数字干预对肯尼亚卡卡梅加生殖、孕产妇、新生儿和儿童健康服务医疗保险覆盖面的影响:分组随机对照试验。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Amanuel Abajobir, Richard de Groot, Caroline Wainaina, Menno Pradhan, Wendy Janssens, Estelle M Sidze
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引用次数: 0

摘要

肯尼亚国家医院保险基金(NHIF)的升级旨在改善贫困家庭获得医疗保健的机会,扩大全民医保(UHC)的覆盖范围,并促进基本生殖、孕产妇、新生儿和儿童保健(RMNCH)服务的普及。然而,最贫困家庭可能负担不起保费。全民可持续医疗保健创新合作计划(i-PUSH)以低收入妇女及其家庭为目标,通过提供基于手机的国家医疗保险基金补贴,结合对社区卫生志愿者(CHVs)的强化、数字化培训和卫生设施的升级,提高他们获得和利用优质医疗保健(包括生殖、孕产妇、新生儿和儿童保健服务)的机会。本研究通过在肯尼亚卡卡梅加(Kakamega)开展纵向群组随机对照试验,评估了在实施 i-PUSH 的地区,扩大国家医疗保险基金的覆盖范围是否提高了优质基本生殖、新生儿和儿童保健服务的可及性和利用率。共有 24 个配对村被随机分配到治疗组或对照组。在每个村庄内,随机抽取 10 个符合条件的家庭(即有一名 15-49 岁的怀孕妇女或有一名 4 岁以下儿童的家庭)。研究采用了基于基线、中线和末线数据的集合横截面分析的差分法,并根据平衡面板和方差分析方法进行了稳健性检验。分析样本包括 346 名妇女(其中 248 人在任何一次调查之前的 3 年内有过一次活产)和 424 名 0-59 个月大的儿童。在中线和终点,国家医疗保险基金覆盖率的提高对任何生殖、新生儿和儿童保健结果指标都没有显著的统计学影响。不过,与基线相比,对照地区和治疗地区在终点线时对生殖、新生儿和儿童保健服务的接受程度都有了大幅提高。例如,产前检查次数从基线到中线(平均值 = 2.62 到 2.92)p < 0.01)以及由熟练助产士接生的次数从基线到中线(平均值 = 0.91 到 0.97(p < 0.01))均有明显增加。扩大国家医疗保险基金(NHIF)的覆盖范围,使人们更容易在公立和私立医疗机构获得无限期的生殖、新生儿和婴幼儿保健服务,但在基本的公立生殖、新生儿和婴幼儿保健服务已经很普及的情况下,这并没有增加保健服务的使用率。然而,在 COVID-19 大流行导致医疗服务受限的情况下,RMNCH 利用率指标的总体趋势是积极的,这表明 i-PUSH 计划的其他组成部分可能是有益的。需要开展进一步的研究,以更好地了解提供保险、加强 CHV 培训和提高医疗保健质量如何相互作用,从而确保孕妇和幼儿能够充分利用连续护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The impact of digital interventions on health insurance coverage for reproductive, maternal, newborn and child health services utilization in Kakamega, Kenya: a cluster randomized controlled trial.

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i-PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15-49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0-59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62-2.92, P < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91-0.97, P < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i-PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care.

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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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