An assessment of out of pocket payments in public sector health facilities under the free maternal healthcare policy in Ghana

Health Economics Review

Research

Maxwell Tii Kumbeni¹  Paschal Awingura Apanga²  Agani Afaya³ 

[1] Department of Health Management and Policy, College of Public Health and Human Sciences, Oregon State University, Corvallis, USA;Kentucky Department for Public Health, Frankfort, USA;Mo Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea;Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana;

关键词: Free maternal healthcare policy;    National health insurance scheme;    Out of pocket payment;    Skilled delivery services;    Public sector health facilities;    Health system factors;    Ghana;   

DOI  :  10.1186/s13561-023-00423-0

 received in 2022-05-30, accepted in 2023-01-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe free maternal healthcare policy was introduced in Ghana in 2008 under the national health insurance scheme as a social intervention to improve access to maternal health services. This study investigated the prevalence of out of pocket (OOP) payment among pregnant women with valid national health insurance who sought skilled delivery services at public sector health facilities in Ghana. The study also assessed the health system factors associated with OOP payment.MethodsWe used data from the Ghana Maternal Health Survey (GMHS), which was conducted in 2017. The study comprised 7681 women who delivered at a public sector health facility and had valid national health insurance at the time of delivery. We used multivariable logistic regression analysis to assess factors associated with OOP payment, whiles accounting for clustering, stratification, and sampling weights.ResultsThe prevalence of OOP payment for skilled delivery services was 19.0%. After adjustment at multivariable level, hospital delivery services (adjusted Odds Ratio [aOR] = 1.23, 95% Confidence Interval [CI] = 1.00, 1.52), caesarean section (aOR = 1.73, 95% CI = 1.36, 2.20), and receiving intravenous infusion during delivery (aOR = 1.31, 95% CI = 1.08, 1.60) were associated with higher odds of OOP payment. Women who were discharged home 2 to 7 days after delivery had 19% lower odds of OOP payment compared to those who were discharged within 24 hours after delivery.ConclusionThis study provides evidence of high prevalence of OOP payment among women who had skilled delivery services in public sector health facilities although such women had valid national health insurance. Government may need to institute measures to reduce OOP payment in public sector facilities especially at the hospitals and for women undergoing caesarean sections.

【 授权许可】

CC BY   
© The Author(s) 2023