The Influence of Health Insurance on the Utilization of Maternal Health Care Services in Kumba Health District: A Community-based Assessment

Abstract

Background:The cash payments required to access services at health facilities called user fees are perceived to be a key barrier to improving maternal health care. This study was carried out to determine the influence of health insurance enrollment on the utilization of maternal health care services in Kumba Health District (KHD). Methods:This was an analytic community-based cross-sectional study carried out in KHD, including women of child-bearing age who have had their latest delivery within 5years prior to the study. Six of the twelve health areas in the KHD were purposively selected due to the presence of health insurance companies. Probability proportionate to size sampling was used to determine the number of eligible women to be selected from each of the health areas. Data were entered into Excel 2013 and analyzed using SPSS version 20. Chi-square tests and Logistic regression were employed to identify associations between variables. Statistical significance was set at P<0.05. Results:A total of 392 eligible women of child-bearing age (15-49years) were recruited into the study. A very high proportion, 94.4% of the women attended at least one ANC visit during their last pregnancy prior to the study. However, only 118(31.9%) started ANC in the critical first trimester. The prevalence of skilled facility delivery was 90.3% (95% CI: 87.2 -93.1%). The proportion of women using a family planning method was low, 45.4% (95%CI: 49.5 -59.2%). In multivariate analyses, insurance enrollment was significantly associated with family planning utilization (P-value: 0.000, AOR: 3.96, 95%CI: 2.14-7.35). Conclusion:Less than a quarter of women of reproductive age are enrolled in health insurance in the KHD. Health insurance has been found to influence the utilization of family planning services in Kumba Health District, but not antenatal care and skilled facility delivery, though insured women are more likely to utilize these services than the uninsured. Universal health care coverage is, therefore, necessary to ensure financial accessibility to maternal health care services by all women.

Cost of Ante-natal Care among Health Insurance (HI) Enrollees and Out-of-Pocket (OOP) Payers accessing Maternal Healthcare Services in a Tertiary Health Institution in Southwest Nigeria

“…The payment of cash in accessing services at health facilities (called user fees) has been identified as a key barrier to improving maternal health care [9]. Several attempts to remove the user fees have failed in many countries [9].…”

“…The payment of cash in accessing services at health facilities (called user fees) has been identified as a key barrier to improving maternal health care [9]. Several attempts to remove the user fees have failed in many countries [9]. User fee removal has also raised sustainability concerns because, with its removal, health financing generally relies on donors or on debt relief schemes that may not be available readily [9].…”

“…Several attempts to remove the user fees have failed in many countries [9]. User fee removal has also raised sustainability concerns because, with its removal, health financing generally relies on donors or on debt relief schemes that may not be available readily [9]. Evidence has shown that there are wide differences in the use of skilled maternal care services between the rich and the poor.…”

“…Health insurance is an alternative approach to health financing, with the possibility of user fee removal at the point of care [9]. However, unlike in developed and high-income countries, where contributions into health insurance are often collected through payroll deductions, it is usually difficult to do so in low-income countries because a large proportion of the population is not formally employed [9].…”

“…Health insurance is an alternative approach to health financing, with the possibility of user fee removal at the point of care [9]. However, unlike in developed and high-income countries, where contributions into health insurance are often collected through payroll deductions, it is usually difficult to do so in low-income countries because a large proportion of the population is not formally employed [9]. The National Health Insurance Scheme is aimed at providing equitable access to quality health care services, financial risk protection, reduction in the cost of health care, and increasing healthcare services efficiency [12].…”