Dataset Information

The Impact of Healthcare Insurance on the Utilisation of Facility-Based Delivery for Childbirth in the Philippines.

ABSTRACT: In recent years, the government of the Philippines embarked upon an ambitious Universal Health Care program, underpinned by the rapid scale-up of subsidized insurance coverage for poor and vulnerable populations. With a view of reducing the stubbornly high maternal mortality rates in the country, the program has a strong focus on maternal health services and is supported by a national policy of universal facility-based delivery (FBD). In this study, we examine the impact that recent reforms expanding health insurance coverage have had on FBD.Data from the most recent Philippines 2013 Demographic Health Survey was employed. This study applies quasi-experimental methods using propensity scores along with alternative matching techniques and weighted regression to control for self-selection and investigate the impact of health insurance on the utilization of FBD.Our findings reveal that the likelihood of FBD for women who are insured is between 5 to 10 percent higher than for those without insurance. The impact of health insurance is more pronounced amongst rural and poor women for whom insurance leads to a 9 to 11 per cent higher likelihood of FBD.We conclude that increasing health insurance coverage is likely to be an effective approach to increase women's access to FBD. Our findings suggest that when such coverage is subsidized, as it is the case in the Philippines, women from poor and rural populations are likely to benefit the most.

SUBMITTER: Gouda HN

PROVIDER: S-EPMC5135090 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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The Impact of Healthcare Insurance on the Utilisation of Facility-Based Delivery for Childbirth in the Philippines.

Gouda Hebe N HN Hodge Andrew A Bermejo Raoul R Zeck Willibald W Jimenez-Soto Eliana E

PloS one 20161202 12

<h4>Objectives</h4>In recent years, the government of the Philippines embarked upon an ambitious Universal Health Care program, underpinned by the rapid scale-up of subsidized insurance coverage for poor and vulnerable populations. With a view of reducing the stubbornly high maternal mortality rates in the country, the program has a strong focus on maternal health services and is supported by a national policy of universal facility-based delivery (FBD). In this study, we examine the impact that ...[more]

PMID: 27911935

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Project description:ObjectivesThe study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups.Design/settingSecondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted.ParticipantsA total of 4900 individuals who reported using healthcare services are analysed.Outcomes measureNumbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year.ResultsThe result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics.ConclusionOur findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level.

Project description:Objectives This study aims to assess the impact of the subsidised community health insurance scheme in Senegal particularly on the poor. Design and setting The study used data from a household survey conducted in 2019 in three regions, representing 29.3% of the total population. Inverse probability of treatment weighting approach was applied for the analysis. Participants 1766 households with 15 584 individuals selected through a stratified random sampling with two draws. Main outcome measures The impact of community-based health insurance (CBHI) was evaluated on poor people’s access to care and on their financial protection. For the measurement of access to care, we were interested in the use of health services and non-withdrawal from care in case of illness. To assess financial protection, we looked at out-of-pocket expenditure by type of provider and by type of service, the weight of out-of-pocket expenditure on household income, non-exposure to impoverishing health expenditure and non-exposure to catastrophic health expenditure. Results The results indicate that the CBHI increases primary healthcare utilisation for non-poor (OR 1.36 (CI90 1.02–1.8) for the general scheme and 1.37 (CI90 1.06–1.77) for the special scheme for indigent recipients of social cash transfers), protect them against catastrophic (OR 1.63 (CI90 1.12–2.39)) or impoverishing (OR 2.4 (CI90 1.27–4.5)) health expenditures. However, CBHI has no impact on the poor’s healthcare utilisation (OR 0.61 (CI90 0.4–0.94)) and do not protect them from the burden related to healthcare expenditures (OR: 0.27 (CI90 0.13–0.54)). Conclusion Our study found that CBHI has an impact on the non-poor but does not sufficiently protect the poor. This leads us to conclude that a health insurance programme designed for the general population may not be appropriate for the poor. A qualitative study should be conducted to better understand the non-financial barriers to accessing care that may disproportionately affect the poorest.

Project description:BACKGROUND:Several recent studies have attempted to measure the prevalence of disrespect and abuse (D&A) of women during childbirth in health facilities. Variations in reported prevalence may be associated with differences in study instruments and data collection methods. This systematic review and comparative analysis of methods aims to aggregate and present lessons learned from published studies that quantified the prevalence of Disrespect and Abuse (D&A) during childbirth. METHODS:We conducted a systematic review of the literature in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Five papers met criteria and were included for analysis. We developed an analytical framework depicting the basic elements of epidemiological methodology in prevalence studies and a table of common types of systematic error associated with each of them. We performed a head-to-head comparison of study methods for all five papers. Using these tools, an independent reviewer provided an analysis of the potential for systematic error in the reported prevalence estimates. RESULTS:Sampling techniques, eligibility criteria, categories of D&A selected for study, operational definitions of D&A, summary measures of D&A, and the mode, timing, and setting of data collection all varied in the five studies included in the review. These variations present opportunities for the introduction of biases - in particular selection, courtesy, and recall bias - and challenge the ability to draw comparisons across the studies' results. CONCLUSION:Our review underscores the need for caution in interpreting or comparing previously reported prevalence estimates of D&A during facility-based childbirth. The lack of standardized definitions, instruments, and study methods used to date in studies designed to quantify D&A in childbirth facilities introduced the potential for systematic error in reported prevalence estimates, and affected their generalizability and comparability. Chief among the lessons to emerge from comparing methods for measuring the prevalence of D&A is recognition of the tension between seeking prevalence measures that are reliable and generalizable, and attempting to avoid loss of validity in the context where the issue is being studied.

Project description:OBJECTIVE:To assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK). DESIGN:We used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK. SETTING:Population-based, inpatient. PARTICIPANTS:HCUP state-wide data comprising over 28?million individuals and over 16?million hospitalisations across three states. MAIN OUTCOME MEASURES:We used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states. RESULTS:In CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95% CI 1.26 to 1.28 and RR 1.16, 95%?CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95%?CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state). CONCLUSIONS:Recreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.

Project description:ObjectiveIncreasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation is often inconsistent and quality of care can be poor. We assessed whether poor quality of sick child healthcare in Malawi is associated with low utilisation of sick child healthcare.DesignWe measured two elements of quality of sick child healthcare: facility structural readiness and process of care using data from the 2013 Malawi Service Provision Assessment. Overall quality was defined as the average of these metrics. We extracted demographic data from the 2013-2014 Malawi Multiple Indicator Cluster Survey and linked households to nearby facilities using geocodes. We used logistic regression to examine the association of facility quality with utilisation of formal health services for children under 5 years of age suffering diarrhoea, fever or cough/acute respiratory illness, controlling for demographic and socioeconomic characteristics. We conducted sensitivity analyses (SAs), modifying the travel distance and population-facility matching criteria.Setting and population568 facilities were linked with 9701 children with recent illness symptoms in Malawi, of whom 69% had been brought to a health facility.ResultsOverall, facilities showed gaps in structural quality (62% readiness) and major deficiencies in process quality (33%), for an overall quality score of 48%. Better facility quality was associated with higher odds of utilisation of sick child healthcare services (adjusted ORs (AOR): 1.66, 95% CI: 1.04 to 2.63), as was structural quality alone (AOR: 1.33, 95% CI: 0.95 to 1.87). SAs supported the main finding.ConclusionAlthough Malawi's health facilities for curative child care are widely available, quality and utilisation of sick child healthcare services are in short supply. Improving facility quality may provide a way to encourage higher utilisation of healthcare, thereby decreasing preventable childhood morbidity and mortality.

Dataset Information

The Impact of Healthcare Insurance on the Utilisation of Facility-Based Delivery for Childbirth in the Philippines.

Publications

The Impact of Healthcare Insurance on the Utilisation of Facility-Based Delivery for Childbirth in the Philippines.

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