Effects of a Temporary Suspension of Community-based Health Insurance in Kwara State, Nigeria

Abstract Background: Social health insurance has been widely proposed as a key strategy to improve access to healthcare and provide financial protection. The Kwara Community Health Insurance Programme (KCHIP) in Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme’s suspension on enrollees’ healthcare utilization and the associated factors with the ability to pay for care. Methods: A mixed-methods study was carried out in Kwara State, Nigeria, in 2018 using a semi-quantitative cross-sectional survey amongst 600 former KCHIP clients, and in-depth interviews with 24 clients and 29 participating public and private healthcare providers in the program. Quantitative data was analyzed using Statistical Package for Social Science (SPSS) version 22 while qualitative data was analyzed thematically.Results: Most of former enrollees (95.3%) kept utilizing programme facilities after the suspension, mainly because of the high quality of care. However, majority of the enrollees (95.8%) reverted to out-of-pocket (OOP) payment while 67% reported constraints in payment for healthcare services after suspension of the program. In the absence of insurance, the most common coping mechanisms for healthcare payment were personal savings (63.3%), donations from friends and families (34.7%) and loans (11.8%). Being a male enrollee (OR=1.61), living in a rural community (OR=1.77), exclusive usage of KCHIP prior to suspension (OR=1.94) and suffering an acute illness (OR=3.38) increased the odds of being financially constrained in accessing healthcare. Expectedly, the wealthy respondents were less likely (OR = 0.78) to be constrained by the suspension of the programme. All healthcare facilities in the study sample experienced a reduced patient load after suspension of the scheme. Seventeen of 29 healthcare facilities recorded a decrease in revenue, more noticeable among private facilities. Conclusion: After the suspension of the KCHIP, many enrollees and health facilities experienced financial constraints. These underscore the importance of sustainable health insurance schemes as a risk-pooling mechanism to sustain access to good quality health care and financial protection from catastrophic health expenditures. Moreover, the findings highlight the importance of effective processes to smooth the transition policy from community- to state-wide health insurance schemes.

Download Full-text

The Role of Trust in the Pattern of Enrolment to a Social Health Insurance Scheme and Distribution of Healthcare Facilities in Ibadan, Southwest, Nigeria

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0331 ◽

2021 ◽

Author(s):

David Ayobami Adewole ◽

Steve Reid ◽

Tolu Oni

Keyword(s):

Health Insurance ◽

Healthcare Providers ◽

Social Health Insurance ◽

Healthcare Services ◽

Health Insurance Scheme ◽

Skewed Distribution ◽

Insurance Scheme ◽

Quality Healthcare ◽

Healthcare Facilities ◽

Southwest Nigeria

The National Health Insurance Scheme (NHIS) of Nigeria established in the year 2005 aims to minimize the inequity of access to quality healthcare services in Nigeria. As of the year 2017, enrolment in NHIS-accredited facilities in the southwest region of Nigeria was significantly clustered, with more than three-quarters of NHIS enrollees registered with only 10% of the available NHIS-accredited facilities in the six states of the region. This study explored the factors associated with the skewed distribution of enrollees across facilities and the influence of stakeholders. This is a descriptive, qualitative, case study design among stakeholders of the NHIS in Ibadan, Oyo State, Southwest, Nigeria. In-depth interviews were conducted between March and June, 2019, with all selected individual stakeholders as listed earlier. Data analysis was done using an inductive thematic approach. Across the board, there was a low level of trust in government and government policies among healthcare providers and enrollees. Few healthcare providers were willing to render services under the scheme at inception. The majority of the enrollees were compelled to register with the few available healthcare providers. Among the enrollees, a few personally chose healthcare facilities and providers that were perceived to render better quality services to receive care. Priority should be given to building trust among stakeholders in the NHIS as this would facilitate cooperation and better working relationship, and reposition the scheme for better performance.

Download Full-text

Baseline assessment of therapeutic injection practices in Pakistan in 2020: a cross-sectional study

Journal of the Pakistan Medical Association ◽

10.47391/jpma.0003 ◽

2021 ◽

pp. 16-21

Author(s):

Syed Sharaf Ali Shah ◽

Safdar Pasha ◽

Nikhat Iftikar ◽

Altaf Ahmed Soomro ◽

Nazia Farrukh ◽

...

Keyword(s):

Public Sector ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Health Facilities ◽

Cross Sectional ◽

Injection Equipment ◽

Public And Private ◽

Healthcare Facilities ◽

The Public ◽

Injection Safety

Objective: To assess the magnitude of the problem of injection safety in public and private health facilities in two districts of Sindh and Punjab provinces of Pakistan. Methods: A cross-sectional observational study was conducted between October and December 2020 among public and private health facilities of two districts of Pakistan: Gujarat in Punjab and Larkana in Sindh provinces. A convenient sample size of 60 healthcare facilities (30 from each district) was taken due to time and resource constraint. Six data collection tools were used which included structured observations and interviews with injection prescribers and providers based on WHO Revised Tool C, which were finalised after piloting. Results: Reuse of injection equipment was not observed in any of the 60 health facilities. In exit interviews of 120 patients, it was found that 27 (22.5%) patients reported receiving an injection, while 11 (9.2%) were prescribed intravenous (IV) drips. More injections and drips were prescribed in the private sector (n=15; 25.0%) in comparison with the public sector (n=12; 20.0%). Slightly higher proportion of IV drips were prescribed by the private providers when compared to public sector healthcare providers: 6 (10.0%) vs 5 (8.3%) respectively. Most of the prescribers (n=58; 96.7%) reported that patients who attended public and private health facilities demanded injectable medicines. Used syringes and drips were noted to be visible in open containers and buckets for final disposal in 20 (33.3%) assessed health facilities. Continuou...

Download Full-text

Stethoscope disinfection is rarely done in Ethiopia: what are the associated factors?

10.1101/474098 ◽

2018 ◽

Author(s):

Biniyam Sahiledengle

Keyword(s):

Associated Factors ◽

Infection Prevention ◽

Addis Ababa ◽

Healthcare Providers ◽

Favorable Attitude ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Healthcare Facilities ◽

Prevention Guideline ◽

Use Factors

AbstractBackgroundThe stethoscope, which is universally used as a medical device by healthcare providers, is likely to be contaminated by pathogenic microorganisms. And regular cleaning of the diaphragm of the stethoscope with a suitable disinfectant is decisive. However, in the resource constrained setting like many healthcare facilities in Ethiopia healthcare provider’s stethoscope disinfection practice and its associated factors have not been well studied so far. Therefore, this study sought to determine stethoscope disinfection practice and associated factors among the healthcare providers in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional survey was carried out between April and May 2016. For this survey, 576 healthcare providers were included from 21 healthcare facilities in Addis Ababa. A pre-tested structured questionnaire was used for data collection. Descriptive statistics were computed. Binary and multivariable logistic regression analyses were used to identify factors that were significantly associated with stethoscope disinfection after every use.ResultsFive hundred forty six participants were take part in this study, for a response rate of 94.7%. Of these, only 39.7% (95%CI: 35.9, 44.0%) of healthcare providers disinfecting their stethoscope after every use. Physicians were less likely to disinfect there stethoscope compared to nurses (AOR=0.21; 95%CI: 0.09, 0.49). Healthcare providers who had awareness on infection prevention guideline, healthcare providers who had favorable attitude towards infection prevention and participants having safe infection prevention practice have better stethoscope disinfection practice after every use as compared to their counterparts (AOR=1.93; 95%CI: 1.31, 2.82), (AOR=1.73, 95%CI: 1.02, 2.93), and (AOR=3.79, 95%CI: 2.45-5.84), respectively.ConclusionsOnly a small proportion of healthcare providers disinfect their stethoscopes after every use. Factors such as awareness on infection prevention guidelines, favorable attitude towards infection prevention and safe infection prevention practice were the independent predictors of stethoscopes disinfection after every use. Hence, implementation of effective training on stethoscope disinfection along with increasing awareness on infection prevention may improve stethoscope disinfection practice.

Download Full-text

Financing and Insurance

10.1093/med/9780190238308.003.0010 ◽

2018 ◽

Author(s):

Samuel H Zuvekas ◽

Earle Buddy Lingle ◽

Ardis Hanson ◽

Bruce Lubotsky Levin

Keyword(s):

Public Health ◽

United States ◽

Health Insurance ◽

Insurance Coverage ◽

Healthcare Providers ◽

Health Insurance Coverage ◽

Healthcare Services ◽

Safety Net ◽

The United States ◽

Public And Private

The complexity of US healthcare systems is staggering. In 2015, Americans spent approximately $3.7 trillion on healthcare, averaging almost $10,000 per person. Further, Americans rely on a mixture of public and private health insurance coverage to pay for the bulk of the healthcare services they receive. To provide a better understanding of the financing of healthcare in the United States, this chapter examines major government healthcare programs and funding. It begins with a look at the US public health insurance system and the healthcare “safety net,” comprised of a patchwork of public, private, and philanthropic providers and programs. The next sections look at how US insurers and families pay doctors, hospitals, nursing homes, and other healthcare providers to deliver services in the United States and how pharmacy services are financed in public health.

Download Full-text

Extent of Healthcare Provider Adherence to National Health Insurance Scheme (NHIS) Operational Guidelines: The Nigeria Experience

Journal of Public Administration and Governance ◽

10.5296/jpag.v9i3.15279 ◽

2019 ◽

Vol 9 (3) ◽

pp. 239

Author(s):

Ikechukwu Vincent Obi ◽

Ijeoma Lewechi Okoronkwo ◽

Emmanuel Chukwunonye Azuike ◽

Kamtoochukwu Maduneme Obi ◽

Ifunanya Rosemary Obi

Keyword(s):

Health Insurance ◽

Healthcare Provider ◽

National Health Insurance ◽

National Health ◽

Healthcare Providers ◽

Sampling Technique ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Provision Of Services ◽

Provider Adherence

The main objective of the National health insurance programme is to improve the health status of the populace in Nigerians. The healthcare provider provision of services in the programme has become a source of worry to government and other stakeholders. This study therefore sets out to examine the extent of healthcare provider adherence to NHIS operational guidelines. Design/Methodology: This is a cross-sectional survey using a questionnaire method. Sample size was calculated (demand side) using G-power 3.1 software and (supply side) Cochran formular and the calculated sample sizes were 1435 and 46 respectively. Multistage sampling technique was applied. Variables were analyzed using descriptive and T- test statistics with SPSS version 25. Result: Out of the 1435 enrollees 80% disagreed that providers provide laboratory services. Also, 91% of them disagreed that providers provide prescribed drugs. In contrast, both the enrollee (67%) and providers (69%) agreed that providers are polite while providing services. The Test value was set at 75%. The calculated T value for operational guideline for enrollees was 70.81 (p<0.05) on the opinion of the enrollees on extent of provider provision of services. The calculated T-value for operational guideline for providers was 2.40 (p<0.05) on the opinion of providers on the provision of services. Conclusion: The evidence from this study have identified areas in the service provision to be addressed by policy makers and in contrast showed that both the enrollees and providers agreed overall that the healthcare providers adhere to NHIS operational guideline.

Download Full-text

Evaluation of parents' knowledge, attitudes, and practices regarding self-medication for their children’s dental problems during the COVID-19 pandemic: a cross-sectional survey

BMC Oral Health ◽

10.1186/s12903-021-01466-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emine Sen Tunc ◽

Emre Aksoy ◽

Hatice Nilden Arslan ◽

Zeynep Kaya

Keyword(s):

Healthcare Providers ◽

Healthcare Services ◽

Pediatric Dentistry ◽

Cross Sectional Survey ◽

Self Medication ◽

Chi Square ◽

Cross Sectional ◽

Attitudes And Practices ◽

Chi Square Test ◽

Knowledge Attitudes And Practices

Abstract Background Self-medication refers to taking medicine without consultation with a doctor or dentist, and it is an important health issue, especially during the COVID-19 pandemic. There are no data about parents’ SM practices for their children’s dental problems during the COVID-19 pandemic. The present study aims to evaluate parents’ knowledge, attitudes, and practices regarding self-medication for their children’s dental problems during the COVID-19 pandemic in Northern Turkey. Methods A cross-sectional survey was carried out in the pediatric dental clinic at Ondokuz Mayis University, Faculty of Dentistry, Department of Pediatric Dentistry, immediately after the COVID-19 lockdown ended. A total of 389 parents who agreed to participate in the study completed the questionnaire from July 1 to October 1. A questionnaire with 18 items was designed to collect information on the parents’ knowledge and attitudes regarding when, why, and how to use drugs and on their practices on medicating their children. The collected data were analyzed using descriptive and analytical statistics (chi-square test). Results The majority of parents (n = 273; 70.2%) practiced self-medication for their children's dental problems. Self-medication with a previously prescribed medications was usually preferred by parents (n = 179; 62.2%). Analgesics (98%) were the most commonly used medicines by parents in their self-medication for their children's dental problems. Conclusion Prevalence of self-medication practices for children's dental problems is high in Turkey during the COVID-19 pandemic. Therefore, new healthcare services, such as teledentistry, may be useful to overcome problems related to the self-medication of children during times when the ability to reach healthcare providers is limited, such as during pandemics.

Download Full-text

Social Health Insurance Difference in Inpatient Expenditure and Service Category in China

Asia Pacific Journal of Public Health ◽

10.1177/1010539517751745 ◽

2018 ◽

Vol 30 (1) ◽

pp. 56-66 ◽

Cited By ~ 1

Author(s):

Qing Wang ◽

Jay Shen ◽

Jennifer Rice ◽

Kaitlyn Frakes

Keyword(s):

Health Insurance ◽

Social Health Insurance ◽

Public Hospitals ◽

Social Health ◽

Institutional Characteristics ◽

Inpatient Service ◽

Care Seeking ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Service Category

China successfully achieved universal health insurance coverage in 2011. Previous work on the effects of social health insurance in China has overlooked the association between health insurance and inpatient service category as well as the mechanisms of institutional characteristics. This study seeks to estimate the social health insurance difference in inpatient expenditure and service category. The role of institutional characteristics was also studied. The logistic model was applied to estimate the association of social health insurance and service category. In addition, Heckman Selected Model and generalized linear model were used to examine the association of health insurance and inpatient expenditure. Estimations were done for 4076 individuals older than 45 years using pooled cross-sectional survey data from the China Health and Retirement Longitudinal Study conducted in 2011 and 2013. Patients with health insurance were more likely to spend more and receive more types of inpatient service. This relationship was partially explained by the institutional characteristics. Therefore, this study highlights the importance of enforcing the regulation of referral mechanisms, the tiered copayment requirement to guide people’s care-seeking behavior, and reforming the allocation of limited health resources between different levels of facilities and also between private and public hospitals.

Download Full-text

Policy Literacy, Barriers, and Gender Impact on Accessibility to Healthcare Services under Compulsory Migrant Health Insurance among Myanmar Migrant Workers in Thailand

Journal of Environmental and Public Health ◽

10.1155/2020/8165492 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Sa Hlyan Htet Naing ◽

Sang-Arun Isaramalai ◽

Phen Sukmag

Keyword(s):

Public Health ◽

Health Insurance ◽

Migrant Workers ◽

Health Care Services ◽

Personal Data ◽

Healthcare Services ◽

Migrant Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

And Gender

Accessibility to health service and experience of healthcare are important factors for public health policymaking. The current study aimed to describe the status of accessibility and barriers to getting care as well as policy literacy among Myanmar migrant workers and ultimately to identify the predictors of accessibility to healthcare services among this population through Thailand’s Compulsory Migrant Health Insurance (CMHI). A cross-sectional survey was used to collect data from 240 Myanmar migrant workers who were 18 years or older, resided in Songkhla Province, and had Compulsory Migrant Health Insurance. The instrument was a set of questionnaires consisting of a Personal Data Form, Policy Literacy Questionnaire, Barriers to Get Care Questionnaire, and Accessibility to Healthcare Services Questionnaire. Descriptive statistics, correlation analysis, and multiple regression analysis were used to analyze data. The majority of participants had a high level of policy literacy (36.3%), barriers to get care (34.2%), and accessibility to health care services (35.8%). Policy literacy (β = 0.35, p < 0.001 ), barriers to get care (β = −0.32, p < 0.001 ), and gender ( p < 0.001 ) were significant predictors of accessibility to healthcare services and could explain 43.2% of the total variance. To increase the accessibility to healthcare services among migrant workers with Compulsory Migrant Health Insurance, public health policymakers are recommended to cooperate more with healthcare staff and the workers’ employers to enhance the distribution of information about the health insurance to decrease barriers to get care.

Download Full-text