Cargando…
The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda
While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact o...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400062/ https://www.ncbi.nlm.nih.gov/pubmed/28365754 http://dx.doi.org/10.1093/heapol/czw135 |
_version_ | 1783230756159488000 |
---|---|
author | Wang, Wenjuan Temsah, Gheda Mallick, Lindsay |
author_facet | Wang, Wenjuan Temsah, Gheda Mallick, Lindsay |
author_sort | Wang, Wenjuan |
collection | PubMed |
description | While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage—Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care. |
format | Online Article Text |
id | pubmed-5400062 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-54000622017-04-28 The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda Wang, Wenjuan Temsah, Gheda Mallick, Lindsay Health Policy Plan Original Articles While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage—Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care. Oxford University Press 2017-04 2016-10-04 /pmc/articles/PMC5400062/ /pubmed/28365754 http://dx.doi.org/10.1093/heapol/czw135 Text en © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Articles Wang, Wenjuan Temsah, Gheda Mallick, Lindsay The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda |
title | The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda |
title_full | The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda |
title_fullStr | The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda |
title_full_unstemmed | The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda |
title_short | The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda |
title_sort | impact of health insurance on maternal health care utilization: evidence from ghana, indonesia and rwanda |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400062/ https://www.ncbi.nlm.nih.gov/pubmed/28365754 http://dx.doi.org/10.1093/heapol/czw135 |
work_keys_str_mv | AT wangwenjuan theimpactofhealthinsuranceonmaternalhealthcareutilizationevidencefromghanaindonesiaandrwanda AT temsahgheda theimpactofhealthinsuranceonmaternalhealthcareutilizationevidencefromghanaindonesiaandrwanda AT mallicklindsay theimpactofhealthinsuranceonmaternalhealthcareutilizationevidencefromghanaindonesiaandrwanda AT wangwenjuan impactofhealthinsuranceonmaternalhealthcareutilizationevidencefromghanaindonesiaandrwanda AT temsahgheda impactofhealthinsuranceonmaternalhealthcareutilizationevidencefromghanaindonesiaandrwanda AT mallicklindsay impactofhealthinsuranceonmaternalhealthcareutilizationevidencefromghanaindonesiaandrwanda |