Does the type of health insurance enrollment affect provider choice, utilization and health care expenditures?

Esso-Hanam Atake

doi:10.1186/s12913-020-05862-7

Abstract

BackgroundTwo 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.MethodsData 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.ResultsPolicyholders 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.ConclusionWe 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.

Highlights

Two of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks
We find that households with private insurance are more likely to use private health center (PHC) and referral hospital (RH) than those who are enrolled in public insurance
Our results suggest that careful attention should be paid to ensuring universal education and literacy as a means of improving access to and the use of health care

Summary

Introduction

Two of the objectives of Universal Health Coverage are equity in access to health services and protection from financial risks. UHC appears to be an appropriate solution to reduce unexpected health care costs, make intensive care accessible and strengthen the community’s sense of solidarity and willingness to provide equal access to health care for poor people [4] Though this effect is predicted by economic theory, health insurance does not always lead to the expected financial protection [5]. Through the introduction of a third-party payment mechanism, the service provider can encourage the patient to ask for increasingly more costly care that is different from what the patient would have chosen if he or she had had the same information as the provider [5, 7] This situation raises the issue of the redistributive effects of health insurance schemes in Sub-Saharan Africa

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