免费医疗政策如何影响脆弱环境中妇幼保健服务的利用?布基纳法索受控中断时间序列分析的证据。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Thit Thit Aye, Hoa Thi Nguyen, Laurène Petitfour, Valéry Ridde, Felix Amberg, Emmanuel Bonnet, Mariam Seynou, Joël Arthur Kiendrébéogo, Manuela De Allegri
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引用次数: 0

摘要

布基纳法索自 2016 年 4 月起在全国范围内对孕妇、哺乳期妇女和五岁以下儿童实施免费医疗政策(gratuité)。研究表明,免费医疗政策可以提高医疗服务的使用率。然而,近年来新出现的 COVID-19 大流行、不断升级的不安全局势以及政治局势可能会影响此类政策的实施。目前还没有研究探讨在这种不断变化的情况下,免费政策是否仍能保持较高的服务使用率。我们的研究旨在评估在这种不断变化的情况下,免费服务对五岁以下儿童使用设施接生和治疗护理的影响。我们利用卫生管理信息系统的数据和 2560 家基层医疗机构 2013 年 1 月至 2021 年 12 月的年度统计报告,采用了受控中断时间序列分析法。我们重点关注设施内的分娩和五岁以下儿童的治疗性护理,并将产前护理和五岁以上儿童的治疗性护理作为非等效对照。我们采用了广义最小二乘法模型进行分段回归,并考虑了自相关性和每月的季节性。与五岁以上儿童(对照组)相比,五岁以下儿童的月使用率因免费而立即增加了 111.19 次/1,000(95% CI:91.12;131.26)。随后,这一直接影响有所减弱,每千名儿童的月变化率为 0.93(95% CI:-1.57, -0.29)。我们发现,免费政策对产妇护理服务的使用没有明显的直接或长期影响。我们的研究结果表明,免费医疗政策有助于改善医疗服务,但还需要更全面的策略来维持医疗服务的使用率。我们的研究结果反映了该国的整体情况,而要想了解不安全因素和大流行病在地方层面的影响,以及免费政策在不同地域和社会经济状况下的影响,还需要进行本地化研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How do free healthcare policies impact utilization of maternal and child health services in fragile settings? Evidence from a controlled interrupted time series analysis in Burkina Faso.

Burkina Faso has implemented a nationwide free healthcare policy (gratuité) for pregnant and lactating women and children under 5 years since April 2016. Studies have shown that free healthcare policies can increase healthcare service use. However, the emerging coronavirus disease 2019 pandemic, escalating insecurity and the political situation in recent years might have affected the implementation of such policies. No studies have looked at whether the gratuité maintained high service use under such changing circumstances. Our study aimed to assess the effects of gratuité on the utilization of facility-based delivery and curative care of children under 5 years in light of this changing context. We employed a controlled interrupted time series analysis using data from the Health Management Information System and annual statistical reports of 2560 primary health facilities from January 2013 to December 2021. We focused on facility-based deliveries and curative care for children under 5 years, with antenatal care and curative care for children over 5 years as non-equivalent controls. We employed segmented regression with the generalized least square model, accounting for autocorrelation and monthly seasonality. The monthly utilization rate among children under 5 years compared to those above 5 years (controls) immediately increased by 111.19 visits per 1000 children (95% CI: 91.12, 131.26) due to the gratuité. This immediate effect declined afterwards with a monthly change of 0.93 per 1000 children (95% CI: -1.57, -0.29). We found no significant effects, both immediate and long-term, on the use of maternal care services attributable to the gratuité. Our findings suggest that free healthcare policies can be instrumental in improving healthcare, yet more comprehensive strategies are needed to maintain healthcare utilization. Our findings reflect the overall situation in the country, while localized research is needed to understand the effect of insecurity and the pandemic at the local level and the effects of gratuité across geographies and socioeconomic statuses.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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