Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children.
Children
Financial risk protection
Ghana
Trauma
Universal health coverage
Journal
African journal of emergency medicine : Revue africaine de la medecine d'urgence
ISSN: 2211-4203
Titre abrégé: Afr J Emerg Med
Pays: Netherlands
ID NLM: 101572277
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
23
06
2020
revised:
28
08
2020
accepted:
21
09
2020
entrez:
8
3
2021
pubmed:
9
3
2021
medline:
9
3
2021
Statut:
ppublish
Résumé
Ghana implemented a National Health Insurance Scheme (NHIS) in 2003 as a step toward universal health coverage. We aimed to determine the effect of the NHIS on timeliness of care, mortality, and catastrophic health expenditure (CHE) among children with serious injuries at a trauma center in Ghana. We performed a retrospective cohort study of injured children aged <18 years who required surgery (i.e., proxy for serious injury) at Komfo Anokye Teaching Hospital from 2015 to 2016. Household income data was obtained from the Ghana Statistical Service. CHE was defined as out-of-pocket payments to annual household income ≥10%. Differences in insured and uninsured children were described. Multivariable regression was used to assess the effect of NHIS on time to surgery, length of stay, in-hospital mortality, out-of-pocket expenditure and CHE. Of the 263 children who met inclusion criteria, 70% were insured. Mechanism of injury, triage scores and Kampala Trauma Score II were similar in both groups (all NHIS did not improve timeliness of care, length of stay or mortality. Although NHIS did provide some financial risk protection for families, it did not eliminate out-of-pocket payments. The families of most seriously injured children experienced CHE, regardless of insurance status. NHIS and similar financial risk pooling schemes could be strengthened to better provide financial risk protection and promote quality of care for injured children.
Identifiants
pubmed: 33680736
doi: 10.1016/j.afjem.2020.09.013
pii: S2211-419X(20)30110-5
pmc: PMC7910164
doi:
Types de publication
Journal Article
Langues
eng
Pagination
144-151Informations de copyright
© 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.
Déclaration de conflit d'intérêts
The authors declared no conflict of interest.
Références
Health Econ Rev. 2019 Jul 6;9(1):23
pubmed: 31280394
Int J Equity Health. 2019 Aug 28;18(1):134
pubmed: 31462303
J Bone Joint Surg Am. 2016 Dec 7;98(23):e104
pubmed: 27926686
BMC Health Serv Res. 2015 Aug 15;15:331
pubmed: 26275412
Med Care. 2016 Sep;54(9):818-26
pubmed: 27367865
Lancet. 2015 May 30;385(9983):2209-19
pubmed: 25662414
Bull World Health Organ. 2009 May;87(5):382-9
pubmed: 19551257
World J Surg. 2012 May;36(5):959-63
pubmed: 22419411
Health Econ Rev. 2012 Jul 23;2(1):13
pubmed: 22828034
Lancet Glob Health. 2015 Apr 27;3 Suppl 2:S38-44
pubmed: 25926319
J Surg Res. 2014 Aug;190(2):522-7
pubmed: 24594216
World J Surg. 2014 Jan;38(1):252-63
pubmed: 24101020
Ann Surg. 2018 Aug;268(2):282-288
pubmed: 28806300
Lancet. 2004 Jun 26;363(9427):2172-9
pubmed: 15220042
Int J Health Policy Manag. 2016 Aug 28;6(4):229-231
pubmed: 28812806
Health Econ. 2002 Jul;11(5):431-46
pubmed: 12112492
J Trauma Acute Care Surg. 2013 May;74(5):1195-205
pubmed: 23609267
Prehosp Emerg Care. 2016 Nov-Dec;20(6):768-775
pubmed: 27074588
Am J Public Health. 1996 Dec;86(12):1791-3
pubmed: 9003139
Bull World Health Organ. 2002;80(8):613-21
pubmed: 12219151
Inj Prev. 2016 Feb;22(1):3-18
pubmed: 26635210
Injury. 2016 Jan;47(1):211-9
pubmed: 26492882
Afr J Emerg Med. 2019 Dec;9(4):202-206
pubmed: 31890485
Health Serv Res. 2015 Jun;50(3):642-62
pubmed: 25290644
Ghana Med J. 2012 Dec;46(4):189-99
pubmed: 23661837
BMC Public Health. 2016 Sep 15;16:992
pubmed: 27633253
Bull World Health Organ. 2008 Nov;86(11):871-6
pubmed: 19030693
J Am Stat Assoc. 2014 Jul 1;109(507):991-1007
pubmed: 25346558
BMC Health Serv Res. 2020 Jan 17;20(1):45
pubmed: 31952520
Health Econ. 2003 Nov;12(11):921-34
pubmed: 14601155
World J Surg. 2015 Oct;39(10):2428-40
pubmed: 26154575
Glob Health Res Policy. 2018 Nov 13;3:32
pubmed: 30460332
Int J Equity Health. 2016 Jul 22;15(1):116
pubmed: 27449349
Am J Public Health. 2001 Nov;91(11):1889-94
pubmed: 11684621
BMC Health Serv Res. 2015 Oct 19;15:473
pubmed: 26482171
Semin Pediatr Surg. 2012 May;21(2):111-5
pubmed: 22475116
World J Surg. 2017 Mar;41(3):639-643
pubmed: 27766400
PLoS One. 2017 Oct 31;12(10):e0187293
pubmed: 29088302
Lancet. 2011 Feb 5;377(9764):505-15
pubmed: 21227492
J Trauma. 2001 Oct;51(4):747-53
pubmed: 11586170
Prehosp Disaster Med. 2017 Feb;32(1):83-93
pubmed: 27938469
JAMA Surg. 2016 Feb;151(2):164-71
pubmed: 26502036
Lancet. 2012 Sep 8;380(9845):933-43
pubmed: 22959390
Health Policy Plan. 2009 Jan;24(1):63-71
pubmed: 19004861
Inj Prev. 2003 Jun;9(2):124-7
pubmed: 12810737
World J Surg. 2015 Nov;39(11):2613-21
pubmed: 26243561
Afr J Emerg Med. 2016 Mar;6(1):30-37
pubmed: 30456061
J Emerg Med. 2014 Oct;47(4):462-8
pubmed: 25066956
J Public Health Manag Pract. 2015 Jan-Feb;21(1):42-50
pubmed: 25414955
Int J Inj Contr Saf Promot. 2008 Mar;15(1):19-24
pubmed: 18344092
Int J Equity Health. 2011 Jan 19;10:4
pubmed: 21247436
J Pediatr Surg. 2015 Nov;50(11):1922-7
pubmed: 25841284
PLoS One. 2013 Apr 09;8(4):e61371
pubmed: 23585897
Int J Surg. 2015 Mar;15:74-8
pubmed: 25659222
Pan Afr Med J. 2016 Aug 03;24:294
pubmed: 28154649
J Trauma. 2009 Aug;67(2 Suppl):S114-9
pubmed: 19667843
PLoS One. 2017 Mar 3;12(3):e0170968
pubmed: 28257418
JAMA Surg. 2016 Aug 17;151(8):e161239
pubmed: 27331865