{"title":"免收使用费政策显著提高了埃塞俄比亚西北部巴哈达尔市孕产妇保健服务的利用率：横断面比较研究》。","authors":"Demlie Mekonnen Marye, Desta Debalkie Atnafu, Melesse Belayneh, Ayenew Takele Alemu","doi":"10.2147/CEOR.S431488","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Increasing free and skilled delivery is a top priority in the global effort to reduce maternal and newborn mortality. Reducing user-fees through exemption policy has contributed to universal health coverage. However, there is scant evidence regarding the effect of exempted maternal services on adherence to utilization in Ethiopia. Thus, this study aimed to assess the effect of fee exemption policy on adherence to maternal health service utilization and its predictors.</p><p><strong>Methods: </strong>A community-based comparative cross-sectional study was conducted in Bahir Dar City. A two-stage multistage sampling was employed; 497 women participated. Data were collected by face-to-face interview; entered and cleaned using Epi-Data 3.1. SPSS version 25 was used for further analysis. Bivariable and multivariable logistic regression models were computed to assess the association between explanatory and outcome variables. An adjusted odds ratio with a 95% confidence interval was used to interpret the degree of association. The effect of fee exemption policy on adherence to maternal health service utilization was measured by propensity score matching.</p><p><strong>Results: </strong>The overall adherence to maternal service utilization was 54.2%. Factors associated with adherence to maternal health service utilization were pregnancy complications [AOR: 4.1, 95% CI (2.32, 7.28)], secondary and above education [AOR: 4.6, 95% CI (1.38, 15.08)], early ANC<sup>1</sup> booking [AOR: 3.1, 95% CI (1.83, 5.16)], autonomous women [AOR: 2.1, 95% CI (1.02, 4.39)], user fee exemption [AOR: 2.3, 95% CI (1.20, 4.47)] and high parity [AOR: 0.39, 95% CI (0.2, 0.75)]. User fee exemption induced a 22.7% increment in adherence to maternal service utilization (ATET=0.227, t=2.13).</p><p><strong>Conclusion: </strong>User fee exemption policy significantly improved adherence to maternal health service utilization. Promoting a fee exemption policy through third-party financing can enhance maternal health service utilization adherence in hard-to-reach settings of Ethiopia by targeting mothers with higher pregnancies, no complications, no autonomy, and less education.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10722901/pdf/","citationCount":"0","resultStr":"{\"title\":\"User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.\",\"authors\":\"Demlie Mekonnen Marye, Desta Debalkie Atnafu, Melesse Belayneh, Ayenew Takele Alemu\",\"doi\":\"10.2147/CEOR.S431488\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Increasing free and skilled delivery is a top priority in the global effort to reduce maternal and newborn mortality. Reducing user-fees through exemption policy has contributed to universal health coverage. However, there is scant evidence regarding the effect of exempted maternal services on adherence to utilization in Ethiopia. Thus, this study aimed to assess the effect of fee exemption policy on adherence to maternal health service utilization and its predictors.</p><p><strong>Methods: </strong>A community-based comparative cross-sectional study was conducted in Bahir Dar City. A two-stage multistage sampling was employed; 497 women participated. Data were collected by face-to-face interview; entered and cleaned using Epi-Data 3.1. SPSS version 25 was used for further analysis. Bivariable and multivariable logistic regression models were computed to assess the association between explanatory and outcome variables. An adjusted odds ratio with a 95% confidence interval was used to interpret the degree of association. The effect of fee exemption policy on adherence to maternal health service utilization was measured by propensity score matching.</p><p><strong>Results: </strong>The overall adherence to maternal service utilization was 54.2%. Factors associated with adherence to maternal health service utilization were pregnancy complications [AOR: 4.1, 95% CI (2.32, 7.28)], secondary and above education [AOR: 4.6, 95% CI (1.38, 15.08)], early ANC<sup>1</sup> booking [AOR: 3.1, 95% CI (1.83, 5.16)], autonomous women [AOR: 2.1, 95% CI (1.02, 4.39)], user fee exemption [AOR: 2.3, 95% CI (1.20, 4.47)] and high parity [AOR: 0.39, 95% CI (0.2, 0.75)]. User fee exemption induced a 22.7% increment in adherence to maternal service utilization (ATET=0.227, t=2.13).</p><p><strong>Conclusion: </strong>User fee exemption policy significantly improved adherence to maternal health service utilization. Promoting a fee exemption policy through third-party financing can enhance maternal health service utilization adherence in hard-to-reach settings of Ethiopia by targeting mothers with higher pregnancies, no complications, no autonomy, and less education.</p>\",\"PeriodicalId\":47313,\"journal\":{\"name\":\"ClinicoEconomics and Outcomes Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2023-12-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10722901/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ClinicoEconomics and Outcomes Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2147/CEOR.S431488\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ClinicoEconomics and Outcomes Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/CEOR.S431488","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
背景：提高免费熟练接生率是全球降低孕产妇和新生儿死亡率工作的重中之重。通过免收政策降低用户费用有助于实现全民医保。然而，在埃塞俄比亚，有关免收孕产妇服务费对坚持使用服务的影响的证据却很少。因此，本研究旨在评估免收费用政策对坚持使用孕产妇保健服务的影响及其预测因素：方法：在巴哈达尔市开展了一项基于社区的横断面比较研究。采用两阶段多阶段抽样，共有 497 名妇女参与。数据通过面对面访谈收集，并使用 Epi-Data 3.1 进行输入和清理。进一步分析使用 SPSS 25 版本。计算了二变量和多变量逻辑回归模型，以评估解释变量和结果变量之间的关联。使用调整后的几率和 95% 的置信区间来解释关联程度。通过倾向得分匹配法测量了免收费用政策对孕产妇保健服务利用率的影响：使用孕产妇保健服务的总体依从性为 54.2%。与坚持使用孕产妇保健服务相关的因素有妊娠并发症[AOR：4.1，95% CI (2.32, 7.28)]、中等及以上教育程度[AOR：4.6，95% CI (1.38, 15.08)]、早期 ANC108）]、早期 ANC1 预约[AOR：3.1，95% CI (1.83，5.16)]、自主妇女[AOR：2.1，95% CI (1.02，4.39)]、免收使用费[AOR：2.3，95% CI (1.20，4.47)]和高奇数[AOR：0.39，95% CI (0.2，0.75)]。免收使用费使孕产妇服务利用率提高了 22.7%（ATET=0.227，t=2.13）：结论：免收使用费政策极大地提高了孕产妇对医疗服务的依从性。在埃塞俄比亚，通过第三方融资推广免收费用政策，可提高妊娠次数较多、无并发症、无自主权且受教育程度较低的母亲对孕产妇保健服务的利用率。
User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.
Background: Increasing free and skilled delivery is a top priority in the global effort to reduce maternal and newborn mortality. Reducing user-fees through exemption policy has contributed to universal health coverage. However, there is scant evidence regarding the effect of exempted maternal services on adherence to utilization in Ethiopia. Thus, this study aimed to assess the effect of fee exemption policy on adherence to maternal health service utilization and its predictors.
Methods: A community-based comparative cross-sectional study was conducted in Bahir Dar City. A two-stage multistage sampling was employed; 497 women participated. Data were collected by face-to-face interview; entered and cleaned using Epi-Data 3.1. SPSS version 25 was used for further analysis. Bivariable and multivariable logistic regression models were computed to assess the association between explanatory and outcome variables. An adjusted odds ratio with a 95% confidence interval was used to interpret the degree of association. The effect of fee exemption policy on adherence to maternal health service utilization was measured by propensity score matching.
Results: The overall adherence to maternal service utilization was 54.2%. Factors associated with adherence to maternal health service utilization were pregnancy complications [AOR: 4.1, 95% CI (2.32, 7.28)], secondary and above education [AOR: 4.6, 95% CI (1.38, 15.08)], early ANC1 booking [AOR: 3.1, 95% CI (1.83, 5.16)], autonomous women [AOR: 2.1, 95% CI (1.02, 4.39)], user fee exemption [AOR: 2.3, 95% CI (1.20, 4.47)] and high parity [AOR: 0.39, 95% CI (0.2, 0.75)]. User fee exemption induced a 22.7% increment in adherence to maternal service utilization (ATET=0.227, t=2.13).
Conclusion: User fee exemption policy significantly improved adherence to maternal health service utilization. Promoting a fee exemption policy through third-party financing can enhance maternal health service utilization adherence in hard-to-reach settings of Ethiopia by targeting mothers with higher pregnancies, no complications, no autonomy, and less education.
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