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Oyediran K, Davis N. Relationship between health insurance enrolment and unintended pregnancy in Ghana. J Biosoc Sci 2024; 56:104-124. [PMID: 36852702 DOI: 10.1017/s0021932023000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
CONTEXT The effect of health insurance coverage on sexual and reproductive health, especially unintended pregnancy, has scantly been researched. Using the 2014 Ghana Demographic and Health Survey, the study examined the links between women's health insurance enrolment on unintended pregnancy in Ghana. METHOD The sample consisted of 9,396 women aged 15-49 years, but the analysis was limited to the 4,544 women who were pregnant in the two years preceding the survey. The effects of health insurance enrolment on unintended pregnancy was examined with the propensity score matching. The health insurance enrolment was the treatment variable and unintended pregnancy as the outcome variable. RESULTS This study showed that 66.0% of all women surveyed had health insurance coverage and 31.8% of all women of childbearing age who were currently or had previously been pregnant reported having at least one unintended pregnancy. Thirty percent of insured women had an unintended pregnancy, compared to 37% of uninsured women. The results showed that education, household wealth index, religion, and type of marital union were significant predictor of health insurance coverage among Ghanaian women. The PSM split the women based on their health insurance status. After matching, the difference between the insured and uninsured women reduces significantly. Results demonstrated that, the probability of unintended pregnancy was 0.312 among insured women and 0.351 among those not insured in Ghana. This implies that having health insurance coverage will help in reducing the likelihood of women experiencing unintended pregnancy. CONCLUSIONS Results highlight the importance of the target of universal health coverage under the sustainable development goal 3 and demonstrate that expanding existing health insurance schemes within Ghana could contribute to reducing the number unintended pregnancies experienced each year.
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Affiliation(s)
| | - Nikki Davis
- Senior Research, Monitoring, and Evaluation Advisor John Snow Inc.Arlington, VA22202
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Shure G, Gamachu M, Mitiku H, Deressa A, Eyeberu A, Mohammed F, Zakaria HF, Ayana GM, Birhanu A, Debella A, Mussa I. Patient satisfaction and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia: a facility-based comparative cross-sectional study. Front Med (Lausanne) 2023; 10:1259840. [PMID: 38204483 PMCID: PMC10777387 DOI: 10.3389/fmed.2023.1259840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Background Patient satisfaction is a crucial measure of healthcare quality, as dissatisfied patients are more likely to miss appointments, disregard treatment plans, and leave hospitals, leading to poor treatment outcomes. Therefore, the study aimed to compare levels of satisfaction with health services and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia. Methods A comparative cross-sectional study with 532 participants was conducted from December 1-30, 2021. Data was collected through a structured questionnaire, analyzed using SPSS, and predictors assessed using a multivariate logistic regression model. Statistical significance was set at p < 0.05. Results Overall, patient satisfaction with health services was 65.6% (95% CI: 61.5-69.5), and the level of patient satisfaction with health services among insured and noninsured patients was 68.8% (95% CI: 62.8-74.4) and 62.4% (95% CI: 56.8-68.0), respectively. In the final model of multivariable analysis, factors such as educational status of secondary school (AOR = 4.90; 95% CI: 2.05-11.76), and a higher level (AOR = 3.08; 95% CI: 1.05-9.03), getting the entire prescribed drugs (AOR = 3.49; 95% CI: 1.43-8.54), getting some of the ordered drugs (AOR = 3.34; 95% CI: 1.61-6.94), paying less than 100 Ethiopian birrs (AOR = 4.85; 1.35-17.40) were significantly associated with patient satisfaction among insured patients. Whereas getting the entire and some prescribed drugs were (AOR = 6.28; 95% CI: 3.26-12.05), and (AOR = 3.40; 95% CI: 1.70-6.78) times more likely to be satisfied with the service among noninsured patients as compared to their counterparts, respectively. Conclusion The study found that about six in 10 patients in the study area were satisfied with healthcare services, with insurance patients reporting higher satisfaction. Factors such as receiving prescribed drugs, paying less than 100 Ethiopian birr, having a secondary school education, and having a higher education were associated with satisfaction.
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Affiliation(s)
- Giduma Shure
- Goro Muti Woreda Health Office, East Hararghe, Ethiopia
| | - Mulugeta Gamachu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Public Health, Rift Valley University, Harar, Ethiopia
| | - Habtamu Mitiku
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fethia Mohammed
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hamdi Fekredin Zakaria
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Kagaigai A, Thomas Mori A, Anaeli A, Grepperud S. Whether or not to enroll, and stay enrolled? A Tanzanian cross-sectional study on voluntary health insurance. HEALTH POLICY OPEN 2023; 4:100097. [PMID: 37383882 PMCID: PMC10297742 DOI: 10.1016/j.hpopen.2023.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/21/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023] Open
Abstract
Lower-middle income countries (LMICs) have invested significant effort into expanding insurance coverage as a means of improving access to health care. However, it has proven challenging to fulfill these ambitions. This study investigates to what extent variables associated with the enrollment decision (stay never-insured or enroll) differ from variables associated with the dropout decision (stay insured or drop out). A cross-sectional survey that included 722 households from rural districts in Tanzania was conducted and multinomial logistic regressions were performed to determine the associations between independent variables and membership status (never-insured, dropouts, or currently insured). Both the decision to enrollment and the decision to drop out were significantly associated with the presence of chronic disease and perceptions about the quality of services provided, insurance scheme management, and traditional healers. The effect of other variables, such as age, gender and educational level of the household head, household income, and perceptions about premium affordability and benefit-premium ratios, varied across the two groups. To improve voluntary health insurance coverage, policymakers must simultaneously increase the enrollment rate among the never-insured and reduce the dropout rate among the insured. Our conclusions suggest that policies to increase insurance scheme enrollment rates should differ for the two uninsured groups.
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Affiliation(s)
- Alphoncina Kagaigai
- University of Oslo, Institute of Health and Society, Department of Health Management and Health Economics, P.O. Box, 0315 Oslo, Norway
- Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Department of Development Studies, P.O. Box, 65001 Dar es Salaam, Tanzania
| | - Amani Thomas Mori
- University of Bergen, Department of Global Health and Primary Health Care, P.O. Box, 5007 Bergen, Norway
| | - Amani Anaeli
- Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Department of Development Studies, P.O. Box, 65001 Dar es Salaam, Tanzania
| | - Sverre Grepperud
- University of Oslo, Institute of Health and Society, Department of Health Management and Health Economics, P.O. Box, 0315 Oslo, Norway
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Magdaleno Herrero R, Murillo-García N, Yorca-Ruiz Á, Neergaard K, Crespo-Facorro B, Ayesa-Arriola R. Biomarkers as proxies for cognitive reserve: The role of high density lipoprotein cholesterol in first episode of psychosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2023:S1888-9891(23)00012-5. [PMID: 37852878 DOI: 10.1016/j.rpsm.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/19/2023] [Accepted: 03/06/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The proxies used to compose cognitive reserve (CR) for patients of a first episode of psychosis (FEP) have varied in the literature. The development of FEP is linked to peripheral pathways of the central nervous system, yet despite this knowledge, no research has considered the introduction of biomarkers as proxies for CR. Meanwhile, schizophrenia has been linked to the metabolic system, indicating that alterations in the levels of biological parameters, in particular high-density lipoproteins (HDL), cause worse global functioning and cognitive impairment. For these reasons, the present study aimed to create a quantifiable and objective CR index that adjusts for the multifactorial nature of FEP. MATERIALS AND METHODS We included 668 FEP patients and 217 healthy controls. Participants were assessed for sociodemographic information, years of education, employment status, premorbid IQ and biological parameters: waist circumference, hypertension, and levels of HDL, triglycerides, and glucose. RESULTS The findings suggest that the years of education proxy showed correlational and higher relationship with HDL levels for both FEP patients (r=0.23, b=0.185) and controls (r=0.31, b=0.342). We found that the CR index composed of years of education and HDL levels showed a higher explanatory power for the phenomenon than the classic CR index composed of years of education, employment status and premorbid IQ. CONCLUSIONS This article proposes an objective and quantifiable method to measure CR that is more the multifactorial nature of FEP.
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Affiliation(s)
- Rebeca Magdaleno Herrero
- Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Doctoral School University of Cantabria (EDUC), Santander, Spain
| | - Nancy Murillo-García
- Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Doctoral School University of Cantabria (EDUC), Santander, Spain
| | - Ángel Yorca-Ruiz
- Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Doctoral School University of Cantabria (EDUC), Santander, Spain
| | - Karl Neergaard
- Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain; Instituto de Investigación Sanitaria de Sevilla, IBiS, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rosa Ayesa-Arriola
- Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
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Kagaigai A, Grepperud S. The role of risk preferences: voluntary health insurance in rural Tanzania. HEALTH ECONOMICS REVIEW 2023; 13:20. [PMID: 37004684 PMCID: PMC10067166 DOI: 10.1186/s13561-023-00432-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Lower-middle-income countries (LMICs) have a common goal to achieve universal health coverage (UHC) through voluntary health insurance schemes. This is important to improve access to healthcare services and ensure financial protection for all by reducing out-of-pocket expenditures. This study aimed to examine the role of risk preferences on enrollment status (currently insured, previously insured, and never insured) into a Tanzanian voluntary health insurance scheme targeted at the informal sector. METHODS Data were collected from households in a random sample of 722 respondents. The risk preference measure was based on a hypothetical lottery game which applies the BJKS instrument. This instrument measures income risk where the respondents are to choose between a certain income and a lottery. Both multinomial and simple logistic regression models have been used to analyze the relationship between risk aversion and enrollment status. RESULTS On average, the respondents have a high degree of risk aversion, and the insured are more risk averse than the uninsured (previously insured and never insured). There is a weak tendency for the wealthiest, measured by household income or total household expenditure, to be somewhat more risk averse than the less wealthy. Logistic and multinomial logistic regressions show that risk aversion is strongly associated with enrollment status. A higher degree of risk aversion significantly increases the probability of being insured, relative to being previously insured, and relative to being never insured. CONCLUSION Risk aversion matters in a decision to enroll into the iCHF scheme. Strengthening the benefit package for the scheme, might increase the enrollment rate and hence improve access to healthcare services for people in rural areas and those employed in the informal sector.
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Affiliation(s)
- Alphoncina Kagaigai
- Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, P.O. Box 0315, Oslo, Norway.
- School of Public Health and Social, Sciences, Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania.
| | - Sverre Grepperud
- Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, P.O. Box 0315, Oslo, Norway
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