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Getachew N, Girma M, Sahilemariam Z, Kabeta T, Arora A. Community-based health insurance beneficiaries' satisfaction on laboratory services and associated factors in selected public hospitals in Jimma Zone, Oromia Region, Southwest, Ethiopia. PLoS One 2024; 19:e0308814. [PMID: 39141624 PMCID: PMC11324112 DOI: 10.1371/journal.pone.0308814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The community-based health insurance (CBHI) scheme is a growing initiative aimed at enhancing healthcare access for the most impoverished members of the community. The Ethiopian CBHI scheme aims to enhance access to essential healthcare services, including medical laboratory services, for the poorest members of the community, but there is limited evidence on satisfaction levels. The aim of this study was to assess the satisfaction level of CBHI beneficiaries with laboratory services and their associated factors among selected public hospitals in Jimma Zone, Oromia Region, Ethiopia. METHODS A facility-based cross-sectional study was conducted on selected public hospitals in the Jimma Zone from September to October 2023. A total of 421 CBHI beneficiaries were enrolled in the study using a convenient sampling technique, and interviewers administered structured questionnaires to collect data. Data were entered into Epi-data and analyzed using the Statistical Package of Social Sciences version 25. Descriptive analysis was used to summarize independent variables; bivariate and multivariable logistic regression analyses were done to test the association between independent and dependent variables; and statistical significance was declared at P<0.05. RESULTS More than half (55.8%) of the 419 study participants were female. Above half, 57.5% of the respondents were satisfied by the clinical laboratory services at public hospitals in Jimma Zone. Components with a higher satisfaction rate were providers' professional appearances (98.3%), procedures for specimen collection (87.6%), and availability of entertainment facilities at the waiting area (67.8%). On the contrary, longer waiting times to receive the test results (76.6%), inefficiency of the reception area (74.7%), and the inability of professionals to explain diagnostic procedures (58.0%) were associated with higher rates of dissatisfaction. Educational status and the number of hospital visits were found to have a statistically significant association with level of satisfaction with laboratory services. CONCLUSIONS CBHI beneficiaries' satisfaction with laboratory service was at a moderate level in Jimma Zone public hospitals. Therefore, attention should be given to continuous monitoring of patients' satisfaction with services, improving reception areas, and practicing routine explanations about the purposes and procedures during specimen collection to improve the beneficiaries' satisfaction level with clinical laboratory services.
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Affiliation(s)
- Nigusu Getachew
- Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mujahid Girma
- Department of Medical Laboratory Sciences Institute of Health Science, Jimma University, Jimma, Ethiopia
| | - Zewudineh Sahilemariam
- Department of Medical Laboratory Sciences Institute of Health Science, Jimma University, Jimma, Ethiopia
| | - Temesgen Kabeta
- Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
- Health Equity Laboratory, Campbelltown, New South Wales, Australia
- Discipline of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, New South Wales, Australia
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Birhan D, Aderaw Z, Agdew E, Siferih M. Satisfaction of chronic patients with community-based health insurance schemes and related factors: Explanatory sequential mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003374. [PMID: 39110655 PMCID: PMC11305578 DOI: 10.1371/journal.pgph.0003374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 05/24/2024] [Indexed: 08/10/2024]
Abstract
Chronic disease poses a serious threat to accessible, high-quality healthcare. Community-based health insurance (CBHI) schemes provide the poor with financial security. However, there is no evidence in Ethiopia on how satisfied chronic patients are with the schemes. The objective of the current study was to evaluate the satisfaction of chronic patients with the schemes and identify contributing factors. A hospital-based explanatory sequential mixed methods study on 632 chronic patients and 12 key informants was carried out between February 28 and May 31, 2022, in the hospitals of East Gojjam, Northwest Ethiopia. Hospitals and study participants were selected using multistage sampling methods. Quantitative data was entered using Epi Data 3.1 and exported to SPSS version 25 for analysis. P value <0.05 was used to consider significant association in multivariable binary logistic regression. Thematic analysis was a method to manually review qualitative data. A narrative approach was used for integrating the two data. The mean age of study participants was 46.1 (46.1± 5.2, range: 25-82). Patients aged 45 to 64 made up the majority of the population (60.6%). Rheumatoid arthritis affected the preponderance of individuals (36.4%). The overall level of satisfaction of chronic patients with the CBHI scheme was 31% (95% CI; 27-35%). Respect and friendliness (AOR = 7.05; CI: 3.71-13.36), knowledge of benefits packages (AOR = 2.02; CI: 1.24-3.27), partial or non-availability of drugs (AOR = 0.24, AOR = 0.21, respectively), waiting times (AOR = 1.84; CI: 1.12-3.0), and availability of laboratory tests (AOR = 1.59; CI: 1.01-2.48) were significantly associated with participants' satisfaction with the schemes. Our study revealed that the overall satisfaction of chronic patients was quite low and affected by the availability of drugs and laboratory tests, caregivers' respect and friendliness, waiting times, and participant knowledge. Therefore, stakeholders must concentrate on reducing waiting times, improving the availability of drugs and laboratory tests at each hospital, opening back up community pharmacies, and promoting awareness about benefits packages primarily through health education. The main focus of researchers needs to be on nationally representative studies that include more important factors.
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Affiliation(s)
- Desalew Birhan
- Department of Public Health, College of Medicine and Health Sciences, Debremarkos University, Debremarkos, Amhara Region, Ethiopia
| | - Zewudie Aderaw
- Department of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Eskeziaw Agdew
- Department of Public Health, College of Medicine and Health Sciences, Debremarkos University, Debremarkos, Amhara Region, Ethiopia
| | - Melkamu Siferih
- Department of Obstetrics and Gynecology, School of Medicine, Debremarkos University, Debremarkos, Amhara Region, Ethiopia
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Ghimire S, Ghimire S, Singh DR, Sagtani RA, Paudel S. Factors influencing the utilisation of National health insurance program in urban areas of Nepal: Insights from qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003538. [PMID: 39058732 PMCID: PMC11280150 DOI: 10.1371/journal.pgph.0003538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
Health insurance has been recognised as a crucial policy measure to enhance citizens' well-being by reducing the financial burden globally. Nepal has also adopted this scheme to support achieving universal health coverage. Various factors influence the overall performance of the program in Nepal. However, there is a lack of evidence on how different factors have influenced the insurance program in the Nepalese context. Therefore, this study aims to explore facilitators and barriers to the utilisation of national health insurance services among service users and other stakeholders. A qualitative study was conducted by interviewing both demand-side participants and supply-side participants in the Bhaktapur District of Nepal. Thematic network analysis was used to analyse data using RQDA software. The socio-ecological model guides the presentation of the identified factors. The study followed the COREQ guidelines to ensure standard reporting of the results. Factors that encourage the use of health insurance services involve individual, community, and policy-related factors. These factors encompass changes in seeking treatment, assistance during enrollment and renewal by enrollment assistant, proximity to the initial point of contact for care, and policy features like individual cards, contribution amount and cashless treatment system. Likewise, lack of physical infrastructure, poor staff management, long waiting times, poor medicine availability, and delays in budget reimbursement were perceived as organisational barriers. At the interpersonal level, obstacles encompass challenges related to staff behaviour, interpersonal relationships, and the information provided by service providers. Identified health services delivery barriers at different levels emphasised the critical need for improving the quality of healthcare and services delivery mechanisms. Overcoming these obstacles is essential for realising health insurance scheme objectives and progressing toward Universal Health Coverage (UHC).
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Affiliation(s)
- Sushmita Ghimire
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | | | - Sudarshan Paudel
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
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Shrestha R, Shakya A, Khanal P, Khanal VK, Jha N, Nepal Gurung G, Subedi L. User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal. PLoS One 2024; 19:e0303045. [PMID: 38787905 PMCID: PMC11125507 DOI: 10.1371/journal.pone.0303045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The Government of Nepal initiated a family-based National Health Insurance Program (NHIP) in April 2016, aiming to ensure universal health coverage (UHC) by enhancing access to and utilization of quality health services. However, NHIP, in its initial years of implementation, encountered challenges such as low population coverage, a high dropout rate, and concerns among the insured regarding the quality of healthcare services. There is a dearth of information regarding user satisfaction with the NHIP in Nepal. This study aimed to assess user satisfaction with NHIP at the household level in Nepal. METHODS We conducted a cross-sectional study among 347 households in the Ilam district using a multi-stage random sampling method. Face-to-face interviews were conducted with household heads enrolled in NHIP. A semi-structured questionnaire was used to collect the data. The multivariable logistic regression analysis was done to identify the predictors of satisfaction level. RESULTS Overall, 53.6% of the insured were satisfied with the NHIP, while 31.1% had comprehensive knowledge about the NHIP. Factors such as gender (AOR: 1.80, 95% CI: 1.08-3.00), distance to the first point of contact (AOR: 2.15, 95% CI: 1.24-3.74), waiting time (AOR: 2.02, 95% CI: 1.20-3.42), availability of diagnostic services (AOR: 1.90, 95% CI: 1.05-3.45), availability of prescribed medicine (AOR: 3.90, 95% CI: 1.97-7.69), perceived service quality (AOR: 2.20, 95% CI: 1.15-4.20), and the behavior of service providers (AOR: 3.48, 95% CI: 1.04-11.63) were significantly associated with user satisfaction. CONCLUSION The satisfaction level among NHIP users was deemed moderate. This study highlighted several factors, such as gender, distance to the first point of contact, waiting time, availability of diagnostic services and prescribed medicine, perceived service quality, and the behavior of service providers, as key determinants impacting user satisfaction. Recognizing the pivotal role of user satisfaction, health insurance stakeholders must prioritize it to ensure higher retention rates and coverage within NHIP.
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Affiliation(s)
- Rasmita Shrestha
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Aditya Shakya
- Health Office Ilam, Ministry of Health, Koshi Province, Nepal
| | - Pratik Khanal
- Nepal Public Health Association, Lalitpur, Nepal
- Bergen Center for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vijay Kumar Khanal
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nilambar Jha
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Gyanu Nepal Gurung
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Laxmi Subedi
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Hasan MZ, Rabbani MG, Akter O, Mehdi GG, Ahmed MW, Ahmed S, Chowdhury ME. Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study. JMIR Form Res 2024; 8:e49815. [PMID: 38656783 PMCID: PMC11079759 DOI: 10.2196/49815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/07/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. OBJECTIVE We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. METHODS A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. RESULTS We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. CONCLUSIONS More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility.
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Affiliation(s)
- Md Zahid Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Md Golam Rabbani
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Orin Akter
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Gazi Golam Mehdi
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Sayem Ahmed
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Hsiao WC, Yip W. Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution? Soc Sci Med 2024; 345:115730. [PMID: 36803450 DOI: 10.1016/j.socscimed.2023.115730] [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: 11/08/2021] [Revised: 03/20/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
The international consensus in support of universal health coverage (UHC), though commendable, thus far lacks a clear mechanism to finance and deliver accessible and effective basic healthcare to the two billion rural residents and informal workers of low- and lower-middle-income countries (LLMICs). Importantly, the two preferred financing modes for UHC, general tax revenue and social health insurance, are often infeasible for LLMICs. We identify from historical examples a community-based model that we argue shows promise as a solution to this problem. This model, which we call Cooperative Healthcare (CH), is characterized by community-based risk-pooling and governance and prioritizes primary care. CH leverages communities' existing social capital, such that even those for whom the private benefit of enrolling in a CH scheme is outweighed by the cost may choose to enroll (given sufficient social capital). For CH to be scalable, it needs to demonstrate that it can organize delivery of accessible and reasonable-quality primary healthcare that people value, with management accountable to the communities themselves through structures that people trust, combined with government legitimacy. Once LLMICs with CH programs have industrialized sufficiently to make universal social health insurance feasible, CH schemes can be rolled into such universal programs. We defend cooperative healthcare's suitability for this bridging role and urge LLMIC governments to launch experiments testing it out, with careful adaptation to local conditions.
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Affiliation(s)
- William C Hsiao
- Emeritus, Global Health and Population, 104 Mount Auburn St., 303, Cambridge, MA, 02138, USA.
| | - Winnie Yip
- Health Policy and Economics, Harvard University T H Chan School of Public Health, Boston, MA, USA
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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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Hamzeh A, Hozarmoghadam N, Ghanbarzadeh M. Investigating the level of satisfaction of policyholders with supplementary health insurance in Iran. BMC Health Serv Res 2023; 23:1242. [PMID: 37951884 PMCID: PMC10638806 DOI: 10.1186/s12913-023-10134-1] [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: 02/19/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
The importance of customer satisfaction in business prosperity is undeniable, so many organizations consider customer satisfaction as the main driver of their business growth and try to keep their customers satisfied. The business market has never been so competitive in most areas. This is the reason why things like customer experience and customer loyalty are more and more important and are considered an indicator to measure the success of the business. Based on this, in this research, we will examine the level of satisfaction of insurance policyholders with supplementary health insurance services in Iran using the SERVQUAL model. This model is one of the most common models used in the field of quality assessment in the service sector. The method of conducting this research is a descriptive survey. The sampling method in the current research is simply random the statistical population is insurance policyholders and the sample number is 686 people from the society. The findings of the current research showed that there is a negative and significant gap in all dimensions of service quality.
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Babore GO, Ashine TM, Heliso AZ, Habebo TT. Client satisfaction and associated factors towards the health service provided to members of a community-based health insurance scheme in Southern Ethiopia. FRONTIERS IN HEALTH SERVICES 2023; 3:1237895. [PMID: 38028942 PMCID: PMC10656742 DOI: 10.3389/frhs.2023.1237895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Background Globally, 1.3 billion poor people have no access to health services due to their inability to afford payment when they need services. According to a report published by the WHO in 2014, globally 150 million people are pushed into poverty as a result of direct payment for health services. Objective This study aims to assess the satisfaction level of clients and associated factors toward health services provided to members of a community-based health insurance (CBHI) scheme. Methods An institutional-based cross-sectional study design was employed. A total sample size of 393 people was estimated using a single population formula, and three health facilities (HFs) were selected using a simple random sampling method, whereas study participants were selected by using a systematic sampling method. All patients who visited the HFs were included, whereas women who visited the HFs for maternity service were excluded from the study. A reliability test (Cronbach's alpha) was performed to determine the internal consistency for these items to measure the satisfaction level of the clients. Epi Info software version 7 was used to calculate the sample size and to enter data, whereas further data cleaning and analysis were conducted using SPSS software version 20. Results A total of 367 clients enrolled in the community-based health insurance scheme were interviewed, showing a response rate of 93%. The reliability test (Cronbach's alpha) value for the items used to measure level of client satisfaction was 0.817. The overall level of the clients' mean satisfaction toward health service provision was 63.1% (3.95 + 0.47 SD). This study found that age with AOR = 0.11 [95% CI (0.01-0.79)], residence with AOR = 1.80 [95% CI (1.79-3.66)], number of family with AOR = 2.27 [95% CI (1.46-11.22)], frequency of visits to HFs with AOR = 13.62 [95% CI (2.09-88.58)], and clients' level of knowledge with AOR = 3.33 [95% CI (1.06-10.42) had a statistical significant association with client satisfaction toward health service provision. Conclusion Our study found that the perceived level of client satisfaction is higher than previous studies. Residence, frequency of visits, level of knowledge, payment during referral time, number of family members, and frequency of visits were identified as predictors of client satisfaction on the health service provision.
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Affiliation(s)
- Getachew Ossabo Babore
- Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Taye Mezigebu Ashine
- Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Asnakech Zekiwos Heliso
- Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Teshome Tesfaye Habebo
- Department of Disease Prevention and Promotion, Kembeta Tembaro Zone Health Department, SNNP, Hossana, Ethiopia
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Merga BT, Raru TB, Deressa A, Regassa LD, Gamachu M, Negash B, Birhanu A, Turi E, Ayana GM. The effect of health insurance coverage on antenatal care utilizations in Ethiopia: evidence from national survey. FRONTIERS IN HEALTH SERVICES 2023; 3:1101164. [PMID: 37869683 PMCID: PMC10587574 DOI: 10.3389/frhs.2023.1101164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023]
Abstract
Background About three-fourths of maternal near-miss events and two-fifths of the risk of neonatal mortality can be reduced by having at least one antenatal visit. Several studies have identified potential factors related to maternal health seeking behavior. However, the association between health insurance membership and antenatal care utilization was not well investigated in Ethiopia. Therefore, this study was aimed at assessing the effect of health insurance coverage on antenatal care use in Ethiopia. Methods The study utilized data from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). The analysis included a weighted sample of 3,919 women who gave birth in the last five years. A logistic regression model was employed to assess the association between antenatal care use and health insurance coverage and other covariates. The results were presented as adjusted odds ratios (AOR) at a 95% confidence interval (CI). Statistical significance was declared at a p-value <0.05 in all analyses. Results Antenatal care was used by 43% (95% CI: 41.46 to 44.56%) of Ethiopian women. Those with health insurance coverage had higher odds of antenatal care use than those without health insurance coverage. Women were 33% more likely to use antenatal care (ANC) if they were covered by health insurance. Age, Media access, marital status, education status, wealth index, and economic regions were also factors associated with antenatal care utilizations. Conclusions According to our findings, less than half of Ethiopian women had four or more antenatal care visits. Health insurance membership, respondent age, media access, marital status, education status, wealth index, and economic region were factors associated with antenatal care utilization. Improving health insurance, women's economic empowerment, and education coverage are critical determinants of antenatal care utilization.
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Affiliation(s)
- Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Temam Beshir Raru
- School of Public Health, 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
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, 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
| | - Belay Negash
- 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
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Zepre K. The level of household satisfaction with community-based health insurance and associated factors in Southern Ethiopia. Front Public Health 2023; 11:1165441. [PMID: 37457275 PMCID: PMC10348874 DOI: 10.3389/fpubh.2023.1165441] [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: 03/10/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Background Community-based health insurance (CBHI) is a program intended to prevent financial hardship brought on by the cost of medical care. All of Ethiopia's regions are implementing it; however, it has not yet been researched how the program is being received by the local population. This study's objective is to determine how satisfied Southern Ethiopian households are with community-based health insurance programs and connected variables. Methods A community-based cross-sectional study was conducted from April to May 2021. Information was gathered from 528 households (HHs) selected at random in the Gurage Zone of Southern Ethiopia using a questionnaire. Bivariate and multivariate logistic regression, as well as descriptive statistics, were applied. p values less than 0.05 was used as a cutoff point for identifying the self-determining factors. Results The adjusted odds ratio (AOR) for HHs with the poorest wealth status was 2.40 (95% confidence interval:1.14-4.90); for HHs with a good knowledge of the CBHI, it was 1.81 (95% CI: 1.87-3.40); and for households with illness in the past 3 months, it was 5.22 (95% CI: 2.91-9.34). Recurrent visits to the facility (AOR:5.04, 95% CI:1.18-23.44), a Model household in rural health extension program (AOR:3.21, 95% CI:1.76-5.85), being enrolled in the scheme for three years or less (AOR:0.55, 95% CI: 0.30-0.95), and having faith in the leadership of the governing board (AOR:10.53, 95% CI:4.690-23.54) and the availability of the prescribed medication (AOR:14.64, 95% CI:5.37-39.84) were the significant influencing factors. Conclusion This study revealed several variables that affected HHs' satisfaction with CBHI. We strongly advise all responsible parties to focus on increasing HH knowledge of the CBHI scheme, supporting HHs to serve as role models for rural health extension packages, and completing the CBHI pledged package to improve HHs' satisfaction with the CBHI scheme, which may then play a role in the sustainability of CBHI.
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Getaneh MM, Bayked EM, Workneh BD, Kahissay MH. Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study. Front Public Health 2023; 11:1127755. [PMID: 37261241 PMCID: PMC10227519 DOI: 10.3389/fpubh.2023.1127755] [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: 12/20/2022] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background The fundamental concept of community-based health insurance is to strengthen the healthcare financing system to access universal healthcare by reducing costly risk-coping strategies. The scheme's sustainability and the quality of services provided by it are highly dependent on the satisfaction of its beneficiaries. Despite beneficiaries' satisfaction being the key determinant for providing evidence for policy revision and decision-making, it has often been neglected. Therefore, the study investigated the community-based health insurance beneficiaries' satisfaction and associated factors in Legambo district, North-East Ethiopia. Methods The study was conducted in the Legambo district with a community-based cross-sectional study design from October to November 2019. The data were collected from 838 households that had been the beneficiaries of the scheme using multi-stage and systematic random sampling. Twelve trained data collectors were employed and gathered the data using a pre-tested, structured questionnaire. We ran descriptive, bivariate, and logistic regression analyses. A value of p less than 0.05 with a 95% CI was used in multivariate logistic regression to determine the association of variables with the beneficiaries' satisfaction. Results The overall satisfaction level of the beneficiaries of the scheme was 58.6% and was associated with the following factors: merchandize (AOR = 1.92, 95% CI = 1.02-3.63), living in rural areas (AOR = 1.52, 95% CI = 1.02-2.27), an early office opening time (AOR = 3.81, 95% CI = 2.04-7.10), a short time interval to use benefit packages (AOR = 4.85, 95% CI = 2.08-11.31), an inexpensive membership premium (AOR =10.58, 95% CI = 3.56-31.44), availability of laboratory services (AOR =2.95, 95% CI = 1.71-5.09), presence of referral services (AOR =1.93, 95% CI = 1.33-2.80), having immediate care at health facilities (AOR = 1.73, 95% CI = 1.01-2.97) and non-compulsory enrolment (AOR = 6.31, 95% CI = 1.64-24.20). Conclusion The beneficiaries' satisfaction with the scheme was suboptimal and found to be determined by occupation, residence, laboratory and referral services, immediate care, office opening time, time interval to use benefit packages, premium amount, and situation of enrollment, most of which are service-related variables. Thus, to improve the satisfaction level, the stakeholders that should work hard seem to be the health insurance agency (the insurer) and the health facilities (the provider or supplier).
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Affiliation(s)
- Melaknesh Minda Getaneh
- Department of Capacity Building and Operational Research, Ethiopian Pharmaceuticals Supply Services (EPSS), Dessie, Ethiopia
| | - Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Asfaw A, Etana B, Mulatu B, Babure ZK. Household heads satisfaction and associated factors on community-based health insurance scheme in Gudeya Bila District, Oromia, Ethiopia. J Public Health Res 2023; 12:22799036231181181. [PMID: 37333029 PMCID: PMC10272642 DOI: 10.1177/22799036231181181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/29/2023] [Indexed: 06/20/2023] Open
Abstract
Background Community-Based Health Insurance (CBHI) scheme refers to a non-profit type of health insurance for the informal sector. There is a paucity of information on this topic in Gudeya Bila, Ethiopia. This study aimed to assess the level of household (HH) satisfaction with the CBHI scheme and its associated factors. Method A community-based cross-sectional study design was employed from November 1-30, 2020, and a sample of 630 HHs who enrolled in the CBHI scheme were included. A multi-stage sampling and systematic random sampling were employed. Data was entered into Epidata version 3.1 and analyzed using SPSS for windows program version 25. A 95% CI was calculated and variables having p-value < 0.05 were considered statistically significant. Descriptive statistics, bivariate, and multivariable logistic regression analyses were performed. Result All HHs heads (630) with a response rate of 100% were involved in the study. The overall HH satisfaction on CBHI was 56.2%. Attending CBHI scheme-related meetings (AOR = 1.948, 95% CI = 1.16-3.27), healthcare provider respectfulness (AOR = 9.209, 95% CI = 2.73-31.06), able to get the ordered laboratory test service (AOR = 2.143, 95% CI = 1.127-4.072) and having paid extra money for drug supply at private health facilities (AOR = 0.492, 95% CI = 0.285-0.847) were independent predictors. Conclusion HH satisfaction level on CBHI scheme was moderate. Attending CBHI scheme-related meetings, health-care provider respectfulness, being able to get the ordered laboratory test services and extra payments for drug supply were significant predictors of satisfaction with CBHI. Therefore, attention should be given to increasing the satisfaction of HHs with CBHI through improving the quality of health services.
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Affiliation(s)
- Ajibew Asfaw
- Gudeya Bila District Health Office, Oromia, Ethiopia
| | - Belachew Etana
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Befirdu Mulatu
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
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Akafu W, Daba T, Tesfaye E, Teshome F, Akafu T. Determinants of trust in healthcare facilities among community-based health insurance members in the Manna district of Ethiopia. BMC Public Health 2023; 23:171. [PMID: 36698154 PMCID: PMC9878736 DOI: 10.1186/s12889-023-15124-w] [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: 06/22/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Low-income countries, including Ethiopia, face substantial challenges in financing healthcare services to achieve universal health coverage. Consequently, millions of people suffer and die from health-related conditions. These can be efficiently managed in areas where community-based health insurance (CBHI) is properly implemented and communities have strong trust in healthcare facilities. However, the determinants of community trust in healthcare facilities have been under-researched in Ethiopia. OBJECTIVE To assess the determinants of trust in healthcare facilities among community-based health insurance members in the Manna District of Ethiopia. METHODS A community-based cross-sectional study was conducted from March 01 to 30, 2020 among 634 household heads. A multistage sampling technique was used to recruit the study participants. A structured interviewer-administered questionnaire was used to collect the data. Descriptive statistics were computed as necessary. Multivariable linear regression analyses were performed, and variables with a p-value < 0.05 were considered to have a significant association with households' trust in healthcare facilities. RESULTS In total, 617 households were included in the study, with a response rate of 97.0%. Household age (ß=0.01, 95% CI:0.001, 0.0013), satisfaction with past health services (ß=0.13, 95% CI:0.05, 0.22), perceived quality of services (ß= -0.47, 95% CI: -0.64, -0.29), perceived provider's attitude towards CBHI members (ß = -0.68, 95% CI: -0.88, -0.49), and waiting time (ß= -0.002, 95% CI:- 0.003, -0.001) were determinants of trust in healthcare facilities. CONCLUSION This study showed that respondents' satisfaction with past experiences, older household age, long waiting time, perceived poor quality of services, and perceived unfavorable attitudes of providers towards CBHI members were found to be determinants of trust in healthcare facilities. Thus, there is a need to improve the quality of health services, care providers' attitudes, and clients' satisfaction by reducing waiting time in order to increase clients' trust in healthcare facilities.
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Affiliation(s)
- Wakuma Akafu
- Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Oromia Ethiopia
| | - Teferi Daba
- Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Oromia Ethiopia
| | - Edosa Tesfaye
- School of Public Health, Institute of Health, Wollega University, Nekemte, Oromia Ethiopia
| | - Firanbon Teshome
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Oromia Ethiopia
| | - Tesfaye Akafu
- Department of Natural Resource Management, Institute of Agriculture and Veterinary Medicine, Jimma University, Jimma, Oromia Ethiopia
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Islam Anne F, Akter SM, Sheikh SP, Ireen S, Escobar-DeMarco J, Kappos K, Ash D, Rasheed S. Quality of nutrition services in primary health care facilities of Dhaka city: State of nutrition mainstreaming in urban Bangladesh. PLoS One 2022; 17:e0278621. [PMID: 36516160 PMCID: PMC9749975 DOI: 10.1371/journal.pone.0278621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Despite high prevalence of malnutrition little is known about the quality of nutrition services provided through urban health systems. This study aimed to fill in knowledge gaps on quality of nutrition service provision at public primary health care facilities in urban Dhaka. METHOD This cross-sectional study was conducted from April-July 2019 in Dhaka City. Fifty-three health facilities were sampled following NetCode protocol. Quality of nutrition services was assessed in terms of structural readiness, process, and client satisfaction. Structural readiness included equipment, guidelines, and registers, and knowledge of health professionals (n = 130). For process, client provider interaction was observed (ANC: n = 159, Pediatric: n = 150). For outcome assessment, client's satisfaction with nutrition service provision was measured through interviews with pregnant women (n = 165) and caregivers of 0-24 month-old children (n = 162). Bivariate and multivariate analyses were conducted using SPSS. RESULTS There were gaps in availability of equipment and guidelines in health facilities. Only 30% of healthcare providers received basic nutrition training. The mean knowledge score was 5.8 (range 0-10) among ANC providers and 7.8 for pediatric service providers. Process: Only 17.6% health facilities had dedicated space for counselling, 48.4% of pregnant women received four key nutrition services; 22.6% of children had adequate growth monitoring; and 38.7% of caregivers received counselling on exclusive breastfeeding. Outcome: The mean satisfaction with services was 4.3 for ANC and 4.0 for paediatric visits (range 1-5). Participants attending public facilities had significantly lower satisfaction compared to those attending private and NGO health facilities. CONCLUSION There were gaps in facility readiness, and implementation of nutrition services. The clients were more satisfied with services at private facilities compared to public. The gaps in nutrition service delivery need to be adequately addressed to ensure promotion of good nutrition and early detection and management of malnutrition among pregnant women and children in urban Bangladesh.
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Affiliation(s)
- Faugia Islam Anne
- Health Systems and Population Studies Division (HSPSD), Urban Health, icddr,b, Dhaka, Bangladesh
| | | | - Sifat Parveen Sheikh
- Health Systems and Population Studies Division (HSPSD), Urban Health, icddr,b, Dhaka, Bangladesh
| | - Santhia Ireen
- Alive & Thrive, FHI Solutions / FHI 360, Dhaka, Bangladesh
| | | | - Kristen Kappos
- Alive & Thrive, FHI Solutions / FHI 360, Dhaka, Bangladesh
| | - Deborah Ash
- Alive & Thrive, FHI Solutions / FHI 360, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Health Systems and Population Studies Division (HSPSD), Urban Health, icddr,b, Dhaka, Bangladesh
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Gowda NR, Hakim A, Singh G, Gupta A, Sharma D. The Experience of Patient and Implementation of the Landmark Scheme Ayushman Bharat (AB-PMJAY) of Government of India in a Tertiary Care Hospital. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221128082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ayushman Bharat is a flagship programme of Government of India and has been much publicised; however, the extent of its translation to the ground level has not been documented. A study was conducted to assess the implementation and satisfaction of the AB-PMJAY scheme in the inpatient department of AIIMS, New Delhi. Data were collected from January 2019 to June 2019. The sample size was a universal sample, and therefore, all the beneficiaries who availed the services at AIIMS, New Delhi were enrolled. A total of 120 patients were enrolled in the study. The mean age of the participant was 36.37 years, about 45.83% of the participants were illiterate and 69.17% resided in the rural area. A total of 88% of patients did not face any problem in availing the scheme, while 18% of the patients were asked to purchase medications from outside. Patients were highly satisfied with the ease and benefits of availing the scheme. The government should examine the reasons why some medications are being purchased from outside, and a contingency fund may be given to the hospital to prevent people from purchasing the medications from outside.
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Affiliation(s)
- Naveen R Gowda
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Abdul Hakim
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Gurpreet Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anant Gupta
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - D.K. Sharma
- All India Institute of Medical Sciences, New Delhi, Delhi, India
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Community-Based Health Insurance Utilization and Its Associated Factors among Rural Households in Akaki District, Oromia, Ethiopia, 2021. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/9280269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Community-based health insurance is widely recognized as the most effective way to achieve universal health coverage (UHC) with adequate financial protection against healthcare costs, to promote equal access to high-quality healthcare, increase financial security, and enhance social cohesion and solidarity. Objective. The objective of this study was to determine community-based health insurance utilization and its associated factors among rural households in Akaki District, Oromia special zone surrounding Finfinnee, Oromia, Ethiopia, in May 2021. Methods and Materials. A community based cross-sectional study was conducted on 600 households in May 2021. A multistage sampling technique was used to select households. Data were collected using pretested and standardized questionnaires entered into Epi Info version 7.2.4 and analyzed using SPSS version 26. Bivariate and multivariate logistic regressions were computed to identify the factors associated with community-based health insurance utilization. A
value <0.05 with 95% CI was used as a cut-off point to declare the level of statistical significance. Results. The magnitude of community-based health insurance (CBHI) utilization was 398 (66.3%) (95% CI: 0.63, 0.70). In the multivariate logistic regression analysis, the odds of CBHI utilization for males were 2 times higher (AOR = 1.629; 95% CI: 1.063, 2.497) compared to female-headed households; household family size <5 was 3 times higher (AOR = 2.99; 95% CI: 1.987, 4.139) compared to household family size >5; farmer was 4 times higher (AOR = 3.763; 95% CI: 1.371, 10.327) compared to other occupational status; household income <30,000 ETB was 2 times higher (AOR = 2.474; 95% CI: 1.514, 4.043) compared to the household income of 30000 ETB, and all these were factors significantly associated with CBHI utilization. Conclusion. The magnitude of CBHI utilization was low (66.3%) compared to the HSTP II target (80%) and other studies. The results of the study showed that age, sex, household family size, household income, and trustworthiness were among the factors significantly associated with community-based health insurance utilization.
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Mashhadi SF, Hisam A, Sikander S, Rathore MA, Rifaq F, Khan SA, Hafeez A. Post Discharge mHealth and Teach-Back Communication Effectiveness on Hospital Readmissions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910442. [PMID: 34639741 PMCID: PMC8508113 DOI: 10.3390/ijerph181910442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.
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Affiliation(s)
- Syed Fawad Mashhadi
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
- Department of Public Health, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan
- Correspondence:
| | - Aliya Hisam
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Siham Sikander
- Global Health Department, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan;
- Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Mommana Ali Rathore
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Faisal Rifaq
- Sehat Sahulat Program, Ministry of National Health Services, Regulations and Coordination, Government of Pakistan, Hall 3A, 3rd Floor, Kohsar Block, Pak Secretariat, Islamabad 44000, Pakistan;
| | - Shahzad Ali Khan
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
| | - Assad Hafeez
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
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Comparison of SVM and BPNN Estimation Models for Satisfaction in Old-Age Security. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-020-09388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nshakira-Rukundo E, Mussa EC, Cho MJ. Dropping out of voluntary community-based health insurance in rural Uganda: Evidence from a cross-sectional study in rural south-western Uganda. PLoS One 2021; 16:e0253368. [PMID: 34270556 PMCID: PMC8284644 DOI: 10.1371/journal.pone.0253368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
AIM Community Based Health Insurance (CBHI) schemes have become central to health systems financing as avenues of achieving universal health coverage in developing countries. Yet, while emphasis in research and policy has mainly concentrated on enrolment, very little has been apportioned to high rates of dropping out after initial enrolment. The main aim of this study is to understand the factors behind CBHI dropping out through a cross-sectional quantitative research design to gain insights into curtailing the drop out of CBHI in Uganda. METHODS The survey for the quantitative research component took place between August 2015 and March 2016 covering 464 households with under-5 children in south-western Uganda. To understand the factors associated with dropping out of CBHI, we employ a multivariate logistic regression on a subsample of 251 households who were either currently enrolled or had enrolled at one time and later dropped out. RESULTS Overall, we find that 25.1 percent of the households that had ever enrolled in insurance reported dropping out. Household socioeconomic status (wealth) was one of the key factors that associated with dropping out. Larger household sizes and distance from the hospital were significantly associated with dropping out. More socially connected households were less likely to drop out revealing the influence of community social capital in keeping households insured. CONCLUSION The findings have implications for addressing equity and inclusion concerns in community-based health insurance programmes such as one in south-western Uganda. Even when community based informal system aim for inclusion of the poorest, they are not enough and often the poorest of the poor slip into the cracks and remain uninsured or drop out. Moreover, policy interventions toward curtailing high dropout rates should be considered to ensure financial sustainability of CBHI schemes.
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Affiliation(s)
- Emmanuel Nshakira-Rukundo
- Institute for Food and Resource Economics, University of Bonn, Bonn, Germany
- Apata Insights, Kampala, Uganda
| | - Essa Chanie Mussa
- Department of Agriculture Economics, University of Gondar, Gondar, Ethiopia
| | - Min Jung Cho
- Faculty Governance and Global Affairs, Leiden University College, The Hague, Netherlands
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Addise T, Alemayehu T, Assefa N, Erkalo D. The Magnitude of Satisfaction and Associated Factors Among Household Heads Who Visited Health Facilities with Community-Based Health Insurance Scheme in Anilemo District, Hadiya Zone, Southern Ethiopia. Risk Manag Healthc Policy 2021; 14:145-154. [PMID: 33469397 PMCID: PMC7812036 DOI: 10.2147/rmhp.s290671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Community-based health insurance (CBHI) schemes are an emerging strategy for providing financial protection against healthcare-related poverty. In Ethiopia, CBHI is being piloted in 13 districts, but community experience and satisfaction with the scheme have yet to be studied. Objective To assess the magnitude of satisfaction and associated factors among household heads who visited health facilities with community-based health insurance schemes in the Anilemo district Hadiya Zone Southern Ethiopia. Methods A community-based cross-sectional study design was conducted for 627 household heads in the Anilemo district, from March 1–30, 2020. Study participants were selected using stratified random sampling for kebeles and systematic sampling for study households. Data were collected by trained data collectors using a pre-tested structured questionnaire. Descriptive statistics, bivariate, and multivariate logistic regression analyses were performed. P values less than 0.05 with 95% confidence intervals were used to determine associations between independent and dependent variables. Results The magnitude of household heads’ satisfaction was 54.1%. Household heads age [AOR=1.70;95% CI 1.09–2.67], households income [AOR=0.19; 95% CI 0.11–0.35], knowledge of CBHI benefit packages [AOR=3.15; 95% CI 1.97–5.03], agreement with laboratory services [AOR=2.25; 95% CI 1.40–3.62], and got and agreed with prescribed drugs [AOR=2.69; 95% CI 1.66–4.37] were significantly associated with the magnitude of household heads satisfaction with community-based health insurance. Conclusion About half of the household heads who visited health facilities with CBHIS were satisfied. Age, household’s income, knowledge of CBHI benefit packages, agreement with laboratory service provision, availability and agreement with prescribed drugs were significant predictors of satisfaction with CBHI. Therefore, much effort could be required to increase the magnitude of the household head’s satisfaction with the scheme.
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Affiliation(s)
- Teketel Addise
- Anilemo District Health Office, Hadiya Zone, Southern Ethiopia
| | - Tadesse Alemayehu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Desta Erkalo
- College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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Akinyinka MR, Oluwole EO, Odusanya OO. Predictors of Client Satisfaction Among Recent Users of Health Services in Lagos, Nigeria. Health Serv Insights 2020; 13:1178632920934499. [PMID: 32636637 PMCID: PMC7318808 DOI: 10.1177/1178632920934499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
Client satisfaction is an important measure of quality of care as it provides information on how well health service providers meet clients' values and expectations. The study was cross-sectional and analytical in nature. Data were obtained with the use of an interviewer-administered questionnaire. Respondents (n = 994) were a subset of a larger group of community members recruited for a study on quality of health care who had used a health facility for care within 3 months prior to data collection. A total of 94% of clients were satisfied with services received although client satisfaction rates were higher with private than public health facilities. Waiting time of less than 20 minutes (adjusted odds ratio [AOR] = 9.35, 95% confidence interval [CI] = 2.08-41.67), cheap cost of all services received (AOR = 7.58, 95% CI = 1.95-29.41), and the ability of the health care provider to offer explanations clearly to clients (AOR = 6.21, 95% CI = 1.90-20.41) were predictors of client satisfaction. However, the use of a government-owned hospital (AOR = 0.23, 95% CI = 0.08-0.63) was predictive of client dissatisfaction. Only service characteristics were predictive of client satisfaction. Improvement in service delivery is recommended.
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Affiliation(s)
- Modupe Rebekah Akinyinka
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Esther Oluwakemi Oluwole
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria
| | - Olumuyiwa Omotola Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Lagos, Nigeria
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Nageso D, Tefera K, Gutema K. Enrollment in community based health insurance program and the associated factors among households in Boricha district, Sidama Zone, Southern Ethiopia; a cross-sectional study. PLoS One 2020; 15:e0234028. [PMID: 32484840 PMCID: PMC7266314 DOI: 10.1371/journal.pone.0234028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background In absence of any form of health insurance, out-of-pocket payments for health care lead to decreased use of health services and catastrophic health expenditures. Community-based health insurances has been promised financial model for informal sectors to reduce these problems in many countries. When this comes down to Ethiopia, in the South Nation Nationality People’s Region of the country established 52 schemes including Boricha district, the study area However, there has been little evidence about the enrollment status and the associated factors in the study area in particular elsewhere in general. Objective The study aims to assess the current enrollment status of households in community based health insurance and the associated factors in Boricha district of Sidama Zone, Southern Ethiopia. Methods and materials A community based cross-sectional study design was employed from February 01, 2019 to March 31, 2019, using a sample of 632 households. Data were collected using interviewer-administered pre-tested questionnaire and entered into EPI-Info 7and transported to SPSSversion20 for analysis. Multi-variable logistic regression analysis along with odds ratio and the corresponding 95% CI was conducted and significance was declared at P-value <0.05. Results Current enrollment status of households in community based health insurance was found to be 81 (12.8%). According to this study, educational status; secondary school& above[AOR = 2.749, 95%CI(1.142, 6.618)], timing of collecting premium [AOR = 0.433; 95% CI (0.196, 0.958)], family size ≥5, [AOR = 4.16;95%CI (1.337, 12.944)], no trust on scheme management[AOR = 0.272; 95%CI (0.140, 0.528)], lack of information [AOR = 0.086; 95%CI (0.026, 0.288)], dissatisfaction with health care service received[AOR = 0.303; 95%CI (0.171, 0.537)], no chronic illness in the family[AOR = 0.259; 95%C.I.(0.137, 0.488)] were factors significantly associated with current enrollment status in CBHI. Conclusions Households head’s education status, timing of premium collection, family size, no trust on scheme management, lack of information, services dissatisfaction and chronic illness in the family member were the identified factors associated with enrollment in CBHI in the study area. Therefore, to enhance the enrollment and sustainability of CBHI in the study area awareness creation, improving timing of premium collection, strengthening scheme management, improving quality of service are the areas that decision makers needs to intervene.
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Affiliation(s)
- Dawit Nageso
- Boricha District Health Office, Balela, Sidama, Ethiopia
- * E-mail:
| | - Kebede Tefera
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Keneni Gutema
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Cai G, Xu L, Gao W, Hong Y, Ying X, Wang Y, Qian F. The Positive Impacts of Exhibition-Driven Tourism on Sustainable Tourism, Economics, and Population: The Case of the Echigo-Tsumari Art Triennale in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051489. [PMID: 32110895 PMCID: PMC7084389 DOI: 10.3390/ijerph17051489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
After the recession in Japan in the 1990s, Japanese art exhibitions began to appear. The purpose of these exhibitions was to revitalize these areas through the presentation of art (attracting visitors and tourists). Correspondingly, this study explores the significance of exhibition-driven tourism in Japan. The Echigo–Tsumari Art Triennial (ETAT) was used as a case to study how exhibition-driven tourism has impacted sustainable tourism, economics, and the population. The current paper collected panel data from 1900 to 2018. These panel data were analyzed by descriptive statistics and a correlation analysis (a one-way ANOVA and a Pearson correlation analysis in SPSS26). The empirical analysis showed that the Echigo–Tsumari Art Triennial (exhibition-driven tourism) had positive impacts on sustainable tourism, economics, and the population; its correlations with Niigata were also clear. This study generated results that are valuable from both academic and industry perspectives (exhibition-driven tourism), as this field has not been extensively researched. The current paper also presents the theoretical and practical implications of the statistical results.
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Affiliation(s)
- Gangwei Cai
- College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310000, China;
| | - Lei Xu
- College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 310000, China;
- Correspondence: (L.X.); (W.G.); Tel.: +86-159-8885-4614 (L.X.)
| | - Weijun Gao
- Faculty of Environmental Engineering, University of Kitakyushu, Fukuoka 8080135, Japan;
- Correspondence: (L.X.); (W.G.); Tel.: +86-159-8885-4614 (L.X.)
| | - Yan Hong
- School of Civil Engineering and Architecture, Zhejiang Sci-Tech University, Hangzhou 310000, China;
| | - Xiaoyu Ying
- Department of Architecture, Zhejiang University City College, Hangzhou 310000, China;
| | - Yan Wang
- School of Architecture, Tianjin Chengjian University, Tianjin 300384, China;
| | - Fanyue Qian
- Faculty of Environmental Engineering, University of Kitakyushu, Fukuoka 8080135, Japan;
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Measuring Patients’ Perception and Satisfaction with the Romanian Healthcare System. SUSTAINABILITY 2020. [DOI: 10.3390/su12041612] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Measuring patient satisfaction of healthcare service quality represents a significant element of a healthcare’s system (HS) overall evaluation. It is the starting point for creating policies in national healthcare. The purpose of this paper was to evaluate Romanian patients’ perception and satisfaction of the quality of the national HS as a whole and of its components. Exploratory and descriptive research was used. Data were collected through face-to-face interviews with Romanian patients, based on a questionnaire. Out of the 2305 respondents, 83% used the Romanian HS in the past 12 months and 58% of the respondents did not trust the system. The accommodation, food, and other facilities of Romanian hospitals were perceived as being at a low level. One third of the respondents were unsatisfied and very unsatisfied with respect to the overall impression of the Romanian HS. In addition, our research found a statistically significant relationship between confidence in the HS, age, and gender, and also between the overall impression on the HS, age and income.
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