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Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?

BACKGROUND: Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to...

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Autores principales: Fenny, Ama Pokuaa, Asante, Felix A, Enemark, Ulrika, Hansen, Kristian S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393865/
https://www.ncbi.nlm.nih.gov/pubmed/25884362
http://dx.doi.org/10.1186/s12889-015-1696-3
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author Fenny, Ama Pokuaa
Asante, Felix A
Enemark, Ulrika
Hansen, Kristian S
author_facet Fenny, Ama Pokuaa
Asante, Felix A
Enemark, Ulrika
Hansen, Kristian S
author_sort Fenny, Ama Pokuaa
collection PubMed
description BACKGROUND: Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy. METHOD: Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study. RESULTS: Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities. CONCLUSION: Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.
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spelling pubmed-43938652015-04-13 Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care? Fenny, Ama Pokuaa Asante, Felix A Enemark, Ulrika Hansen, Kristian S BMC Public Health Research Article BACKGROUND: Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy. METHOD: Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study. RESULTS: Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities. CONCLUSION: Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria. BioMed Central 2015-04-12 /pmc/articles/PMC4393865/ /pubmed/25884362 http://dx.doi.org/10.1186/s12889-015-1696-3 Text en © Fenny et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Fenny, Ama Pokuaa
Asante, Felix A
Enemark, Ulrika
Hansen, Kristian S
Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?
title Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?
title_full Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?
title_fullStr Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?
title_full_unstemmed Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?
title_short Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?
title_sort malaria care seeking behavior of individuals in ghana under the nhis: are we back to the use of informal care?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393865/
https://www.ncbi.nlm.nih.gov/pubmed/25884362
http://dx.doi.org/10.1186/s12889-015-1696-3
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