引入了不同的预付款机制,以减少大量自付费用,并克服获得医疗保健的经济障碍。尽管在埃塞俄比亚进行了许多关于社会医疗保险支付意愿的研究,但在国家层面没有汇总数据。因此,本系统评价和荟萃分析旨在估计埃塞俄比亚公务员对社会医疗保险的支付意愿的总体规模及其相关因素。
方法:检索了截至 2022 年 6 月 1 日之前发表的电子数据库(PubMed/Medline、Science Direct、African Journals Online、Google Scholar 和 Web of Science)以及大学数字资源库中的研究。使用 Microsoft Excel 准备的数据提取格式提取数据,并使用 STATA 16 统计软件进行分析。使用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale)对纳入的研究进行质量评估。使用漏斗图和 Egger 回归检验评估发表偏倚。使用 Cochrane Q 检验统计量和 I2 检验来确定研究之间的异质性。使用 DerSimonian 和 Laird 随机效应模型确定 across studies 的汇总效应大小、优势比和 95%置信区间。通过亚组分析按地区、样本量和发表年份进行分层。通过敏感性分析确定单个研究对整体估计的影响。
结果:为了估计埃塞俄比亚对社会健康保险计划的支付意愿的总体规模,共纳入了 20 篇文章,总计 8744 名参与者。埃塞俄比亚对社会健康保险的支付意愿的总体规模为 49.62%(95%置信区间:36.41-62.82)。月工资(OR = 6.52;95%置信区间:3.67,11.58)、具有学位及以上学历(OR = 5.52;95%置信区间:4.42,7.17)、大家庭规模(OR = 3.69;95%置信区间:1.10,12.36)、支付账单困难(OR = 3.24;95%置信区间:1.51, 6.96)、服务质量好(OR = 4.20;95%置信区间:1.97, 8.95)、态度良好(OR = 5.28;95%置信区间:1.45, 19.18)和对社会健康保险计划的认识(OR = 3.09;95%置信区间:2.12,4.48)与支付社会健康保险计划的意愿呈统计学相关。
结论:在这项研究中,埃塞俄比亚公务员对社会健康保险的支付意愿较低。对社会健康保险的支付意愿与月工资、教育程度、家庭规模、支付医疗费用的困难程度、医疗保健服务质量、意识和对社会健康保险计划的态度显著相关。因此,建议通过在职培训来提高公务员对社会健康保险福利套餐和原则的认识,以提高支付意愿。
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