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Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?
BACKGROUND: Two of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. This paper seeks to examine whether the type of health insurance enrollment affects the utilization of health services, choice of provider and financial protect...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607548/ https://www.ncbi.nlm.nih.gov/pubmed/33143717 http://dx.doi.org/10.1186/s12913-020-05862-7 |
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author | Atake, Esso-Hanam |
author_facet | Atake, Esso-Hanam |
author_sort | Atake, Esso-Hanam |
collection | PubMed |
description | BACKGROUND: Two of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. This paper seeks to examine whether the type of health insurance enrollment affects the utilization of health services, choice of provider and financial protection of households in Togo. METHODS: Data were obtained from a cross-sectional, representative household survey involving 1180 insured households that had reported either illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. A nested logit model was used to account for the utilization of health services and provider choice, and methods of assessing catastrophic health care expenditures were used to analyze the level of household financial protection. RESULTS: Policyholders of private health insurance use private health care facilities more than policyholders of public health insurance. The main reasons for not using health centers among households with public insurance were out-of-pocket payments (49.19%), waiting time (36.80%), and distance to the nearest health center (36.76%). Furthermore, on average, households with public insurance spent a higher proportion of their total monthly nonfood expenditures on health care than those with private insurance. We find that the type of insurance, share of expenditures allocated to food, distance to the nearest health center, and waiting time significantly impact the choice of provider. Regardless of the type of health insurance, elderly individuals avoid using private health centers and referral hospitals due to the high cost. CONCLUSION: We found that a multiple health insurance system results in a multilevel health system that is not equitable for everyone. The capacity of the health insurance system to provide equitable health care services and protect its members from catastrophic health care expenditures should be at the core of health care reform. This study recommends raising awareness of the criteria for the reimbursement of medical procedures within the framework of public insurance and promoting specific health insurance mechanisms for elderly individuals. Careful attention should be paid to ensuring universal education and literacy as a means of improving access to and the use of health care. |
format | Online Article Text |
id | pubmed-7607548 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-76075482020-11-03 Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? Atake, Esso-Hanam BMC Health Serv Res Research Article BACKGROUND: Two of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. This paper seeks to examine whether the type of health insurance enrollment affects the utilization of health services, choice of provider and financial protection of households in Togo. METHODS: Data were obtained from a cross-sectional, representative household survey involving 1180 insured households that had reported either illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. A nested logit model was used to account for the utilization of health services and provider choice, and methods of assessing catastrophic health care expenditures were used to analyze the level of household financial protection. RESULTS: Policyholders of private health insurance use private health care facilities more than policyholders of public health insurance. The main reasons for not using health centers among households with public insurance were out-of-pocket payments (49.19%), waiting time (36.80%), and distance to the nearest health center (36.76%). Furthermore, on average, households with public insurance spent a higher proportion of their total monthly nonfood expenditures on health care than those with private insurance. We find that the type of insurance, share of expenditures allocated to food, distance to the nearest health center, and waiting time significantly impact the choice of provider. Regardless of the type of health insurance, elderly individuals avoid using private health centers and referral hospitals due to the high cost. CONCLUSION: We found that a multiple health insurance system results in a multilevel health system that is not equitable for everyone. The capacity of the health insurance system to provide equitable health care services and protect its members from catastrophic health care expenditures should be at the core of health care reform. This study recommends raising awareness of the criteria for the reimbursement of medical procedures within the framework of public insurance and promoting specific health insurance mechanisms for elderly individuals. Careful attention should be paid to ensuring universal education and literacy as a means of improving access to and the use of health care. BioMed Central 2020-11-03 /pmc/articles/PMC7607548/ /pubmed/33143717 http://dx.doi.org/10.1186/s12913-020-05862-7 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data. |
spellingShingle | Research Article Atake, Esso-Hanam Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? |
title | Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? |
title_full | Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? |
title_fullStr | Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? |
title_full_unstemmed | Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? |
title_short | Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? |
title_sort | does the type of health insurance enrollment affect provider choice, utilization and health care expenditures? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607548/ https://www.ncbi.nlm.nih.gov/pubmed/33143717 http://dx.doi.org/10.1186/s12913-020-05862-7 |
work_keys_str_mv | AT atakeessohanam doesthetypeofhealthinsuranceenrollmentaffectproviderchoiceutilizationandhealthcareexpenditures |