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Bayked EM, Assfaw AK, Toleha HN, Zewdie S, Biset G, Ibirongbe DO, Kahissay MH. Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis. Front Public Health 2024; 12:1390937. [PMID: 38706546 PMCID: PMC11066245 DOI: 10.3389/fpubh.2024.1390937] [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: 02/24/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia. Methods Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI. Results Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it. Conclusion The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Abebe Kibret Assfaw
- Department of Psychology, Institute of Teachers’ Education and Behavioral Science, Wollo University, Dessie, Ethiopia
| | - Husien Nurahmed Toleha
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Segenet Zewdie
- Department of Pharmacy, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
| | - Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, 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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Derakhshani N, Maleki M, Pourasghari H, Azami-Aghdash S. The influential factors for achieving universal health coverage in Iran: a multimethod study. BMC Health Serv Res 2021; 21:724. [PMID: 34294100 PMCID: PMC8299681 DOI: 10.1186/s12913-021-06673-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran. METHODS This is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system's control knobs framework during three expert panel sessions. RESULTS Finally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts' panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the "regulation and supervision" dimension, whilst the "payment system" entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC. CONCLUSION Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries' experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.
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Affiliation(s)
- Naser Derakhshani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Chaleunvong K, Phoummalaysith B, Phonvixay B, Sychareun V, Durham J, Essink DR. Factors affecting knowledge of National Health Insurance Policy among out-patients in Lao PDR: an exit interview study. Glob Health Action 2021; 13:1791414. [PMID: 32741346 PMCID: PMC7480647 DOI: 10.1080/16549716.2020.1791414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Universal health coverage is target 3.8 of the Sustainable Development Goals. In many lower-middle-income countries, however, major coverage gaps exist. Those who do receive services often experience high out-of-pocket expenses. To achieve universal health coverage, Lao PDR, a lower-middle-income country in South-East Asia, is shifting from a fragmented model of health financing to a national health insurance scheme. OBJECTIVE The objective of this cross-sectional survey was to assess the knowledge of the NHI in Lao PDR among insured in- and out-patients using health services at selected public health facilities at provincial, district and health centre level in six provinces. METHODS This was a cross-sectional survey. Healthcare facilities were selected based on the rate of use of health services at the health facility and participants selected using systematic random sampling. Exit interviews were conducted with in- and out-patients of each selected health facility, using a pre-tested structured questionnaire. Descriptive statistics were generated including means (median), frequency and percentages. Poisson regression was applied to determine the factors associated with knowledge of the insurance scheme. RESULTS In total 326 participants were recruited (response rate 93%). Of these, less than two-thirds (62.3%) said they had their eligibility documents with them. Only 23.6% knew the co-payment fee at the health centre level; while 18.1% and 18.7% knew about the co-payment fee at the district and provincial healthcare level, respectively. A key determinant of accessing NHI and health services was knowledge of the scheme and its benefits. CONCLUSION This study suggests in Lao PDR, awareness about health insurance is low. More innovative demand-side strategies are needed to create awareness and understanding of the NHI and its benefits. Without an understanding of what insurance policies mean, universal health coverage cannot be achieved, even where appropriate and acceptable services are accessible.
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Affiliation(s)
- Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences , Vientiane, Lao PDR
| | | | | | - Vanpahnom Sychareun
- Institute of Research and Education Development, University of Health Sciences , Vientiane, Lao PDR
| | - Jo Durham
- School of Public Health, Queensland University of Technology , Brisbane, Australia
| | - Dirk R Essink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit , Amsterdam, Netherlands
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Petrunoff N, Yao J, Sia A, Ng A, Ramiah A, Wong M, Han J, Tai BC, Uijtdewilligen L, Müller-Riemenschneider F. Activity in nature mediates a park prescription intervention's effects on physical activity, park use and quality of life: a mixed-methods process evaluation. BMC Public Health 2021; 21:204. [PMID: 33482787 PMCID: PMC7825241 DOI: 10.1186/s12889-021-10177-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background This process evaluation explored the implementation and mechanisms of impact of a Park Prescription Intervention trial (PPI), including the effects of hypothesised mediators (motivation, social support, recreational physical activity [PA], park use and park PA) on trial outcomes. Methods Participants from the community were randomly allocated to intervention (n = 80) or control (n = 80) group. The intervention included baseline counselling, a prescription of exercise in parks, materials, three-month follow-up counselling and 26 weekly group exercise sessions in parks. Process evaluation indicators were assessed at three- and six-months. Implementation indicators included participation rates in intervention components and survey questions plus focus group discussions (FGDs) to understand which components participants valued. FGDs further assessed barriers and facilitators to intervention participation. To explore mechanisms of impact, linear regression was used to compare objectively measured PA between quantiles of group exercise participation. Structural equation modelling (SEM) explored hypothesised mediation of the significant intervention effects. Framework analysis was conducted for FGDs. Results Participants were middle-aged (mean 51, SD ± 6.3 years), predominantly female (79%) and of Chinese ethnicity (81%). All intervention participants received baseline counselling, the park prescription and materials, whilst 94% received the follow-up counselling. Mean minutes of moderate-to-vigorous PA/week (95% CI) differed by group exercise participation (p = 0.018): 0% participation (n = 18) 128.3 (69.3, 187.2) minutes, > 0–35.9% participation (n = 18) 100.3 (36.9, 163.6) minutes, > 35.9–67.9% participation (n = 17) 50.5 (− 4.9, 105.9) minutes and > 67.9% participation (n = 18) 177.4 (122.0, 232.8) minutes. Park PA at three-months had significant mediating effects (95% CI) on recreational PA 26.50 (6.65, 49.37) minutes/week, park use 185.38 (45.40, 353.74) minutes/month, park PA/month 165.48 (33.14, 334.16) minutes and psychological quality of life score 1.25 (0.19, 2.69) at six-months. Prioritising time with family and preferences for unstructured activities were barriers to intervention participation. Human interaction via follow-up or group exercise were facilitators. Conclusion This process evaluation showed park PA consistently mediated effects of the PPI, suggesting activity in parks was a mechanism of its effects. To optimise effectiveness, participants’ preference for prioritising time with family through family involvement and tailoring the intervention to participants’ preferences for structured or unstructured PA could be considered in future studies. Trial registration ClinicalTrials.gov NCT02615392, 26 November 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10177-1.
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Affiliation(s)
- Nicholas Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| | - Jiali Yao
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Angelia Sia
- Centre for Urban Greenery & Ecology, National Parks Board Singapore, 1E Cluny Rd., Singapore Botanic Gardens, Singapore, 259569, Singapore
| | - Alwyn Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Anbumalar Ramiah
- Health for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun Central, Singapore, 768828, Singapore
| | - Michael Wong
- Health for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun Central, Singapore, 768828, Singapore
| | - Jane Han
- Health for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun Central, Singapore, 768828, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Léonie Uijtdewilligen
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.,Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre Berlin, Luisenstrasse 57, 10117, Berlin, Germany
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Fernandopulle BMR, Gunawardena N, de Silva SHP, Abayawardana C, Hirimuthugoda LK. Patient experiences of access to NCD medicines in Sri Lanka: Evidence of the success story towards universal coverage. MEDICINE ACCESS @ POINT OF CARE 2019. [DOI: 10.1177/2399202619873228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: In Sri Lanka in 2013, 16 medicines were identified as priority to manage non-communicable disease (NCD), and in 2017, 48 NCD medicines were price-regulated. Objective: The aim of the present study was to describe the experiences on availability of drugs and out-of-pocket expenditure (OOPE) for drugs among patients with NCDs in Sri Lanka. Methods: This community-based, household survey was conducted in nine districts of the country. The survey included 1100 adults (aged 50 years and above) with a diagnosis of NCD for 5 years. They were interviewed by trained pharmacy students. Results: Approximately 66%, 49% and 21.6% suffering from hypertension, diabetes and ischaemic heart disease, respectively, with a majority having more than one NCD. The evidence showed that prescribers align to drugs that have been recognized to be made more available and more affordable. Of all, 14% had prescriptions with all NCD medicines classified in the list, while 40% had only one or two of the drugs prescribed which are not in the list. Most of the prescribed drugs were also included in the price regulation – with 29% having all medicines included, while 31.6% having only one or two drugs prescribed out of the list. Approximately, two-thirds (64.2%) had exclusively used government hospitals for NCD care during the past 5 years. A majority (58.3%) had all prescribed drugs available at the last visit to the state sector clinic, while almost all of the others (35.7%) had some of the drugs available. Conclusion: The study concluded that patient experiences in Sri Lanka showed good availability and access to NCD medicines in Sri Lanka.
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Affiliation(s)
| | | | - SHP de Silva
- World Health Organization, Country Office, Sri Lanka
| | | | - LK Hirimuthugoda
- Ministry of Health, Nutrition and Indigenous Medicine , Colombo, Sri Lanka
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