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...

Descripción completa

Detalles Bibliográficos
Autores principales: Wang, Wenjuan, Temsah, Gheda, Mallick, Lindsay
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