scholarly journals The Impact of i-PUSH on Maternal and Child Health Outcomes, Health Care Utilization and Financial Protection: A Cluster Randomised Controlled Trial Based on Financial and Health Diaries Data

2020 ◽  
Author(s):  
Amanuel Abajobir ◽  
Richard de Groot ◽  
Caroline Wainaina ◽  
Anne Njeri ◽  
Daniel Maina ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Low Income ◽  
Health Knowledge ◽  
Care Utilization ◽  
Quality Health ◽  
Randomised Controlled ◽  
The Impact ◽  
Quality Health Services

Abstract Background: Universal Health Coverage (UHC) ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries (LMICs), including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing CHVs’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake.Methods: This is a cluster randomised controlled trial (RCT) study that uses a four-pronged approach –including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study and behavioral lab-in-the-field experiments–in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures and enrolment in health insurance over time. A random half of the households live in villages assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board (AMREF-ESRC). Research permits were obtained from the National Commission for Science, Technology and Innovation (NACOSTI) agency of Kenya. Discussion: People in LMICs often suffer from high out-of-pocket healthcare expenditures, which in turn, impedes access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels–individuals, families and communities. Notable, i-PUSH fosters savings for health care through the mobile-phone based “health wallet”, it enhances enrolment in subsidized health insurance through the mobile platform–M-TIBA–developed by PAF, and it seeks to improve health knowledge and behavior through Community Health Volunteers (CHVs) who are trained using the LEAP tool–AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to UHC in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. Trial registration history: Registered with Protocol Registration and Results System (Protocol ID: AfricanPHRC; Trial ID: NCT04068571: AEARCTR-0006089; Date: 29 August 2019) and The American Economic Association's registry for randomised controlled trials (Trial ID: AEARCTR-0006089; Date: 26 June 2020).

scholarly journals The impact of i-PUSH on maternal and child health care utilization, health outcomes, and financial protection: study protocol for a cluster randomized controlled trial based on financial and health diaries data

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Amanuel Abajobir ◽  
Richard de Groot ◽  
Caroline Wainaina ◽  
Anne Njeri ◽  
Daniel Maina ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Study Protocol ◽  
Low Income ◽  
Health Knowledge ◽  
Randomized Controlled ◽  
Quality Health ◽  
The Impact ◽  
Quality Health Services

Abstract Background Universal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior, and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing community health volunteers’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake. Methods This is a study protocol for a cluster randomized controlled trial (RCT) study that uses a four-pronged approach—including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study, and behavioral lab-in-the-field experiments—in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures, and enrolment in health insurance over time. Half of the households live in villages randomly assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board. Research permits were obtained from the National Commission for Science, Technology and Innovation agency of Kenya. Discussion People in low-and middle-income countries often suffer from high out-of-pocket healthcare expenditures, which, in turn, impede access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels—individuals, families, and communities. Notably, i-PUSH fosters savings for health care through the mobile-phone based “health wallet,” it enhances enrolment in subsidized health insurance through the mobile platform—M-TIBA—developed by PAF, and it seeks to improve health knowledge and behavior through community health volunteers (CHVs) who are trained using the LEAP tool—AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to Universal Health Coverage in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. Trial registration Registered with Protocol Registration and Results System (protocol ID: AfricanPHRC; trial ID: NCT04068571: AEARCTR-0006089; date: 29 August 2019) and The American Economic Association’s registry for randomized controlled trials (trial ID: AEARCTR-0006089; date: 26 June 2020).

scholarly journals Analysis of the Effect of Health Insurance on Health Care Utilization in Rwanda

2021 ◽  
Author(s):  
Roger Muremyi ◽  
Dominique Haughton ◽  
François Niragire ◽  
Ignace Kabano
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Care Utilization ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Secondary Data ◽  
Living Condition ◽  
Care Utilization ◽  
Health Coverage

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

scholarly journals Does a Different Household Registration Affect Migrants’ Access to Basic Public Health Services in China?

2019 ◽  
Vol 16 (23) ◽  
pp. 4615 ◽  
Author(s):  
Meng
Keyword(s):  
Public Health ◽  
Health Services ◽  
Low Income ◽  
Health Knowledge ◽  
Medical Knowledge ◽  
Public Health Services ◽  
Household Registration ◽  
Career Training ◽  
Permanent Settlement ◽  
The Impact

On the basis of the China Migrants Dynamic Survey Data of 2015, the author provides an analysis of how a different household registration impacts migrants’ access to preventive care provided by public health services, such as health records and medical knowledge, in areas of immigration. This study shows that eliminating the distinction between agricultural and non-agricultural permanent residence registration could raise the rate of establishing health files, but it has no significant effect on migrants’ health knowledge. In fact, encouraging those with non-agricultural registration to move to different counties that belong to the same city or to different cities that belong to the same province can notably eliminate the impact of a different household registration status. Improving the income level of low-income migrants can have the same impact. Recommendations to enable migrants to obtain basic public health services include abolishing the separation of agricultural and non-agricultural household registration, increasing the permanent settlement rate of resident migrants, promoting basic medical security systems across the whole country, strengthening career training, and enhancing the education level of migrants.

Consumer-Driven Health Care

2000 ◽  
Vol 35 (5) ◽  
pp. 477-478
Author(s):  
F. Randy Vogenberg
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Services ◽  
Health Systems ◽  
Quality Health Care ◽  
Managed Health Care ◽  
The Future ◽  
Quality Health ◽  
The Many ◽  
The Impact

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.

scholarly journals Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Huan Liu ◽  
Hong Zhu ◽  
Jiahui Wang ◽  
Xinye Qi ◽  
Miaomiao Zhao ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Low Income ◽  
Health Expenditure ◽  
Concentration Index ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Integration System ◽  
Integration Policies ◽  
The Impact

Abstract Background By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is − 0.071 and − 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

Reining in the Pharmacy Budget

2000 ◽  
Vol 35 (4) ◽  
pp. 354-356
Author(s):  
F. Randy Vogenberg
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Services ◽  
Health Systems ◽  
Quality Health Care ◽  
Managed Health Care ◽  
The Future ◽  
Quality Health ◽  
The Many ◽  
The Impact

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.

Talking about and Using Pharmacoeconomics Properly

2001 ◽  
Vol 36 (7) ◽  
pp. 717-722
Author(s):  
F. Randy Vogenberg
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Services ◽  
Health Systems ◽  
Quality Health Care ◽  
Managed Health Care ◽  
The Future ◽  
Quality Health ◽  
The Many ◽  
The Impact

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.

scholarly journals The Oregon Health Insurance Experiment: Evidence from the First Year*

2012 ◽  
Vol 127 (3) ◽  
pp. 1057-1106 ◽  
Author(s):  
Amy Finkelstein ◽  
Sarah Taubman ◽  
Bill Wright ◽  
Mira Bernstein ◽  
Jonathan Gruber ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Treatment Group ◽  
Low Income ◽  
Health Care Use ◽  
Financial Strain ◽  
Care Utilization ◽  
Control Group ◽  
First Year ◽  
Physical And Mental Health

Abstract In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

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