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

International Journal for Equity in Health

Research

Till Bärnighausen¹  Rainer Sauerborn²  Aurélia Souares²  Germain Savadogo³  Paul Jacob Robyn⁴  Brice Bicaba⁵  Ali Sié⁶ 

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

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

DOI  :  10.1186/1475-9276-12-31

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

来源: Springer

【 摘 要 】

IntroductionIn 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.MethodsWe 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.ResultsObjective 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.ConclusionsCBI 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】

CC BY   
© Robyn et al.; licensee BioMed Central Ltd. 2013