SSM - Health Systems最新文献

{"title":"The role of routine health information systems in supporting the COVID-19 pandemic response in the Philippines and Indonesia","authors":"Mingqi Song ,&nbsp;Lutfan Lazuardi ,&nbsp;Raymond Francis R. Sarmiento ,&nbsp;Brian Sahar Afifah ,&nbsp;Gabi Ceria ,&nbsp;Razel G. Custodio ,&nbsp;Zahrotul Kamilah ,&nbsp;Romeo Luis A. Macabasag ,&nbsp;Tiara Marthias ,&nbsp;Monica B. Sunga ,&nbsp;Karen A. Grépin","doi":"10.1016/j.ssmhs.2024.100043","DOIUrl":"10.1016/j.ssmhs.2024.100043","url":null,"abstract":"<div><div>The COVID-19 pandemic highlighted the importance of high-quality, geographically disaggregated, and high-frequency data for real-time evidence-based decision-making in health systems. Routine health information systems (RHIS) collect and aggregate such data but to date there have been few case studies of how RHIS were used to support COVID-19 responses in low and middle-income countries. From July-October 2021, we conducted 112 in-depth key informant interviews (KII) and seven focus group discussions (FGDs) with policymakers in Indonesia and the Philippines to better understand the role of RHIS in supporting national responses to COVID-19. Data were analysed thematically to answer key research questions: (1) How did the pandemic affect RHIS data processes? (2) How were COVID-specific data collected and integrated into RHIS? (3) How were RHIS data used to inform response measures? (4) How did RHIS interact with other health system building blocks? We found that pandemic disrupted RHIS processes, leading to a decline in the quantity, quality, and availability of RHIS data. But the pandemic also increased awareness and appreciation of RHISs, creating opportunities to strengthen and improve the utilization of the system. RHIS data and processes were directly leveraged in critical ways to strengthen the COVID-19 response, such as contact tracing and vaccination. It also indirectly supported responses via other health system building blocks, for example, by providing important data to support the design of a COVID-19 benefit package design. However, the study also identified pre-existing challenges that limited the ability of health system planners and policymakers to optimally leverage RHIS data during the pandemic. Strengthening RHIS should be integrated into future pandemic planning activities as RHIS data and processes played critical roles during the pandemic in both countries.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-country mixed method evaluation of the HERA (Healthcare Responding to Domestic Violence and Abuse) intervention: A comparative analysis","authors":"Loraine J. Bacchus ,&nbsp;Stephanie Pereira ,&nbsp;Nagham Joudeh ,&nbsp;Beatriz Diniz Kalichman ,&nbsp;Samita K.C. ,&nbsp;Prabhash Siriwardhana ,&nbsp;Tharuka Silva ,&nbsp;Ana Flavia Pires Lucas d’Oliveira ,&nbsp;Poonam Rishal ,&nbsp;Satya Shrestha ,&nbsp;Lilia Blima Schraiber ,&nbsp;Abdulsalam Alkaiyat ,&nbsp;Thilini Rajapakse ,&nbsp;Amira Shaheen ,&nbsp;Gene Feder ,&nbsp;Helen Lambert ,&nbsp;Claudia Garcia Moreno ,&nbsp;Manuela Colombini ,&nbsp;the HERA research team","doi":"10.1016/j.ssmhs.2024.100042","DOIUrl":"10.1016/j.ssmhs.2024.100042","url":null,"abstract":"<div><h3>Background</h3><div>Domestic violence (DV) against women has adverse health consequences and demands a comprehensive healthcare response. Interventions adapted from high-income countries encounter implementation challenges in low-and-middle-income countries, due to diverse socio-cultural, political and economic contexts. This study explored HERA (Healthcare Responding to Violence and Abuse) implementation, that aimed to strengthen the healthcare response to DV in Brazil, Nepal, the occupied Palestinian territory (oPt), and Sri Lanka.</div></div><div><h3>Methods</h3><div>Parallel mixed method study (2019 – 2022). Quantitative data included the Provider Intervention Measure (PIM), training attendance records and DV documentation before and after the intervention. Qualitative data included semi-structured interviews with providers and DV survivors, field notes and stakeholder meetings. Data were integrated at the level of interpretation and reporting using a narrative approach, drawing on theories of Complex Adaptive Systems and sensemaking.</div></div><div><h3>Results</h3><div>HERA enhanced healthcare provider readiness to address DV and fostered a women-centred approach. The interaction between HERA and the diverse contexts impacted the reciprocal relationship between sensemaking and sensegiving within health systems, leading to adaptive behaviours among providers and women. This included mediation practices, negotiating DV documentation, modified roles, and containment of DV cases within the clinic. Normative gender roles, normalised DV attitudes, biomedical sensemaking frameworks, community violence, austerity policies, scarce resources, and weak leadership and management support affected implementation success.</div></div><div><h3>Conclusion</h3><div>It is important to consider the interplay between context and intervention goals during development, implementation and evaluation of health system responses to DV. Managers require specific intervention components to support organisational change. Culturally appropriate support for women should acknowledge limitations to their agency.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100042"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on the functioning of front-line health services in the Kati health district in Mali, West Africa: A qualitative study","authors":"Mohamed Ali Ag Ahmed ,&nbsp;Mahmoud Cissé ,&nbsp;Hassane Alami ,&nbsp;Bart Criel","doi":"10.1016/j.ssmhs.2024.100041","DOIUrl":"10.1016/j.ssmhs.2024.100041","url":null,"abstract":"<div><h3>Background</h3><div>Front-line health services (FHSs) are the gateway to health systems. FHSs in Africa have been hit hard by the COVID-19 pandemic. In Mali, FHSs are provided by community health centres (<em>Centres de Santé Communautaires</em> (CSComs)). The objective of this study, which, to our knowledge, is the first of its kind in Mali, was to assess the impact of the COVID-19 pandemic on the functioning of CSComs within a health district.</div></div><div><h3>Method</h3><div>This qualitative case study was carried out in four CSComs in the Kati Health District in Mali. A three-dimensional analytical framework was designed and used. Data was collected from 24 key informants through semi-structured interviews. Thematic content analysis was performed, and Nvivo software was used.</div></div><div><h3>Results</h3><div>Data analysis showed that the COVID-19 pandemic impacted all dimensions of our analytical framework. Within the CSComs, the following were particularly impacted: 1) the management of activities with adaptations in the management of human and financial resources, infrastructure and equipment, the supply of inputs and medicines and the national health information system/surveillance; 2) the provision of curative, preventive and promotional health services; and 3) the interactions among stakeholders with little coordination of their actions.</div></div><div><h3>Conclusion</h3><div>This study offers insights into how to improve FHSs' resilience to crises. The results indicated dysfunction in routine health services, a decline in patients' use of them, and inadequate coordination among stakeholders. Despite their low level of preparedness, the CSComs were able to ensure continuity of care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying the active ingredients in payment for performance programmes using system dynamics modelling","authors":"Rachel Cassidy ,&nbsp;Agnes Rwashana Semwanga ,&nbsp;Peter Binyaruka ,&nbsp;Karl Blanchet ,&nbsp;Neha S. Singh ,&nbsp;John Maiba ,&nbsp;Josephine Borghi","doi":"10.1016/j.ssmhs.2024.100040","DOIUrl":"10.1016/j.ssmhs.2024.100040","url":null,"abstract":"<div><div>Payment for performance (P4P) is not a uniform intervention, with programme effect dependent on several interconnected factors. In this study, a system dynamics model was developed to explore the pathways to improved outcomes and how changes in the design, implementation and context of a P4P programme affected maternal and child health (MCH) service delivery outcomes in Tanzania. A previously developed causal loop diagram of the programme effects was used to inform model development, with further data sources (including an impact evaluation of programme, health surveys, stakeholder feedback and relevant literature) used to build the model. A number of pathways were identified to improved services under P4P, with increased availability of drugs underpinning the content of care outcome (intermittent preventative treatment during ANC), which together with increased supervision, enhanced health worker motivation. This in turn increased perceived quality of care at the facility which improved the coverage of services outcome (facility-based deliveries), and with increased outreach, increased awareness of services also boosted demand. Minor delays in payment reduced provider purchasing power for medicines, with severe delays driving erosion of provider trust and motivation for programme participation. Allocating a larger share of funds for facility operations can enhance performance effects, particularly for those services that rely on efficient drug administration. Contextual factors including limited baseline provision of essential medications, lower community awareness of facility services and dispersed/distant populations reduced programme effect. This paper demonstrates the feasibility and the potential of such models to inform the design of effective health system interventions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100040"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing challenges and solutions in substance abuse prevention, harm reduction, and treatment services in New York State","authors":"Daniel J. Kruger ,&nbsp;Hilary M. Kirk ,&nbsp;Kenneth E. Leonard ,&nbsp;Joshua J. Lynch ,&nbsp;Nancy Nielsen ,&nbsp;Brian M. Clemency","doi":"10.1016/j.ssmhs.2024.100039","DOIUrl":"10.1016/j.ssmhs.2024.100039","url":null,"abstract":"<div><div>Drug overdose is a leading cause of death in New York State, with opioid-related deaths increasing by more than 300 % from 2010 to 2020. Survey respondents (<em>N</em> = 392) for organizations providing a wide range of substance misuse related services rated the importance of barriers to accessing services, the helpfulness of strategies in addressing challenges, and priorities for further scientific study. Difficulties in obtaining funding were rated the highest barrier to accessing substance use services, insufficient skills in the workforce were rated as the second most important barrier, and stigma towards addiction was rated third. An analysis of wages and scale-up strategies to provide competitive workforce opportunities was rated as the most helpful strategy in addressing workforce challenges. The most helpful strategy in addressing stigma was to work in partnership with other organizations to enhance the continuum of substance misuse related services. Most of the strategies that were surveyed were rated as very helpful overall, which may not be surprising given that they were nominated by experts as very important. Customized prevention, treatment, harm reduction, and recovery services based on individual characteristics and integrating medications for opioid use disorder into other medical settings were rated as the most important strategies in prioritizing further scientific study. The pattern of ratings showed only a few differences based on organizational role and geographic region, for example respondents in New York City considered increasing the availability of telemedicine as a higher priority.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100039"},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating access during change: A qualitative exploration of access impacts to Canadian primary care rehabilitation providers during the COVID-19 pandemic","authors":"Tory Crawford,&nbsp;Louise Chartrand,&nbsp;Cara Brown,&nbsp;Brontë Vollebregt,&nbsp;Patricia Thille","doi":"10.1016/j.ssmhs.2024.100038","DOIUrl":"10.1016/j.ssmhs.2024.100038","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic required substantial changes in delivery of team-based primary care, impacting both <em>how</em> and <em>which</em> patients accessed the more comprehensive services teams provide. We sought to explore changes in access to primary care rehabilitation services during the first year of the COVID-19 pandemic to identify potential new problems and improvements.</div></div><div><h3>Methods</h3><div>In this longitudinal study, sixteen rehabilitation professionals working on primary care teams in Manitoba and Ontario recorded audio-diaries and later participated in interviews throughout the first year of the pandemic. Qualitative analysis included data immersion, coding to identify the practice changes and associated access impacts, then applying Levesque and colleagues’ Patient-Centred Access to Healthcare framework to interpret findings.</div></div><div><h3>Findings</h3><div>Participants described service changes that both enhanced and reduced access, including redeployment, outreach, virtual care, discontinuation of some services and start of new ones, and new risk management strategies. Some implied equity-specific impacts. Virtual care and outreach activities created access for patient populations who previously may have been underserved, while virtual care, redeployment, and new risk management activities created new access barriers and inequities, leaving some patients completely unable to reach care. Changes to team collaboration activities could help or hinder access.</div></div><div><h3>Conclusion</h3><div>Continuing outreach activities, strengthening team collaboration, and thoughtfully integrating virtual care can improve access to comprehensive primary care. As the primary care sector works to recover from pandemic impacts and address population health needs, applying a patient-centred access framework during practice redesign offers a meaningful way to strengthen services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100038"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ongoing impacts of the COVID-19 pandemic on access to primary care among im/migrant communities in British Columbia, Canada","authors":"Elmira Tayyar ,&nbsp;Yasmin Bozorgi ,&nbsp;Cecilia Sierra-Heredia ,&nbsp;Hanah Damot ,&nbsp;Ruth Carrillo ,&nbsp;Stefanie Machado ,&nbsp;Mei-ling Wiedmeyer ,&nbsp;Shira Goldenberg ,&nbsp;Ruth Lavergne","doi":"10.1016/j.ssmhs.2024.100037","DOIUrl":"10.1016/j.ssmhs.2024.100037","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic changed healthcare delivery in multiple ways, including a widespread shift to virtual care. Evidence of how these changes were experienced is mixed and varies among populations and Canadian provinces. We sought to generate new information about how these changes were experienced by im/migrants in British Columbia (BC), assessing their impact on access to virtual and in-person primary care.</div></div><div><h3>Methods</h3><div>We conducted in-depth, semi-structured interviews in Dari, English, Farsi, Spanish, and Tigrinya with im/migrants living in BC for less than 10 years. We analyzed 50 interviews using a team-based approach to reflexive thematic analysis to explore how changes in service delivery in the context of the COVID-19 pandemic impacted im/migrant's healthcare experiences and access in BC.</div></div><div><h3>Results</h3><div>Interview participants described impacts of changes in service delivery in terms of accessibility, human connections, quality of care, and safety. Impacts were experienced positively as opportunities or negatively as obstacles. Experiences were shaped by immigration status, English language fluency, having a regular source of primary care before the pandemic, and economic resources. An overarching theme was trust, with healthcare experiences during the pandemic either increasing or decreasing participants’ trust in the healthcare system.</div></div><div><h3>Conclusions</h3><div>Our findings reveal that within im/migrant communities, the same changes in health service delivery were experienced differently, depending on various determining factors. Whether people experienced opportunities or obstacles, and increased or decreased trust, was shaped by modifiable policies that predate the pandemic and will persist beyond the pandemic unless significant and intentional, evidence-based changes are implemented.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The COVID-19 pandemic: A focusing event to promote domestic investment for health systems strengthening in the WHO African Region","authors":"Alison T. Mhazo ,&nbsp;Arush Lal ,&nbsp;Elias Mossialos","doi":"10.1016/j.ssmhs.2024.100034","DOIUrl":"10.1016/j.ssmhs.2024.100034","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has been framed as a catalytic occurrence that exposed the chronic underinvestment in health systems strengthening (HSS) in the WHO African Region as well as its potential to galvanize much-needed political attention towards the issue. This expectation aligns with the portrayal of COVID-19 as a ‘focusing event’ for HSS. This study analyzes whether COVID-19 met the criteria of a focusing event for HSS as set forth by John Kingdon, and then, if as a focusing event, it generated political attention towards policy making and implementation for HSS and whether there could be prospects for sustaining such momentum in the post COVID-19 era.</div></div><div><h3>Methods</h3><div>We carried out a scoping review of available literature using the O’Malley and Arksey method (2005).</div></div><div><h3>Results</h3><div>The COVID-19 pandemic presented an unprecedented crisis that drew attention to the problem of weak health systems in the WHO African region, a problem that had long been acknowledged but largely ignored. This study has also shown that COVID-19 had a profound personal experience on policy makers since it severely limited their opportunity to seek medical care abroad and forced them to personally witness the weak state of domestic health systems. These attributes suit the criteria of COVID-19 as a focusing event according to Kingdon, which helped to stimulate governmental action on HSS.</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic can indeed be leveraged as a salient focusing event to generate political attention for HSS in the WHO African Region. However, such attention cannot be guaranteed in the long-term, due to the differential dynamics between policy making and implementation in crises and non-crisis situations. By casting light on a plausible but rarely examined mechanism for driving policy change –the personal experience of policy makers, we conclude that lack of financial resources does not sufficiently explain the lack of domestic investments for HSS. This calls for attention towards other reasons of inaction towards HSS, including the insulation of the elite from facing the weak health systems.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100034"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana","authors":"Justine Guguneni Tuolong ,&nbsp;Kennedy A. Alatinga ,&nbsp;Elijah Yendaw","doi":"10.1016/j.ssmhs.2024.100036","DOIUrl":"10.1016/j.ssmhs.2024.100036","url":null,"abstract":"<div><div>Supply-side factors, such as the availability of health facilities, equipment, practitioners, and drugs, are crucial for improving global healthcare systems. However, systematic evidence of how these factors affect health insurance clients’ access to primary healthcare (PHC) services in Ghana is lacking. This study addresses this gap by examining the impact of these factors on insured individuals' access to PHC services in Wa Municipality. An explanatory sequential mixed-methods design was employed, involving a quantitative survey of 413 insured individuals randomly selected from 40 communities and 47 healthcare facilities. Purposive sampling was used for qualitative interviews with 17 healthcare providers and 20 key insured informants. Quantitative data were analysed using descriptive statistics, correlation, independent t-tests, and binary logistic regression, while qualitative data were thematically analysed to provide insight into the quantitative findings. Result from quantitative data showed that Community-Based Health Planning and Services (CHPS) were more accessible than hospitals, diagnostic centres, and health centres. Proximity to health facilities influenced access to PHC services and National Health Insurance Scheme (NHIS) uptake. Perceived availability and functionality of healthcare equipment also affected NHIS uptake. Qualitatively, health facilities reported a shortage of human resources, such as midwives and nurses, for PHC service delivery. Triangulating quantitative and qualitative results show that healthcare supplies and skilled professionals are essential for NHIS uptake and access to PHC services. This study recommends that Government of Ghana prioritise expanding healthcare facilities, recruiting and retaining skilled practitioners, procuring medical equipment, and equitably distributing essential medications to improve access to essential healthcare services in underserved areas.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100036"},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of Ghana’s national health insurance exemption policies on healthcare-seeking behaviour","authors":"Yaw Boateng Atakorah ,&nbsp;Eric Arthur ,&nbsp;Anthony Kofi Osei-Fosu ,&nbsp;Jacob Novignon","doi":"10.1016/j.ssmhs.2024.100035","DOIUrl":"10.1016/j.ssmhs.2024.100035","url":null,"abstract":"<div><div>Countries all over the world are seeking to enhance the general well-being of their populations by instituting a prepayment health system in which people can access healthcare at any time without financial risks. In Ghana, the National Health Insurance Scheme (NHIS) seeks to achieve this objective while leaving no one behind. To accelerate the country’s UHC agenda, the scheme was designed to also provide premium exemptions to the poor and vulnerable. While the exemption policy removes financial barriers to both subscription and healthcare, its impact on health-seeking is unknown. This study, therefore, sought to evaluate the impact of the premium exemption policies on healthcare-seeking behaviours. Data from the most recent round of the Ghana Living Standards Survey (GLSS 7) was used. A total sample of 8297 individuals were included in the analysis comprising 5686 rural and 2611 urban dwellers. We used the Lewbel instrumental variable technique to correct potential endogeneity problems. We found that NHIS exemption policies improved both general and formal healthcare-seeking. For general healthcare-seeking, the impact was driven by individuals exempted through under 18 and aged category. However, focusing on formal care, both exemption through under 18 or aged category as well as through indigents or Free Maternal Services category both improved healthcare-seeking. The magnitude of the impact was also greater for categories that were fully exempted and did not require any form of payment to subscribe. The findings call for a policy review to differentially target individuals living in areas with different economic and health system realities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}