Does enrollment status in community-based insurance lead to poorer quality of care? Evidence from Burkina Faso

International Journal for Equity in Health

Rainer Sauerborn³  Ali Sié¹  Brice Bicaba²  Germain Savadogo¹  Aurélia Souares³  Till Bärnighausen⁴  Paul Jacob Robyn⁵ 

[1] Nouna Health Research Centre, Ministry of Health, Nouna, Burkina Faso;Nouna Health District, Ministry of Health, Ouagadougou, Burkina Faso;Institute of Public Health, University of Heidelberg, Heidelberg, Germany;Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa;The World Bank, 1818 H Street NW, Washington, DC, USA

关键词: Burkina Faso;    Health care utilization;    Quality of health care;    Health care providers;    Health insurance;    Community-based health insurance;   

Others  :  824885
DOI  :  10.1186/1475-9276-12-31

 received in 2012-11-25, accepted in 2013-05-03,  发布年份 2013

【 摘 要 】

Introduction

In 2004, a community-based health insurance (CBI) scheme was introduced in Nouna health district, Burkina Faso, with the objective of improving financial access to high quality health services. We investigate the role of CBI enrollment in the quality of care provided at primary-care facilities in Nouna district, and measure differences in objective and perceived quality of care and patient satisfaction between enrolled and non-enrolled populations who visit the facilities.

Methods

We interviewed a systematic random sample of 398 patients after their visit to one of the thirteen primary-care facilities contracted with the scheme; 34% (n = 135) of the patients were currently enrolled in the CBI scheme. We assessed objective quality of care as consultation, diagnostic and counselling tasks performed by providers during outpatient visits, perceived quality of care as patient evaluations of the structures and processes of service delivery, and overall patient satisfaction. Two-sample t-tests were performed for group comparison and ordinal logistic regression (OLR) analysis was used to estimate the association between CBI enrollment and overall patient satisfaction.

Results

Objective quality of care evaluations show that CBI enrollees received substantially less comprehensive care for outpatient services than non-enrollees. In contrast, CBI enrollment was positively associated with overall patient satisfaction (aOR = 1.51, p = 0.014), controlling for potential confounders such as patient socio-economic status, illness symptoms, history of illness and characteristics of care received.

Conclusions

CBI patients perceived better quality of care, while objectively receiving worse quality of care, compared to patients who were not enrolled in CBI. Systematic differences in quality of care expectations between CBI enrollees and non-enrollees may explain this finding. One factor influencing quality of care may be the type of provider payment used by the CBI scheme, which has been identified as a leading factor in reducing provider motivation to deliver high quality care to CBI enrollees in previous studies. Based on this study, it is unlikely that perceived quality of care and patient satisfaction explain the low CBI enrollment rates in this community.

【 授权许可】

   
2013 Robyn et al.; licensee BioMed Central Ltd.

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