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Azaare J, Aninanya GA, Abdulai K, Adane F, Bio RB, Hushie M. Maternal health care utilization following the implementation of the free maternal health care policy in Ghana: analysis of Ghana demographic and health surveys 2008-2014. BMC Health Serv Res 2024; 24:207. [PMID: 38360707 PMCID: PMC10870471 DOI: 10.1186/s12913-024-10661-5] [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] [Received: 02/24/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND In July 2008, Ghana introduced a 'free' maternal health care policy (FMHCP) through the national health insurance scheme (NHIS) to provide comprehensive antenatal, delivery and post-natal care services to pregnant women. In this study, we evaluated the 'free' policy impact on antenatal care uptake and facility-level delivery utilization since the policy inception. METHODS The study used two rounds of repeated cross-sectional data from the Ghana Demographic and Health Survey (GDHS, 2008-2014) and constructed exposure variable of the FMHCP using mothers' national health insurance status as a proxy variable and another group of mothers who did not subscribe to the policy. We then generated the propensity scores of the two groups, ex-post, and matched them to determine the impact of the 'free' maternal health care policy as an intervention on antenatal care uptake and facility-level delivery utilization, using probit and logit models. RESULTS Antenatal care uptake and facility-level delivery utilization increased by 8 and 13 percentage points difference, observed coefficients; 0.08; CI: 95% [0.06-0.10]; p < 0.001 and 0.13; CI: 95% [0.11-0.15], p < 0.001, respectively. Pregnant women were 1.97 times more likely to make four plus [a WHO recommended number of visits at the time] antenatal care visits and 1.87 times more likely to give birth in a health care facility of any level in Ghana between 2008 and 2104; aOR = 1.97; CI: 95% [1.61-2.4]; p < 0.001 and aOR = 1.87; CI: 95% [1.57-2.23]; p < 0.001, respectively. CONCLUSIONS Antenatal care uptake and facility-level delivery utilization improved significantly in Ghana indicating a positive impact of the FMHCP on maternal health care utilization in Ghana since its implementation.
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Affiliation(s)
- John Azaare
- Department of Health Service, Policy Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.
| | - Gifty Apiung Aninanya
- Department of Health Service, Policy Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Kasim Abdulai
- Translational Nutrition Research Group, Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Francis Adane
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Martin Hushie
- Department of Health Service, Policy Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
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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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George J, Jack S, Gauld R, Colbourn T, Stokes T. Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e073669. [PMID: 38081664 PMCID: PMC10729209 DOI: 10.1136/bmjopen-2023-073669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Improving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs. METHODS We conducted a scoping review of the literature. The search strategy used a combination of keywords and phrases relevant to health system governance, quality of healthcare and LMICs. Studies published in English until August 2023, with no start date limitation, were searched on PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, Google Scholar and ProQuest. Additional publications were identified by snowballing. The effects reported by the studies on processes of care and quality impacts were reviewed. RESULTS The findings from 201 primary studies were grouped under (1) leadership, (2) system design, (3) accountability and transparency, (4) financing, (5) private sector partnerships, (6) information and monitoring; (7) participation and engagement and (8) regulation. CONCLUSIONS We identified a stronger evidence base linking improved quality of care with health financing, private sector partnerships and community participation and engagement strategies. The evidence related to leadership, system design, information and monitoring, and accountability and transparency is limited.
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Affiliation(s)
- Joby George
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
| | - Susan Jack
- Te Whatu Ora - Southern, National Public Health Service, Dunedin, New Zealand
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | | | - Tim Stokes
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
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Azaare J, Kolekang AS, Agyeman YN. Maternal health care policy intervention and its impact on perinatal mortality outcomes in Ghana: evidence from a quasi-experimental design. Public Health 2023; 222:37-44. [PMID: 37515835 DOI: 10.1016/j.puhe.2023.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/29/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of Ghana's free maternal health care policy on stillbirth and perinatal death since its implementation a decade ago. STUDY DESIGN The study used the propensity score matching method, a quasi-experimental design technique and secondary data to construct two groups of mothers with a history of perinatal deaths who subscribed to the 'free' maternal health care policy versus mothers who did not. METHOD The study merged two rounds of repeated cross-sectional data sets obtained from the Ghana Demographic and Health Survey (GDHS), 2008 and 2014, and generated exposure variables; pregnant women policy holding status and outcome variables; stillbirth and perinatal death by constructing binary outcomes from the under-five mortality variables of the DHS data sets. Fetal and early neonatal deaths within the data set were categorized into two groups: those exposed to the free maternal health care policy and those who did not. The propensity scores of the two groups were then generated and analyzed after checking for bias and common support. The analysis applied sample weighting to account for clustering and stratification due to the complex design of the DHS. All analyses were done with STATA 15 and adjusted for confounding using independent covariates. RESULTS Stillbirth (43.3%) and perinatal death (60.2%) were high in the intervention group compared to the comparison group, and the differences were statistically significant (stillbirth, 0.0156, and perinatal death, 0.0012). Stillbirth and perinatal deaths were 12 and 13 percentage points higher in the intervention group, and these were statistically significant: adj. coef. = 0.12; 95% CI: [0.03-0.19]; P = 0.005 and adj. coef. = 0.13; 95% CI: [0.03-0.22]; P = 0.005. CONCLUSION The results show that stillbirth and perinatal death were high in the maternal health care policy group, poorly reflecting as outcomes. However, the percentage point difference between stillbirth and perinatal death suggests a decline in early neonatal mortality and a positive impact of the 'free' maternal health care policy on perinatal death over stillbirth.
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Affiliation(s)
- J Azaare
- Department of Health Service, Policy Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.
| | - A S Kolekang
- Department of Epidemiology, Biostatics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Y N Agyeman
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
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The Shared Experience of Insured and Uninsured Patients: A Comparative Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:7712938. [PMID: 35685864 PMCID: PMC9173905 DOI: 10.1155/2022/7712938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/04/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022]
Abstract
Background Despite efforts to ensure equitable quality of care for all patients, a significant gap persists between the quality of care experienced by insured and uninsured patients in Saudi Arabia. This study aims to identify and compare the differences between insured and uninsured patients in terms of their experience of quality of care in a tertiary hospital. Methods A descriptive cross-sectional study was utilized. Insured and uninsured individuals who had undergone identical medical procedures in early 2021 were identified from a public 500-bed tertiary hospital. About 350 patients participated in this study by completing an online, self-administered questionnaire, adopted by Abuosi and others in 2016, assessing six dimensions of quality of care. Results Significant differences were reported between the quality of care experienced by insured and uninsured subjects (M = 3.37, SD = 0.525, and M = 3.06, SD = 0.452, respectively, p=0.001). While insured group reported high quality of care, followed by fairness of care (r = 0.744 and r = 0.675, p ≤ 0.001, n = 175), uninsured subjects experienced less fairness with low quality of care. Conclusions The insured individuals were found to be more attentive to the quality of care offered by the hospital than their counterparts. Efforts to close the gap in quality of care should include monitoring healthcare outcomes, adopting transparency standards, and facilitating procedures to minimize barriers among patients.
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Umar S, Fusheini A, Ayanore MA. The shared experiences of insured members and the uninsured in health care access and utilization under Ghana's national health insurance scheme: Evidence from the Hohoe Municipality. PLoS One 2020; 15:e0244155. [PMID: 33362232 PMCID: PMC7757881 DOI: 10.1371/journal.pone.0244155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 to remove financial barriers and to promote equitable access to health care services. Post implementation has been characterized by increases in access and utilization of services among the insured. The uninsured have been less likely to utilize services due to unaffordability of health care costs. In this study, we explored the experiences of the insured members of the NHIS, the uninsured and health professionals in accessing and utilizing health care services under the NHIS in the Hohoe Municipality of Ghana. METHODS Qualitative in-depth interviews were held with twenty-five NHIS insured, twenty-five uninsured, and five health care professionals, who were randomly sampled from the Hohoe Municipality to collect data for this study. Data was analyzed using thematic analysis. RESULTS Participants identified both enablers or motivating factors and barriers to health care services of the insured and uninsured. The major factors motivating members to access and use health care services were illness severity and symptom persistence. On the other hand, barriers identified included perceived poor service quality and lack of health insurance among the insured and uninsured respectively. Other barriers participants identified included financial constraints, poor attitudes of service providers, and prolonged waiting time. However, the level of care received were reportedly about the same among the insured and uninsured with access to quality health care much dependent on ability to pay, which favors the rich and thereby creating inequity in accessing the needed quality care services. CONCLUSION The implication of the financial barriers to health care access identified is that the poor and uninsured still suffer from health care access challenges, which questions the efficiency and core goal of the NHIS in removing financial barrier to health care access. This has the potential of undermining Ghana's ability to meet the Sustainable Development Goal 3.8 of universal health coverage by the year 2030.
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Affiliation(s)
- Suraiya Umar
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, Accra, Ghana
| | - Martin Amogre Ayanore
- Department of Health Policy, Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Amani PJ, Tungu M, Hurtig AK, Kiwara AD, Frumence G, San Sebastián M. Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study. Int J Equity Health 2020; 19:179. [PMID: 33046058 PMCID: PMC7549195 DOI: 10.1186/s12939-020-01270-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients' expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population. METHODS A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors. RESULTS A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (- 1; 95% CI: - 1.45, - 0.45) and inpatient (- 2; 95% CI: - 2.69, - 1.30) care. CONCLUSION The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.
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Affiliation(s)
- Paul Joseph Amani
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
| | - Malale Tungu
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna-Karin Hurtig
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
| | - Angwara Denis Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Miguel San Sebastián
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
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Christmals CD, Aidam K. Implementation of the National Health Insurance Scheme (NHIS) in Ghana: Lessons for South Africa and Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:1879-1904. [PMID: 33061721 PMCID: PMC7537808 DOI: 10.2147/rmhp.s245615] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND South Africa is having difficulties in rolling out the National Health Insurance(NHI) policy. There are ongoing arguments on whether the NHI will provide access to quality and equitable healthcare it is intended to and whether South Africa is ready to implement the policy. Many stakeholders believe the country needs more preparation if the policy will be successful. Ghana, on the other hand, has successfully implemented the National Health Insurance Scheme(NHIS) for over 15 years. OBJECTIVE This paper sought to explore the implementation of the NHIS in Ghana and the lessons South Africa and other low- and middle-income countries can learn from such a process. METHODS A scoping review was conducted using the Joanna Brigs Institute's System for the Unified Management, Assessment and Review of Information (SUMARI) and Mendeley reference manager to manage the review process. Journal articles published on the NHIS in Ghana from January 2003 to December 2018 were searched from Science Direct, PubMed, Scopus, CINAHL, and Medline using the keywords: Ghana, Health, and Insurance. RESULTS The implementation of the NHIS has provided access to healthcare for the Ghanaian population, especially to poor and vulnerable . Despite the successful implementation of the NHIS in Ghana, the scheme is challenged with poor coverage; poor quality of care; corruption and ineffective governance; poor stakeholder participation; lack of clarity on concepts in the policy; intense political influence; and poor financing. CONCLUSION The marked inequity in the South African health system makes the implementation of the NHI inevitable. The challenges experienced in the implementation of the NHIS in Ghana are not new to the South African healthcare system. South Africa must learn from the experiences of Ghana,a context that shares common socio-cultural and economic factors and disease burden,in order to successfully implement the NHI.
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Affiliation(s)
- Christmal Dela Christmals
- Research on the Health Workforce for Equity and Quality, Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Kizito Aidam
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Ayanore MA, Pavlova M, Kugbey N, Fusheini A, Tetteh J, Ayanore AA, Akazili J, Adongo PB, Groot W. Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana. HEALTH ECONOMICS REVIEW 2019; 9:39. [PMID: 31885056 PMCID: PMC6935470 DOI: 10.1186/s13561-019-0255-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ghana's National Health Insurance Scheme has improved access to care, although equity and sustainability issues remain. This study examined health insurance coverage, type of payment for health insurance and reasons for being uninsured under the National Health Insurance Scheme in Ghana. METHODS The 2014 Ghana Demographic Health Survey datasets with information for 9396 women and 3855 men were analyzed. The study employed cross-sectional national representative data. The frequency distribution of socio-demographics and health insurance coverage differentials among men and women is first presented. Further statistical analysis applies a two-stage probit Hackman selection model to determine socio-demographic factors associated with type of payment for insurance and reasons for not insured among men and women under the National Health insurance Scheme in Ghana. The selection equation in the Hackman selection model also shows the association between insurance status and socio-demographic factors. RESULTS About 66.0% of women and 52.6% of men were covered by health insurance. Wealth status determined insurance status, with poorest, poorer and middle-income groups being less likely to pay themselves for insurance. Women never in union and widowed women were less likely to be covered relative to married women although this group was more likely to pay NHIS premiums themselves. Wealth status (poorest, poorer and middle-income) was associated with non-affordability as a reason for being not insured. Geographic disparities were also found. Rural men and nulliparous women were also more likely to mention no need of insurance as a reason of being uninsured. CONCLUSION Tailored policies to reduce delays in membership enrolment, improve positive perceptions and awareness of National Health Insurance Scheme in reducing catastrophic spending and addressing financial barriers for enrolment among some groups can be positive precursors to improve trust and enrolments and address broad equity concerns regarding the National Health Insurance Scheme.
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Affiliation(s)
- Martin Amogre Ayanore
- Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nuworza Kugbey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - James Akazili
- Ghana Health Service Research Division, Accra, Ghana
| | - Philip Baba Adongo
- Department of Social and Behavioral Science, School of Public Health, University of Ghana, Accra, Ghana
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Siita S, Cox SE, Hanson K. Does capitation affect patient satisfaction and prevalence of out-of-pocket payments in the insured? A propensity score analysis of Ghana's demographic and health survey data. BMC Health Serv Res 2019; 19:732. [PMID: 31640699 PMCID: PMC6805416 DOI: 10.1186/s12913-019-4581-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 10/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background Ghana’s National Health Insurance Scheme (NHIS) piloted capitation payment for primary care services in the Ashanti region from 2012 to 2017. Capitation was piloted as a means of cost containment but also to induce managed competition among health providers to improve the responsiveness of healthcare delivery. This study examined the effects of exposure to capitation on perceived health service quality and prevalence of out-of-pocket payments in NHIS insured clients. Methods Respondents of the 2014 Ghana Demographic and Health Survey (G-DHS) who reported having a valid NHIS card as their only form of health insurance coverage and made a health facility visit within the 6 months prior to the survey were used to assess the exposure effects of capitation on four outcomes: overall patient satisfaction, perceived friendliness of health staff, perceived adequacy of consultation time, and prevalence of out-of-pocket payments. We applied propensity score matching to balance distributions of covariates and to compare outcomes between exposed NHIS insured clients and their unexposed counterparts. Results NHIS insured clients exposed to capitation had 10 percentage points higher probability of encountering out-of-pocket payments than their unexposed counterparts (p = 0.009; 95% CI: 2.5–17.8%). There was no evidence of a difference between the two exposure groups for ratings of the three quality perceptions outcomes examined: overall patient satisfaction, difference 0.63 units (p = 0.46); perceived friendliness of health staff, difference 1.1% (p = 0.50); and perceived adequacy of consultation times, difference 0.1% (p = 0.96). Conclusion In the Ghanaian context, our results suggest capitation was associated with a greater probability of out-of-pocket payments and no difference in perceived service quality. Future research should examine clinical quality of healthcare and how much out-of-pocket payment occurred under capitation.
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Affiliation(s)
- Shafiq Siita
- National Health Insurance Authority, Upper East Regional Office, Bolgatanga, Ghana.
| | - Sharon E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Nshakira-Rukundo E, Mussa EC, Nshakira N, Gerber N, von Braun J. Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda. Int J Health Policy Manag 2019; 8:593-606. [PMID: 31657186 PMCID: PMC6819630 DOI: 10.15171/ijhpm.2019.49] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/09/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households' decisions to enrol and renew membership in these schemes. METHODS We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. RESULTS Results revealed that household's socioeconomic status, husband's employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. CONCLUSION While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.
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Affiliation(s)
| | - Essa Chanie Mussa
- Department of Economics and Technological Change, Center for Development Research (ZEF), University of Bonn, Bonn, Germany
| | - Nathan Nshakira
- Department of Environmental and Public Health, Kabale University, Kabale, Uganda
| | - Nicolas Gerber
- Department of Economics and Technological Change, Center for Development Research (ZEF), University of Bonn, Bonn, Germany
| | - Joachim von Braun
- Department of Economics and Technological Change, Center for Development Research (ZEF), University of Bonn, Bonn, Germany
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Sengupta M, Chakrabarti S, Mukhopadhyay I. Waiting Time: The Expectations and Preferences of Patients in a Paediatric OPD. JOURNAL OF HEALTH MANAGEMENT 2019. [DOI: 10.1177/0972063419868586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality healthcare and satisfaction are gradually emerging as important areas, which need much attention. The factors of patient satisfaction have been identified under varied conditions globally. In the Indian context, one key patient satisfaction factor has been attributed to waiting time. Long waiting time has been one of the major reasons of patient dissatisfaction and assumes significance when associated with paediatric events. The following study has successfully identified key attributes, which are associated with long waiting times within paediatric outpatient department (OPD) settings. The possible implications of the long waiting periods have been recorded through semi-structured interviews, and further in-depth analysis of individual factors were carried out to predict the probable outcomes.The qualitative exploratory study design has helped to understand the perception of parents/care givers (in case of neonates and toddlers) and adolescents, thereby successfully highlighting the need for further study in the patient satisfaction domain involving paediatric population. The various implications which the waiting time has on them have been taken into consideration. The inter-related themes have been identified after analyzing the interviews. These substantiate the fact that designing innovative mitigation strategies on proper and timely communication, updated technological know-how, improvising hospital protocols for better operational processes and coordination among the staff can go a long way in enhancing the patient/parent experience within OPD settings.
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Affiliation(s)
- Mitali Sengupta
- University of Engineering & Management, Kolkata, West Bengal, India
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Abuosi AA, Braimah M. Patient satisfaction with the quality of care in Ghana’s health-care institutions. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2019. [DOI: 10.1108/ijphm-08-2018-0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study was to examine patient satisfaction with the quality of care in Ghana’s health-care facilities using a disaggregated approach.
Design/methodology/approach
The study was a cross-sectional national survey. A sample of 4,079 males and females in the age group of 15-49 years were interviewed. Descriptive statistics, principal component analysis and t-tests were used in statistical analysis.
Findings
About 70 per cent of patients were satisfied with the quality of care provided in health-care facilities in Ghana, whereas about 30 per cent of patients were fairly satisfied. Females and insured patients were more likely to be satisfied with the quality of care, compared with males and uninsured patients.
Research limitations/implications
Because data were obtained from a national survey, the questionnaire did not include the type of facility patients attended to find out whether satisfaction with the quality of care varied by the type of health facility. Future studies may, therefore, include this.
Practical implications
The study contributes to the literature on patient satisfaction with the quality of care. It highlights that long waiting time remains an intractable problem at various service delivery units of health facilities and constitutes a major source of patient dissatisfaction with the quality of care. Innovative measures must, therefore, be adopted to address the problem.
Originality/value
There is a paucity of research that uses a disaggregated approach to examine patient satisfaction with the quality of care at various service delivery units of health facilities. This study is a modest contribution to this research gap.
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Badu E, Agyei-Baffour P, Ofori Acheampong I, Opoku MP, Addai-Donkor K. Perceived satisfaction with health services under National Health Insurance Scheme: Clients' perspectives. Int J Health Plann Manage 2018; 34:e964-e975. [PMID: 30468521 DOI: 10.1002/hpm.2711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/12/2022] Open
Abstract
The study aims to explore the perceived satisfaction of insured clients in financing health services through National Health Insurance in Ghana. A quantitative method was used to recruit 380 respondents, selected by multistage cluster sampling. Data were collected through the administration of questionnaires. More than half, 57.9%, of respondents were males, and the average age was 34 years. Most respondents, 74.3%, were insured. Overall, 53.12% of insured clients were dissatisfied with the services of providers. Factors, such as benefit package of insurance, willingness to pay higher premium, and perceived discrimination were significantly associated with poor satisfaction with health services. The current advocacy for and awareness about the use of health insurance as a prepayment plan should be prioritised in policy initiatives. The benefit package for the insurance should be increased in order to cover all disease conditions that afflict the Ghanaian population.
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Affiliation(s)
- Eric Badu
- School of Nursing and Midwifery, Faculty of Medicine and Public Health, The University of Newcastle, Australia/Centre for Disability and Rehabilitation Studies/Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Agyei-Baffour
- Department of Health Policy, Management and Economics/School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Isaac Ofori Acheampong
- Department of Health Education and Promotion/School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Maxwell Preprah Opoku
- University of Tasmania, Australia, Faculty of Education, Locked Bag 1340, Launceston, TAS, 7250, Australia
| | - Kwasi Addai-Donkor
- Department of Health Policy, Management and Economics/School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Ayanore MA, Ofori-Asenso R, Laar A. Predictors of Health Care Service Quality among Women Insured Under Ghana's National Health Insurance Scheme. Ann Glob Health 2018. [PMID: 30779512 PMCID: PMC6748285 DOI: 10.29024/aogh.2371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Insured women in Ghana are more likely to use maternity care services than their uninsured counterparts. To improve service quality among insured women in Ghana, better understanding of the factors that predict quality standards of primary health care services is essential. Objective: To examine predictors of health care service quality among insured women under the National Health Insurance Scheme (NHIS) in Ghana. Methods: Data from the 2014 Ghana Demographic Health Survey was analysed. Cluster analysis was applied to construct a dependent variable; service care quality. Socio-demographic/background characteristics were used as independent variables. Descriptive and inferential analyses were performed followed by multiple regression to predict service quality among the insured population of women aged 15–49 years. SPSS version 21 was used during the clustering while STATA version 14 was used to perform the inferential and regression analyses. Findings: A total of 5,457 women with valid health insurance were included in the analysis. Overall, geographical region of respondents was significant to expressions of insured service quality (χ2 = 495.4, p ≤ 0.001). Literacy levels were significant at χ2 = 69.232 and p < 0.001 for service quality. On place of residence, the estimation showed urban residency to be more positively correlated with indicating quality ratings of health services compared to rural residency (χ2 = 70.29, p < 0.001). Highest educational level had the highest predictive influence (coefficient = 0.15) on women’s views about the quality of health care services. Conclusions: A health insurance system that shifts towards introducing valued-based care models for patients, insurers, and health care providers could be supportive in improving the quality of healthcare delivered to Ghanaians.
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Affiliation(s)
- Martin Amogre Ayanore
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences.,Centre for Health Policy Advocacy, Innovation and Research in Africa (CHPAIR-Africa), GH
| | | | - Amos Laar
- Department of Population Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, GH
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Ayanore MA, Ofori-Asenso R, Laar A. Predictors of Health Care Service Quality among Women Insured Under Ghana's National Health Insurance Scheme. Ann Glob Health 2018; 84:640-649. [PMID: 30779512 DOI: 10.9204/aogh.2371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Insured women in Ghana are more likely to use maternity care services than their uninsured counterparts. To improve service quality among insured women in Ghana, better understanding of the factors that predict quality standards of primary health care services is essential. OBJECTIVE To examine predictors of health care service quality among insured women under the National Health Insurance Scheme (NHIS) in Ghana. METHODS Data from the 2014 Ghana Demographic Health Survey was analysed. Cluster analysis was applied to construct a dependent variable; service care quality. Socio-demographic/background characteristics were used as independent variables. Descriptive and inferential analyses were performed followed by multiple regression to predict service quality among the insured population of women aged 15-49 years. SPSS version 21 was used during the clustering while STATA version 14 was used to perform the inferential and regression analyses. FINDINGS Overall, geographical region of respondents was significant to expressions of insured service quality (χ2=495.4, p ≤ 0.001). Literacy levels were significant at χ2=69.232 and p ≤ 0.001 for service quality. On place of residence, the estimation show urban residency was more positively correlated with indicating quality ratings of health services compared to rural residency (χ2=70.29, p ≤ 0.001). Highest educational level had the highest predictive influence with a coefficient of 0.15. CONCLUSIONS A more supportive health insurance system approach that shifts towards introducing valued-based care models for patients, insurers and health care providers could be supportive in improving quality standards among insured population groups in Ghana.
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Affiliation(s)
- Martin Amogre Ayanore
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences.,Centre for Health Policy Advocacy, Innovation and Research in Africa (CHPAIR-Africa), GH
| | | | - Amos Laar
- Department of Population Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, GH
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