Factors affecting the uptake of community-based health insurance in Ethiopia: a systematic review

<p class="abstract">The goal of health care financing in Ethiopia is achieving universal health care coverage by community-based health insurance which was expected to cover more than eighty percent of the population. The aim was to minimize catastrophic out-of-pocket health service expenditure. We systematically reviewed factors affecting the uptake of community-based health insurance in Ethiopia. We searched various databases by 09 to 10 March 2019. We included articles regardless of their publication status with both quantitative and qualitative approaches. The factors determining the uptake of community-based health insurance in Ethiopia were found to be demographic and socio-economic, and health status, and health service-related issues. Among demographic and socio-economic factors, the report of the studies regarding gender and age was not consistent. However, income, education, community participation, marriage, occupation, and family size were found to be significant predictors and were positively related to the uptake of the scheme.<strong> </strong>Concerning health status and health service-related factors; illness experience, benefit package, awareness level, previous out of pocket expenditure for health care service, and health service status (quality, adequacy, efficiency, and coverage) were significantly and positively related but the premium amount, self-rated health status and bureaucratic complexity were found to be negative predictors. To achieve universal health care coverage through community-based health insurance, special attention should be given to community-based intervention.</p>

When the Masks Come Off in Canada and Guatemala: Will the Realities of Racism and Marginalization of Midwives Finally Be Addressed?

This article addresses the effects of COVID-19 in Eastern and Northern Ontario, Canada, with a comparative glimpse at the small province of Totonicapán, Guatemala, with which Canadians have been involved in obstetric and midwifery care in particular over the last 5 years. With universal health care coverage since 1966 and well-integrated midwifery, Canada's system would be considered relatively well set up to deal with a disaster like COVID-19 compared to low resource countries like Guatemala or countries without universal health care insurance (like the USA). However, the epidemic has uncovered the fact that in Ontario, Indigenous, Black, and People of Color (IBPOC), as elsewhere, may have been hardest hit, often not by actually contracting COVID-19, but by suffering secondary consequences. While COVID-19 could be an issue through which health care professionals can come together, there are signs that the medical hierarchies in many hospitals in both Ontario and Totonicapán are taking advantage of COVID-19 to increase interventive measures in childbirth and reduce midwives' involvement in hospitals. Meanwhile, home births are on the rise in both jurisdictions. Stories from a Jamaican Muslim woman in Ottawa, an Indigenous midwifery practice in Northern Ontario, registered midwives in Eastern Ontario, and about the traditional midwives in Guatemala reveal similar as well as unique problems resulting from the lockdowns. While this article is not intended to constitute an exhaustive analysis of social justice and human rights issues in Canada and Guatemala, we do take this opportunity to demonstrate where COVID-19 has become a catalyst that challenges the standard narrative, exposing the old ruts and blind spots of inequality and discrimination that our hierarchies and inadequate data collection—until the epidemic—were managing to ignore. As health advocates, we see signs that this pandemic is resulting in more open debate, which we hope will last long after it is over in both our countries.

Prevalence and Characteristics of Psoriasis Patients in a Primary Care Area in Thailand

Background: Psoriasis is a chronic dermatological illness with a high burden of morbidity. There is no collective data on its prevalence and incidence in Thailand to date. Objective: To explore the prevalence and patient characteristics in a primary care area with a population of approximately 30,000 under the Universal Health Care Coverage Scheme serviced by the authors’ university hospital. Materials and Methods: The authors conducted a retrospective database analysis from the hospital electronic medical record system on patients seen between January 2015 and December 2019. Psoriasis patients were identified by using the International Statistical Classification of Diseases and Related Health Problems Tenth Revision codes containing L40 (L40.0 to L40.9). The diagnosis for each patient was then confirmed from the medical chart review. The number of visits and number of psoriasis patients in the Universal Health Care Coverage Scheme in the primary care setting was counted, and a five-year period prevalence was calculated. Characteristics of psoriasis patients were analyzed including their ages, gender, comorbidity, and systemic treatment received. Results: During the five-year period, there were 338 visits from 40 individual psoriasis patients. The five-year period prevalence of psoriasis was 0.13% or 133 per 100,000 persons. The mean age of psoriasis patients was 50 years. Male consisted of 47% of patients. Forty-two percent of patients required systemic treatment. Conclusion: The five-year period prevalence of psoriasis was 0.13%, which is less than the prevalence in the western countries but similar to other east Asian countries. The limitation of the present study was the relatively small geographic area and the possibility of underestimating prevalence due to some patients may not have sought treatment or were treated at other health facilities. After adjusting for underreporting bias, the adjusted prevalence is 0.43%. Keywords: Psoriasis, Prevalence, Thailand

What explains the inequalities in health care utilization between immigrants and non-migrants in Switzerland?

Background Inequalities in health care use between immigrants and non-migrants are an important issue in many countries, with potentially negative effects on population health and welfare. The aim of this study is to understand the factors that explain these inequalities in Switzerland, a country with one of the highest percentages of foreign-born population. Methods Using health survey data, we compare non-migrants to four immigrant groups, differentiating between first- and second-generation immigrants, and culturally different and similar immigrants. To retrieve the relative contribution of each inequality-associated factor, we apply a non-linear decomposition method and categorize the factors into demographic, socio-economic, health insurance and health status factors. Results We find that non-migrants are more likely to visit a doctor compared to first-generation and culturally different immigrants and are less likely to visit the emergency department. Inequalities in doctor visits are mainly attributed to the explained component, namely to socio-economic factors (such as occupation and income), while inequalities in emergency visits are mainly attributed to the unexplained component. We also find that despite the universal health care coverage in Switzerland systemic barriers might exist. Conclusions Our results indicate that immigrant-specific policies should be developed in order to improve access to care and efficiently manage patients in the health system.

COVID-19 Vaccination Rates by Global Universal Health Care Coverage Status

Healthcare coverage and the type of insurance have always played huge roles in public health outcomes. With coronavirus disease-2019 (COVID-19) vaccination now available across the world, we sought to determine vaccination rates across countries with Universal Health Care (UHC) coverage versus those without. We utilized the vaccination information from the Coronavirus (COVID-19) Vaccinations website, and calculated early vaccination rate for each country as of January, 13, 2021 by dividing the total number of vaccinations given to the total population of the country. We observed that the average early vaccination rate for countries with UHC was 1.55%, whereas that for countries without UHC was 0.51%. Countries with UHC are performing much better than those without UHC in this initial race for providing herd immunity across the globe. Copyright © 2021 Dongarwar and Salihu. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Factors affecting community based health insurance utilization in Ethiopia: A systematic review

Background: The goal of health care financing in Ethiopia has been to achieve universal health care coverage by minimizing the catastrophic out of pocket health service expenditure. Even though the performance was not as planned, the promising strategy to achieve universal health care coverage in the informal sector was community based health insurance which was expected to cover more than 83 % of the population. So, we systematically reviewed determinants of community based health insurance utilization in Ethiopia. Methods: We searched DOAJ, EconBiz, ERIC, Google Scholar, Oxford Journals, PubMed, SpringerLink, Europe PMC, Microsoft Academic Search, OAIster and AJ including various relevant websites by March 9 to 10, 2019. We included articles regardless of their publication status with both quantitative and qualitative approaches. Results: The factors determining community based health insurance utilization in Ethiopia were found to be associated with supply side, health facility, demographic and socioeconomic predictors. Among demographic and socio-economic factors, the report of the studies regarding to gender and age was not consistent. However income, education, community participation, marriage, occupation and family size were found to be significant predictors and were positively related with the scheme’s utilization. With respect to health status and health service related factors; illness experience, benefit package, awareness level, previous out of pocket expenditure for health care service and health service status (quality, adequacy, efficiency and coverage) were significantly and positively related but premium amount, self-rated health status and bureaucratic complexity were found to be negative predictors. Conclusion: To achieve universal health care coverage through community based health insurance, it is advisable that special attention should be given to income level, education, community participation, marriage, family size, benefit package, awareness level and health service quality, premium amount and bureaucratic or governance issue.