Hussien Mohammed
Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box: 79, Bahir Dar, Ethiopia.
Health Econ Rev. 2024 Oct 4;14(1):82. doi: 10.1186/s13561-024-00565-9.
Solidarity is an aspect of human association that gives emphasis to the cohesive social bond that holds a group together and is valued and understood by all members of the group. A lack of understanding of the solidarity principle is one of the main reasons for low population coverage in microhealth insurance schemes. This study aimed to examine the extent to which people value solidarity and the factors that explain the differences.
A community-based cross-sectional study was carried out in two districts of northeast Ethiopia among 1232 randomly selected households which have ever been registered in a community-based health insurance scheme. Face-to-face interviews were conducted with household heads using a standardized questionnaire deployed to an electronic data collection platform. Solidarity was measured using three dimensions: income solidarity, risk solidarity, and cost coverage. Principal component analysis was used to construct composite variables, and the reliability of the tools was checked using Cronbach's alpha. A multivariable analysis was performed using the partial proportional odds model to determine the associations between variables. The degree of association was assessed using the odds ratio, and statistical significance was determined at 95% confidence interval.
Three-quarters (75%) of the respondents rated risk solidarity as high, while 70% and 63% rated income solidarity and cost coverage as high, respectively. Place of residence (AOR = 2.23; 95% CI: 1.68, 2.94), wealth index (AOR = 1.51; 95% CI: 1.07, 2.12), self-rated health status (AOR = 1.64; 95% CI: 1.12, 2.40), trust in insurance schemes (AOR = 1.68; 95% CI: 1.22, 2.30), perceived quality of care (AOR = 1.75; 95% CI: 1.33, 2.31) and frequency of outpatient visits (AOR = 2.05; 95% CI: 1.30, 3.24) were significant predictors of value for solidarity.
The community placed greater value for solidarity, indicating community understanding and acceptance of the core principles of microhealth insurance. Administrators of the insurance scheme, health authorities, and other actors should strive to create a transparent management system and improve access to high-quality health care, which will facilitate community acceptance of the insurance scheme and its guiding principles.
团结是人类交往的一个方面，强调将群体凝聚在一起的社会凝聚力纽带，且该群体的所有成员都重视并理解这一纽带。对团结原则缺乏理解是小额医疗保险计划人口覆盖率低的主要原因之一。本研究旨在探讨人们对团结的重视程度以及解释差异的因素。
在埃塞俄比亚东北部的两个地区开展了一项基于社区的横断面研究，研究对象为1232户曾在基于社区的医疗保险计划中登记的随机选取家庭。使用部署到电子数据收集平台的标准化问卷对户主进行面对面访谈。团结通过三个维度进行衡量：收入团结、风险团结和费用覆盖。采用主成分分析构建复合变量，并使用克朗巴哈系数检验工具的可靠性。使用部分比例优势模型进行多变量分析，以确定变量之间的关联。使用优势比评估关联程度，并在95%置信区间确定统计显著性。
四分之三（75%）的受访者将风险团结评为高，而分别有70%和63%的受访者将收入团结和费用覆盖评为高。居住地（调整后优势比[AOR]=2.23；95%置信区间[CI]：1.68，2.94）、财富指数（AOR=1.51；95%CI：1.07，2.12）、自评健康状况（AOR=1.64；95%CI：1.12，2.40）、对保险计划的信任（AOR=1.68；95%CI：1.22，2.30）、感知的医疗质量（AOR=1.75；95%CI：1.33，2.31）和门诊就诊频率（AOR=2.05；95%CI：1.30，3.24）是团结价值观的显著预测因素。
社区对团结的重视程度更高，表明社区对小额医疗保险核心原则的理解和接受。保险计划管理者、卫生当局和其他行为主体应努力建立一个透明的管理系统，并改善获得高质量医疗服务的机会，这将促进社区对保险计划及其指导原则的接受。
