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Odonkor SNNT, Koranteng F, Appiah-Danquah M, Dini L. Do national health insurance schemes guarantee financial risk protection in the drive towards Universal Health Coverage in West Africa? A systematic review of observational studies. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001286. [PMID: 37556426 PMCID: PMC10411819 DOI: 10.1371/journal.pgph.0001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
To facilitate the drive towards Universal Health Coverage (UHC) several countries in West Africa have adopted National Health Insurance (NHI) schemes to finance health services. However, safeguarding insured populations against catastrophic health expenditure (CHE) and impoverishment due to health spending still remains a challenge. This study aims to describe the extent of financial risk protection among households enrolled under NHI schemes in West Africa and summarize potential learnings. We conducted a systematic review following the PRISMA guidelines. We searched for observational studies published in English between 2005 and 2022 on the following databases: PubMed/Medline, Web of Science, CINAHL, Embase and Google Scholar. We assessed the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist. Two independent reviewers assessed the studies for inclusion, extracted data and conducted quality assessment. We presented our findings as thematic synthesis for qualitative data and Synthesis Without Meta-analysis (SWiM) for quantitative data. We published the study protocol in PROSPERO with ID CRD42022338574. Nine articles were eligible for inclusion, comprising eight cross-sectional studies and one retrospective cohort study published between 2011 and 2021 in Ghana (n = 8) and Nigeria (n = 1). While two-thirds of the studies reported a positive (protective) effect of NHI enrollment on CHE at different thresholds, almost all of the studies (n = 8) reported some proportion of insured households still encountered CHE with one-third reporting more than 50% incurring CHE. Although insured households seemed better protected against CHE and impoverishment compared to uninsured households, gaps in the current NHI design contributed to financial burden among insured populations. To enhance financial risk protection among insured households and advance the drive towards UHC, West African governments should consider investing more in NHI research, implementing nationwide compulsory NHI programmes and establishing multinational subregional collaborations to co-design sustainable context-specific NHI systems based on solidarity, equity and fair financial contribution.
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Affiliation(s)
- Sydney N. N. T. Odonkor
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Appiah-Danquah
- Department of Surgery, NES Healthcare, Parkside Hospital, London, Wimbledon, United Kingdom
| | - Lorena Dini
- Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Guo P, Qin Y, Wang R, Li J, Liu J, Wang K, Li Y, Kang Z, Hao Y, Liu H, Sun H, Cui Y, Shan L, Wu Q. Perspectives and evaluation on the effect of financial burden relief of medical insurance for people with catastrophic diseases and its influencing factors. Front Public Health 2023; 11:1123023. [PMID: 37089514 PMCID: PMC10117759 DOI: 10.3389/fpubh.2023.1123023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
Background Catastrophic disease sufferers face a heavy financial burden and are more likely to fall victim to the "illness-poverty-illness" cycle. Deeper reform of the medical insurance system is urgently required to alleviate the financial burden of individuals with catastrophic diseases. Methods Data were obtained from a cross-sectional questionnaire survey conducted in Heilongjiang in 2021, and logistic regression and restricted cubic spline model was used to predict the core factors related to medical insurance that alleviate the financial burden of people with catastrophic diseases. Results Overall, 997 (50.92%) medical insurance-related professionals negatively viewed financial burden relief for people with catastrophic diseases. Factors influencing its effectiveness in relieving the financial burden were: whether or not effective control of omissions from medical insurance coverage (OR = 4.04), fund supervision (OR = 2.47) and degree of participation of stakeholders (OR = 1.91). Besides, the reimbursement standards and the regional and population benefit package gap also played a role. The likelihood of financial burden relief increased by 21 percentage points for each unit increase in the level of stakeholder discourse power in reform. Conclusion China's current medical insurance policies have not yet fully addressed the needs of vulnerable populations, especially the need to reduce their financial burden continuously. Future reform should focus on addressing core issues by reducing the uninsured, enhancing the width and depth of medical insurance coverage, improving the level and capacity of medical insurance governance that provides more discourse power for the vulnerable population, and building a more responsive and participatory medical insurance governance system.
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Affiliation(s)
- Pengfei Guo
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yinghua Qin
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
- Department of Health Economy and Social Security, College of Humanities and Management, Guilin Medical University, Guilin, China
| | - Rizhen Wang
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiacheng Li
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jingjing Liu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Kexin Wang
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ye Li
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zheng Kang
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanhua Hao
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Huan Liu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hong Sun
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Cui
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Linghan Shan
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
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Shokri A, Bolbanabad AM, Rezaei S, Moradi G, Piroozi B. Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey. Health Sci Rep 2023; 6:e1199. [PMID: 37064323 PMCID: PMC10102736 DOI: 10.1002/hsr2.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023] Open
Abstract
Background and Aims One of the goals of the Islamic Republic of Iran is to reduce the prevalence of catastrophic health expenditures among Iranian households to 1% by the end of the sixth 5-year development plan (2016-2021). This study was conducted to evaluate the level of access to this goal in the final year of this program. Methods A national cross-sectional study was conducted on 2000 Iranian households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with catastrophic health expanditure (CHE). Determinants of CHE were identified using univariate and multivariate regression analysis. Results 8.3% of households had experienced CHE. The variables of being a female head of household (odd ratio [OR] = 2.7), use of inpatient (OR = 1.82), dental (OR = 3.09), and rehabilitation services (OR = 6.12), families with disabled members (OR = 2.03) and low economic status of the households (OR = 10.73) were significantly associated with increased odds of facing CHE (p < 0.05). Conclusion In the final year of the sixth 5-year development plan, Iran has not yet achieved its goal of "reducing the percentage of households exposed to CHE to 1%." Policymakers should pay attention to factors increasing the odds of facing CHE in designing interventions.
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Affiliation(s)
- Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentUniversity of Medical SciencesKurdistanSanandajIran
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentUniversity of Medical SciencesKurdistanSanandajIran
| | - Satar Rezaei
- Department of Public Health, School of Health, Research Center for Environmental Determinants of Health, Research Institute for HealthKermanshah University of Medical SciencesKermanshahIran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentUniversity of Medical SciencesKurdistanSanandajIran
| | - Bakhtiar Piroozi
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentUniversity of Medical SciencesKurdistanSanandajIran
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Afkhamzadeh A, Shokri A, Safari H, Nouri E, Bolbanabad AM, Amirihosseini S, Piroozi B. Unmet health care needs among pregnant women during COVID-19 pandemic and its determinants in Kurdistan province, Iran: A cross-sectional study. Health Sci Rep 2022; 5:e804. [PMID: 36090625 PMCID: PMC9436299 DOI: 10.1002/hsr2.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background and Aims The aim of this study was to assess unmet needs for health care and its determinants during COVID-19 pandemic among pregnant women in Iran. Methods This cross-sectional study was performed among pregnant women in Kurdistan province in 2020 with a sample size of 800 people who were selected by multistage sampling method. Data were collected using a structured questionnaire that was completed through interviews. Also, multiple logistic regression was used to determine the relationship between independent variables and outcome variable. Statistical tests were performed using Stata software package. Results The highest unmet needs for health care were related to dental services with 66%, rehabilitation services with 58.6%, and psychological services with 43.2% and the lowest were related to hospital services with 12%, midwifery services with 15.6%, and physician visit services with 39.1%. The most important reasons for unmet needs for health care were fear of getting COVID-19 and the cost of the services. The variables of age group and spouse education for physician visit services; age group for midwifery services; age group, education and employment status for dental services; age group, supplementary insurance and economic status for rehabilitation services; and age group and economic status for psychological services were significantly associated with unmet needs for health care (p < 0.05). Conclusion A significant percentage of health care needs of pregnant women was unmet, for which the fear of getting COVID-19 and financial barriers were the main reasons.
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Affiliation(s)
- Abdorrahim Afkhamzadeh
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Hossein Safari
- Health Promotion Research CenterIran University of Medical ScienceTehranIran
- School of Nursing and MidwiferyQazvin University of Medical SciencesQazvinIran
| | - Elham Nouri
- Student Research CommitteeKurdistan University of Medical SciencesSanandajIran
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Shina Amirihosseini
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Bakhtiar Piroozi
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
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