TY - JOUR
T1 - The complex association of health insurance and maternal health services in the context of a premium exemption for pregnant women
T2 - A case study in Northern Ghana
AU - Frimpong, Jemima A.
AU - Helleringer, Stephane
AU - Awoonor-Williams, John Koku
AU - Aguilar, Thomas
AU - Phillips, James F.
AU - Yeji, Francis
N1 - Publisher Copyright:
© 2013 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Background Health insurance premium exemptions for pregnant women are a strategy to increase coverage of maternal health services in sub-Saharan countries. We examine health insurance registration among pregnant women before or after the introduction of a premium exemption, and test whether registration increases utilization of maternal health services. Methods Data were drawn from a retrospective cohort study of 1641 women having given birth between January 2008 and August 2010 in two impoverished districts of Northern Ghana. Among those, 1411 became pregnant after premium exemption was adopted in July 2008. We compared registration rates before and after the exemption. We used logistic regressions to measure the association between insurance registration and receipt of essential maternal health interventions in the context of the premium exemption. We tested whether this association varied across levels of the health system [e.g. hospitals and health centres (HCs) vs community health compounds (CHC)]. Results Health insurance registration increased significantly among pregnant women after adoption of the premium exemption. Coverage of clinical and diagnostic services was high, but antenatal care (ANC) clients received only partial counselling about safe motherhood (e.g. pregnancy-related danger signs). Three out of four clients who sought ANC in hospitals and HCs delivered at a health facility vs. slightly more than 50% among clients of CHC. In hospitals and HCs, National Health Insurance Scheme (NHIS) registration was associated with higher quality of services. In CHCs, NHIS registrants received fewer diagnostic tests, were less extensively counselled about safe motherhood and were less likely to be vaccinated against tetanus toxoid than non-registered clients. Among CHCs clients, being a NHIS registrant was however associated with an increased likelihood of delivering at a health facility. Conclusions In the context of premium exemptions, association of health insurance with use of maternal health services, and quality of services received, depends on place where pregnant women seek ANC.
AB - Background Health insurance premium exemptions for pregnant women are a strategy to increase coverage of maternal health services in sub-Saharan countries. We examine health insurance registration among pregnant women before or after the introduction of a premium exemption, and test whether registration increases utilization of maternal health services. Methods Data were drawn from a retrospective cohort study of 1641 women having given birth between January 2008 and August 2010 in two impoverished districts of Northern Ghana. Among those, 1411 became pregnant after premium exemption was adopted in July 2008. We compared registration rates before and after the exemption. We used logistic regressions to measure the association between insurance registration and receipt of essential maternal health interventions in the context of the premium exemption. We tested whether this association varied across levels of the health system [e.g. hospitals and health centres (HCs) vs community health compounds (CHC)]. Results Health insurance registration increased significantly among pregnant women after adoption of the premium exemption. Coverage of clinical and diagnostic services was high, but antenatal care (ANC) clients received only partial counselling about safe motherhood (e.g. pregnancy-related danger signs). Three out of four clients who sought ANC in hospitals and HCs delivered at a health facility vs. slightly more than 50% among clients of CHC. In hospitals and HCs, National Health Insurance Scheme (NHIS) registration was associated with higher quality of services. In CHCs, NHIS registrants received fewer diagnostic tests, were less extensively counselled about safe motherhood and were less likely to be vaccinated against tetanus toxoid than non-registered clients. Among CHCs clients, being a NHIS registrant was however associated with an increased likelihood of delivering at a health facility. Conclusions In the context of premium exemptions, association of health insurance with use of maternal health services, and quality of services received, depends on place where pregnant women seek ANC.
KW - Ghana
KW - Health insurance
KW - health facilities
KW - health systems
KW - maternal health
KW - premium exemption
KW - user fees
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U2 - 10.1093/heapol/czt086
DO - 10.1093/heapol/czt086
M3 - Article
C2 - 24262280
AN - SCOPUS:84925306906
SN - 0268-1080
VL - 29
SP - 1043
EP - 1053
JO - Health Policy and Planning
JF - Health Policy and Planning
IS - 8
ER -