Jurnal Internasional Afrika vol. 11 issue 1 2021
African Journal of Emergency Medicine
Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children
Dublin Core
Title
Jurnal Internasional Afrika vol. 11 issue 1 2021
African Journal of Emergency Medicine
Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children
African Journal of Emergency Medicine
Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children
Subject
Ghana
Financial risk protection
Universal health coverage
Trauma
Children
Financial risk protection
Universal health coverage
Trauma
Children
Description
Introduction: 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.
Methods: 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.
Results: 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 p > 0.10). Uninsured children were more likely to have
a delay in care for financial reasons (17.3 vs 6.4%, p < 0.001) than insured children, and the families of
uninsured children paid a median of 1.7 times more out-of-pocket costs than families with insured children (p <
0.001). Eighty-six percent of families of uninsured children experienced CHE compared to 54% of families of
insured children (p < 0.001); however, 64% of all families experienced CHE. Insurance was protective against
CHE (aOR 0.21, 95%CI 0.08–0.55).
Conclusions: 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
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.
Methods: 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.
Results: 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 p > 0.10). Uninsured children were more likely to have
a delay in care for financial reasons (17.3 vs 6.4%, p < 0.001) than insured children, and the families of
uninsured children paid a median of 1.7 times more out-of-pocket costs than families with insured children (p <
0.001). Eighty-six percent of families of uninsured children experienced CHE compared to 54% of families of
insured children (p < 0.001); however, 64% of all families experienced CHE. Insurance was protective against
CHE (aOR 0.21, 95%CI 0.08–0.55).
Conclusions: 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
Creator
Barclay T. Stewart , Adam Gyedu , Stephanie K. Goodman , Godfred Boakye ,
John W. Scott , Peter Donkor , Charles Mock
John W. Scott , Peter Donkor , Charles Mock
Source
www.elsevier.com/locate/afjem
Publisher
elsevier
Date
21 September 2020
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Citation
Barclay T. Stewart , Adam Gyedu , Stephanie K. Goodman , Godfred Boakye ,
John W. Scott , Peter Donkor , Charles Mock, “Jurnal Internasional Afrika vol. 11 issue 1 2021
African Journal of Emergency Medicine
Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/2469.
African Journal of Emergency Medicine
Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/2469.