Health Service Utilization Among Out-of-Pocket Payers and Fee-Wavier Users in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia: A Comparative Cross-Sectional Study

The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study

BACKGROUND

Patients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users' perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers.

METHODS

A community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval.

RESULTS

A typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0-10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091).

CONCLUSIONS

Service users' perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users' perceptions, with a special emphasis on improving health care providers' communication skills and removing facility-level access barriers.

Health services utilization and associated factors among fee waiver beneficiaries' in Dessie city administration, Northeast Ethiopia: a cross-sectional study design

BACKGROUND

The fee waiver system is one of the components of the 2004 health care financing reform in Ethiopia. It is a system for granting access to health services to those who are unable to pay. The utilization health services among fee waiver beneficiaries remain low and unevenly distributed. This study aimed to assess the utilization of health services and associated factors among fee waiver beneficiaries in Dessie City, Northeast Ethiopia.

METHODS

A community-based cross-sectional study design was employed in Dessie City from March 23 to April 23, 2021. The study was conducted among 407 fee waiver beneficiaries. A structured, interviewer-administered questionnaire was used to collect data. Participants were selected using a simple random sampling technique. Both bi-variable and multi-variable binary logistic regressions were performed. Significant factors for the outcome variable were identified at 95% CI with a p-value < 0.05.

RESULTS

The overall health service utilization among fee waiver beneficiaries was found to be 62.4% (95% CI: 58.1-67.2). Being an urban resident [AOR:2.83, 95% CI:1.26-6.32], having a merchant occupation [AOR:0.20, 95% CI:0.05-0.80], having an average monthly income of 500-1000 birr [AOR:3.22, 95% CI:1.06-6.90], having a chronic disease [AOR:8.36, 95% CI:4.47-15.62], and perceiving the severity of illness as mild [AOR: 0.24, 95% CI: 0.07-0.81] were found to be statistically associated factors with health service utilization.

CONCLUSIONS

The fee waiver beneficiaries were not fully utilizing health services at public health facilities. Being an urban resident, being a merchant, having an average monthly income of 500-1000 birr, having a chronic disease, and perceived severity of illness were significantly associated with health service utilization. As a result, boosting income-generating strategies and urbanizing rural parts of the city may improve health service utilization among fee waiver beneficiaries.

Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis

Background

High burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia.

Methods

We searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing.

Results

A total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia’s health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments.

Conclusion

Ethiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.

Utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, North Wollo zone, Ethiopia

OBJECTIVE

This study aimed to assess the utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, Ethiopia, in 2020.

STUDY DESIGN

A community-based cross-sectional study was used.

METHODS

Using an interviewer-administered questionnaire, data were collected from 550 randomly selected households. EpiData version 4.6 was used to enter data, and SPSS version 23 was used to analyze it. Multivariable logistic regression analysis was applied to identify the associated factors with health service utilization.

RESULTS

The overall health service utilization among fee waiver beneficiaries was 60.98% (95% confidence interval [CI]: 56.4-64.4%). Being an urban resident (adjusted odds ratio [AOR]: 3.2, 95% CI: 1.41-7.28), family size (AOR: 3.17, 95% CI: 1.49-6.75), perceived health status (AOR: 6.26, 95% CI: 3.76-10.41), travel time (AOR: 2.75, 95% CI: 1.25-6.06), perceived distance (AOR: 13.69, 95% CI: 5.22-35.91), and perceived medium (AOR: 3.07, 95% CI: 1.71-5.52) and cheap (AOR: 3.02, 95%CI: 1.43-6.36) transport costs were significantly associated with utilization of health services.

CONCLUSIONS

This study revealed that the level of health service utilization among beneficiaries in the Dawunt district was 60.98%. Residence, family size, perceived health status, travel time to the nearest Health Facility (HF), perceived distance, and travel cost to reach the HFs were significantly associated with Health Services Utilization (HSU). Therefore, improving physical accessibility of health services and availability of necessary health services at an affordable cost will possibly result in better utilization of healthcare services.