健康保险状况是否会影响农村社区的就医行为？来自加纳农村的证据。

Does health insurance status influence healthcare-seeking behavior in rural communities? evidence from rural Ghana.

作者信息

Kumah Emmanuel, Asana Yussif, Agyei Samuel Kofi, Kokuro Collins, Ankomah Samuel E, Fusheini Adam

机构信息

Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana.

Department of Public Health, Faculty of Health Sciences, Catholic University, Ghana.

出版信息

Health Policy Open. 2024 Apr 16;6:100119. doi: 10.1016/j.hpopen.2024.100119. eCollection 2024 Dec.

DOI:10.1016/j.hpopen.2024.100119

PMID:38680189

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11047188/

Abstract

INTRODUCTION

National health insurance programs are considered important mechanisms for ensuring equity in access to and utilization of healthcare services by removing financial barriers associated with seeking treatment in healthcare facilities. Although studies on health insurance schemes in many low-and-middle-income countries (LMICs) have demonstrated a significant relationship between health insurance status and healthcare-seeking behavior, data on the influence of this health financing policy on the decision to seek formal healthcare among rural inhabitants remains limited. Underpinned by the Andersen-Newman behavioral model of healthcare use, this study examined the influence of health insurance status on healthcare-seeking behavior among rural dwellers in Ghana.

METHODS

A community-based cross-sectional study was conducted among 460 rural residents in Ghana from 8th September to 5th December 2022 Chi-square tests were used to study the significance level and association between healthcare-seeking behavior and selected independent variables. A multiple logistic regression model was fitted to test the association between health insurance status and healthcare-seeking behavior, introducing other selected explanatory variables as controls.

RESULTS

The mean age of the respondents was 29.6 ± 6.8 years. A little above half (53.1 %) disclosed having insurance, whereas 46.1 % stated they were without coverage. Regarding healthcare-seeking behavior, the most commonly chosen treatment source was traditional healers (37.2 %), followed by the public healthcare system (28.3 %) and self-treatment (18.2 %). The private healthcare system was the least preferred, with only 16.3 % opting for it. While the bivariate analysis demonstrated a significant relationship between health insurance status and healthcare-seeking behavior (p-0.001), the logistic regression model results showed that health insurance status was not an independent predictor of healthcare-seeking behavior (p = 0.069).

CONCLUSION

It could, therefore, not be concluded that the respondents with health insurance coverage were more likely than the uninsured to use formal healthcare providers as their most frequent source of treatment during illness. This study provides vital information for policymakers aiming at increasing access to and utilization of facility-based formal care in rural and remote settings.

摘要

引言

国家医疗保险计划被视为确保医疗服务获取和利用公平性的重要机制，它消除了与在医疗机构寻求治疗相关的经济障碍。尽管许多低收入和中等收入国家（LMICs）关于医疗保险计划的研究表明医疗保险状况与就医行为之间存在显著关系，但关于这种卫生筹资政策对农村居民寻求正规医疗决策的影响的数据仍然有限。本研究以安德森 - 纽曼医疗保健使用行为模型为基础，考察了医疗保险状况对加纳农村居民就医行为的影响。

方法

2022年9月8日至12月5日，在加纳对460名农村居民进行了一项基于社区的横断面研究。卡方检验用于研究就医行为与选定自变量之间的显著性水平和关联性。拟合多元逻辑回归模型以检验医疗保险状况与就医行为之间的关联性，并引入其他选定的解释变量作为对照。

结果

受访者的平均年龄为29.6±6.8岁。略高于一半（53.1%）的人表示有保险，而46.1%的人表示没有保险。关于就医行为，最常选择的治疗来源是传统治疗师（37.2%），其次是公共医疗系统（28.3%）和自我治疗（18.2%）。私人医疗系统是最不受青睐的，只有16.3%的人选择它。虽然双变量分析表明医疗保险状况与就医行为之间存在显著关系（p = 0.001），但逻辑回归模型结果显示医疗保险状况不是就医行为的独立预测因素（p = 0.069）。