Utilization Of Health Facilities Research Articles

Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo

ABSTRACT Background: The disruptive effect of protracted socio-political instability and conflict on the health systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts. Objective: To examine whether the level of healthcare need is associated with health facility utilisation in post-conflict settings. Methods: We conducted a cross-sectional study among adults with diabetes, hypertension, mothers of infants with acute malnutrition, informal caregivers (of participants with diabetes and hypertension) and helpers of mothers of children acutely malnourished, and randomly selected neighbours in South Kivu province, eastern DR Congo. Healthcare need levels were derived from a combination, summary and categorisation of the World Health Organisation Disability Assessment Schedule 2.0. Health facility utilisation was defined as having utilised in the first resort a health post, a health centre or a hospital as opposed to self-medication, traditional herbs or prayer homes during illness in the past 30 days. We used mixed-effects Poisson regression models with robust variance to identify the factors associated with health facility utilisation. Results: Overall, 82% (n = 413) of the participants (N = 504) utilised modern health facilities. Health facility utilisation likelihood was higher by 27% [adjusted prevalence ratio (aPR): 1.27; 95% CI: 1.13–1.43; p < 0.001] and 18% (aPR: 1.18; 95% CI: 1.06–1.30; p = 0.002) among participants with middle and higher health needs, respectively, compared to those with low healthcare needs. Using the lowest health need cluster as a reference, participants in the middle healthcare need cluster tended to have a higher hospital utilisation level. Conclusion: Greater reported healthcare need was significantly associated with health facility utilisation. Primary healthcare facilities were the first resort for a vast majority of respondents. Improving the availability and quality of health service packages at the primary healthcare level is necessary to ensure the universal health coverage goal advocating quality health for all can be achieved in post-conflict settings.

NATIONAL TRENDS IN HOSPITALIZATIONS, MORTALITY AND COST OF CARE AMONG ACUTE MYOCARDIAL INFARCTION PATIENTS IN THE UNITED STATES: NATIONWIDE INPATIENT SAMPLE FROM 2001 TO 2014

Despite the advances in the management of coronary artery disease, acute myocardial infarction (AMI) has remained a significant health problem. While various factors including but not limited to demographics, socio-economic, environmental, and health-care facility utilization may impact the

Disrespectful Maternity Care Experiences Negatively Influence Future Intention to Use Institutional Delivery in Northern Ethiopia

Background Ethiopia has successfully increased antenatal care coverage substantially, but deliveries attended by skilled providers are still low. Disrespectful and abusive maternity care practices are believed to be among the factors deterring institutional delivery services. However, information on the relationship between women’s experience of disrespect and abuse (D&amp;A) and their future intention to give birth at health facilities is lacking in our context. Therefore, the aim of this study was to examine the association between experiencing disrespectful care and future intention of women to utilize health facilities for delivery. Methods A cross-sectional study was conducted in Tigray, Ethiopia. Data were collected using a structured questionnaire. Women who had given birth in the health facilities in the twelve months preceding the study were interviewed. D&amp;A was self reported by the women. Bivariable and multivariable logistic regression models were employed to examine the relationship between future intention of women to use institutional delivery services and their past experience of D and A while receiving maternity care services. Results A total of 1,031 women who delivered in health facilities in the last 12 months participated in the study. Of which, 156 (15.1%) reported having experienced two or more types of D&amp;A while receiving labour and delivery care services. Experiences of D&amp;A were strongly associated with the intention to use the health facility in future deliveries. The odds of having no intention to use health facilities for future deliveries was extremely high among women who reported they had experienced D&amp;A (aOR= 59.42; 95% CI: 30.082, 117.359). Conclusion Disrespectful and abusive experiences strongly deterred future use of maternal health services. In order to achieve the desired level of institutional delivery coverage in low- and middle-income countries, attention must be given to improve the manner in which services are offered. Keywords: Intention to deliver at a health facility, Respectful maternity care, Disrespect and abuse, Tigray, Ethiopia DOI: 10.7176/JHMN/72-01 Publication date: March 31 st 2020

Utilization of healthcare facilities among farming households in Yewa South Local Government Area, Ogun State, Nigeria

The study investigated the utilization of healthcare facilities among farming households in Yewa South Local Government Area of Ogun State. Multi-stage sampling technique was used to select 120 farming households and primary data were collected through the use of questionnaire. The data were analyzed using descriptive statistics and multivariate probit regression model. The results indicated that the mean age of the respondents was 41 years with an average household size of five people. About 31%of the respondents had no formal education and farming is the main occupation of respondents. Most (45.8%) of the respondents travelled a distance of 5 km or less before accessing health care facilities. Primary health care was the major health care service utilized by respondents in the study area. Results further revealed that age, education, household size, income, distance to healthcare facilities, severity of ailments and belief were the major socioeconomic factors determining demand for healthcare facilities in the study area. The findings call for government at all tiers to establish more healthcare facilities closer to the residence of the rural areas to increase the farming households’ accessibility to these facilities. Keywords: healthcare, households, multivariate probit, trado-medicals

Factors affecting utilization of health facilities for labour and childbirth: a case study from rural Uganda

BackgroundSince 2000 considerable attention has been placed on maternal health outcomes as the 5th Millennium Goal. In Uganda, only 65% of births are delivered by a skilled birth attendant, contributing to the 435 women that die in every 100,000 births from unattended complications. Factors that impact a women’s decision on where to deliver include cost and household barriers, poor health services and lack of education.MethodsInsight into factors impacting maternal health decision-making in two villages in South Eastern Uganda, were explored through a cross-sectional study using focus group discussions (FDGs) with men and women and administering a simple questionnaire.ResultsFor men and women in the villages, cultural and community patterns of behavior have the strongest impact on delivery options. While women with no complications could often find options to deliver safely, lack of emergency obstetric care remains a strong factor in maternal deaths.ConclusionsThis article proposes that communities be engaged in identifying and leveraging their strengths to find solutions for challenges facing women in achieving safe deliveries.

Utilization of Health Facilities for Under-five Children with Diarrhea in Indonesia: Data Analysis of the IDHS 2017

Utilization of Health Facilities for Under-five Children with Diarrhea in Indonesia: Data Analysis of the IDHS 2017

Relationships between Family Support of Type 2 Diabetics and the Utilization of Healthcare Facilities in Tebet

&lt;div&gt;&lt;p class="Keywords"&gt;&lt;strong&gt;Objective&lt;/strong&gt;: This study aimed to identify the characteristics of type 2 diabetes patients, family support, the utilization of healthcare facilities, and their interrelationships.&lt;/p&gt;&lt;p class="Keywords"&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This was a quantitative study with cross sectional approach. As many as 100 patients with type 2 diabetes mellitus who visited Tebet Community Health Services were selected using consecutive sampling method. We collected data using the 29- items Hensarling Diabetes Family Support Scale (HDFSS) questionnaire to measure family support. We also developed a 10- items questionnaire to measure the utilization of healthcare facilities.&lt;/p&gt;&lt;p class="Keywords"&gt;&lt;strong&gt;Results&lt;/strong&gt;: Most patients received good family support (61%), good informational support (57%), and good rewarded support (55%). The utilization of health care facilities was good (56%). Results of our study showed a significant relationship between family support and the utilization of healthcare facilities (p= 0.0001). Patients with good family support were 348.3 times more likely to use healthcare facilities. There was a significant relationship between informational support and the utilization of healthcare facilities (p = 0.0001). Patients with good informational support were 5.8 times more likely to use healthcare facilities. Likewise, good rewarded support was significantly associated with good utilization of healthcare facilities (p= 0.0001). Patients with good rewarded support were 4.8 times more likely to use healthcare facilities.&lt;/p&gt;&lt;p class="Keywords"&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: The majority patients received good supports and utilized healthcare facilities. Healthcare professionals in the facilities need to involve family in health promotion and education related to patient care at home.&lt;/p&gt;&lt;/div&gt;&lt;strong&gt;Key words&lt;/strong&gt;: family support, type 2 diabetes, and utilization of healthcare

Health Seeking Behaviours and Challenges to Utilizing Health Facilities in the North West Region of Cameroon

In a given community, health seeking behaviours determine how health care services are used. This in turn determine the health outcomes on members of this community. Utilization of health care facilities can be determined by cost, cultural beliefs, level of education, family incomeand distance to health facility. The purpose of this study was to determine the influence of socio-demographic factors on healthcare seeking behaviors and challenges in utilizing health facilities in the North West Region of Cameroon. The study was a cross sectional survey that used a structured questionnaire to collect quantitative data from 430 participants. The findings showed that despite low incomes and education levels, the study communities have moderate levels of access to services for curative and preventive care. About half of the participants preferred Government health facilities (50.5%) while a small number of participants preferred seeking care from traditional medicine (0.9%). In rural areas, Government health facilities are more preferred than in urban areas; 69.6% of participants in rural zones preferred government facilities whereas they were 43.7% in urban areas (p<0.001, V=0.228). In conclusion, the study sought to evaluate health seeking behaviors of rural and urban dwellers. The goal is to trigger discussions and re-evaluation of health promotion and education policies and programmes to bring about improvement in health seeking behaviours and address issues around health disparities and inequalities.

Patterns and determinants of healthcare-seeking behavior among hypertensive patients in a rural population of north India: A mixed-method study.

The prevalence of hypertension in india over the last 30 years is known to have increased rapidly. Hypertension is a chronic disease that needs to be managed within its sociological context as experienced by individuals. This study was conducted to identify the quantitative and qualitative determinants of healthcare-seeking behavior among hypertensive individuals in a rural population of north india.Methodology:A mixed-method study involving 100 adult hypertensive patients was employed. Data were collected on demographic characteristics, health-seeking behavior, and the reasons for choosing a particular health service using a structured questionnaire and interview guide. Descriptive statistics were used to examine the influence of determinants on health-seeking behavior and utilization of healthcare facilities and expressed as percentages. Qualitative data were thematically analyzed.Results:A total of 100 participants with hypertension between 38 and 76 years of age were included in the study. Out of the total study participants, 66.0% of the respondents were males and 34.0% were females. Participants demonstrated a generalized knowledge of hypertension and showed significant gaps and misconceptions in their understanding of the disease and the need for seeking expert care. There was also a lack of sense of trust in the healthcare system. Various demographic, sociocultural, and economic determinants of healthcare-seeking behavior in these rural patients’ services were explored. This evidence can prove helpful in streamlining interventional programs and realigning the existing interventions to prevent and control hypertension in rural settings.

Vaccination Coverage Under the Expanded Program on Immunization in South West Cameroon.

Background:Inadequate vaccination coverage with increased risk of vaccine preventable disease outbreaks remain a problem in Africa. The aim of this study was to assess the vaccination coverage levels under the Expanded Program on Immunization (EPI) in a health area and to identify factors that affect vaccination coverage in view of providing valuable data for disease prevention.Methods:A cross-sectional household survey was conducted in August 2017 in the Mbonge health area, Southwest Cameroon. Clustered sampling technique was used to select study communities and a purposive sampling design was used to select households. An interviewer-administered questionnaire was used to obtain information from consenting caregivers of children aged 9–23 months. Vaccination coverage was assessed by consulting the vaccination cards and parents’ recall. In households with more than one child aged 9-23months, the youngest was chosen.Results:Overall, 300 caregivers were enrolled into the study. The average vaccination coverage for the past three years (2014-2016) was 34.0%. Two hundred and fifty-five (85%) children had vaccination cards. Amongst the children, 143 (47.7%) had taken all vaccines as recommended while 30 (10%) had not received a single dose. Factors significantly associated with incomplete vaccination status included: occupation (being a farmer) (p-value=0.011), marital status (married) (p-value=0.048), caregiver’s utilization of health facility (p-value=0.003), low levels of mothers’ utilization of antenatal care (ANC) services (p-value=0.000), and low knowledge on vaccination (p-value=0.000).Conclusion and Global Health Implications:Adequate vaccination coverage can be attained through good sensitization and health education for primary caregivers. Targeting families living far away from vaccination centers, using appropriate communication and vaccination strategies may improve vaccination coverage in the Mbonge Health Area of South West Region, Cameroon.

Analysis of distribution, capacity and utilization of public health facilities in Borno, North-Eastern Nigeria

IntroductionThis study aimed to analyze the spatial distribution and capacities of public health facilities and assess utilization of the facilities in Biu area of Borno State, Nigeria.MethodsA descriptive survey of health facilities and households were conducted by stratifying the area into 11 electoral wards. Data collection instruments include a hand-held GPS (Garmin 76CSx) and 2 sets of structured questionnaires (facility and household). The hand-held GPS was used in taking the coordinates of each health facility in the area. Twenty-five facility-based and 400 household-based questionnaires were administered.ResultsIt was identified that 138 public health personnel serve the area’s population of 240,838. Medical professionals (doctors/nurses/midwives) to patient ratio is 1:2973, about 7 times less than the minimum WHO recommendation of 2.5 medical personal per 1000 population. Uneven distribution of facilities exists, which impact on utilisation. For instance, a ward (Mandaragrau) with a population of 18,732 have 5 facilities (4 dispensaries and 1 primary health care) in comparison to a ward (Miringa) with a population of 21,343 with only one Dispensary. Income level and distance were significant socio-economic factors affecting service utilisation (p < 0.001). Area’s households Gini index was 26.7, most of which (49.7%) survive on less than USD2/day and majority (33.6%) spend an average cost of treatment of ₦2,750 (approx. $8) per clinic visit.ConclusionIt was concluded that insufficiency and inequity in distribution of healthcare services exist in Borno State. It is thus recommended that future policies be directed toward improving healthcare in under-served areas.

Choices and determinants of delivery location among mothers attending a primary health facility in Southern Nigeria.

The delivery locations of pregnant women contribute greatly to their birth outcome. The objectives of this study were to determine the choices and determinants of delivery locations among mothers attending a primary health centre (PHC) in southern Nigeria. This was a descriptive cross-sectional study among mothers attending PHC, West Itam, Itu, Nigeria. Data were collected using interviewer-administered questionnaire and analysed with STATA version 12.0. Level of significance was set at 0.05. A total of 185 mothers participated in the study. The mean age of respondents was 27.6 ± 5.2 years. The delivery locations of last pregnancy were health facility (64.9%), traditional birth attendant's place (23.3%), respondent's residence (6.3%) and church (5.4%). The top five reasons that influenced the choice of delivery locations were distance (45.4%), cost (34.6%), skills of healthcare workers (30.3%), drug availability (27.6%) and attitude of healthcare workers (26.5%). Utilisation of healthcare facilities for delivery increased significantly with level of education and income of respondents and spouses (P < 0.05). Different non-institutionalised delivery locations were utilised by some of the respondents. Factors influencing women's choices of delivery locations included distance, cost and attitude of health workers. It is recommended that pregnant women be offered free or highly subsidised healthcare services to encourage their delivery at health facilities. Healthcare providers should endeavour to develop better relationship with clients who patronise their services. Female education should also be encouraged as this would empower them to make better choices about their health services options.

A COMPREHENSIVE STUDY OF HEALTHCARE FACILITY UTILIZATION AND HEALTH-RELATED PROBLEMS IN PREGNANT WOMEN IN URBAN NORTH INDIA

Ponte Academic JournalNov 2020, Volume 76, Issue 11 A COMPREHENSIVE STUDY OF HEALTHCARE FACILITY UTILIZATION AND HEALTH-RELATED PROBLEMS IN PREGNANT WOMEN IN URBAN NORTH INDIAAuthor(s): Mohammad Inam Khan ,Mohammad aadil KhanJ. Ponte - Nov 2020 - Volume 76 - Issue 11 doi: 10.21506/j.ponte.2020.11.6 Abstract:Background: The Sub Saharan African countries constitutes nearly half of maternal deaths, and Southern Asian countries ranks as second of the total 85% death which occurs all over the world. Despite the fact there is rapid enhancement in the number of skilled health workers. There been a sharp increase of 53% in 1990 and 61% in 2007 in TBA utilization shows that the attention is being paid towards the management of labor services. But surprisingly, still the births take place without the assistance of trained health personnel in Southern Asian countries and in Sub-Saharan Africa. Objective: The objective of this study is toward the assessment on barrier to health care facility utilization and its management concerning to labor problems in urban North India. Methodology: The factor analysis was implied for the interpretation and analysis of the data. Results: It was found the inadequacies in services as well as unawareness of services in almost all urban areas among the pregnant women. Monumental rise in the cost of services and corrupt behavior among the services provider rampantly found in the urban locations, inaccessibility of proper means of communication and also economic backwardness and low literacy became the impediment in the utilization of maternal healthcare services in North India. Download full text:Check if you have access through your login credentials or your institution Username Password

Impact of the Covid-19 pandemic on the elimination of hepatitis C virus in Duhok, Kurdistan, Iraq: A retrospective cross-sectional study

Background and Aim:Infection with hepatitis C virus (HCV) is a public health threat worldwide. The World Health Organization aims to eliminate HCV. However, the coronavirus disease (COVID-19) pandemic has led to a severe compromise in health services, and this has halted efforts to eliminate HCV. Herein, we report our experience with the initiative of HCV elimination in Duhok city, Kurdistan Region of Iraq, with a focus on the effect of the COVID-19 pandemic on the HCV elimination plan.Materials and Methods:An anti-HCV antibody test was used to screen subjects. All positive results were then confirmed by reverse-transcription polymerase chain reaction (RT-PCR) testing. All patients with current HCV infection were treated with direct-acting antiviral regimens.Results:During the study period, 459,015 subjects were tested for anti-HCV antibody positivity, with a monthly average of 9,562 tests for HCV. This number dropped to zero during the lockdown period between 1March and 31May 2020. Among the tested samples, 0.29% (1350/459015) tested positive for anti-HCV antibodies. RT-PCR testing of all positive samples revealed that 0.020% (93/459015) were positive. Of the 93 recruited subjects, 3 patients did not complete the treatment course due to the lockdown. All patients who finished the treatment course were cured as determined by sustained virologic response 12 (SVR12) weeks after finishing the treatment course.Conclusion:During the COVID-19 pandemic, reductions in health facility utilisation led to a significant decrease in services offered for HCV screening and treatment. Such a decrease in services has had a negative impact on HCV elimination. An urgent plan is needed to resume the services, and strict follow-up is needed for patients whose treatment was interrupted.

Utilization of healthcare services among Chinese migrants in Kenya: a qualitative study

BackgroundThe number of Chinese migrants in Sub-Saharan Africa (SSA) is increasing, which is part of the south-south migration. The healthcare seeking challenges for Chinese migrants in Africa are different from local people and other global migrants. The aim of this study is to explore utilization of local health services and barriers to health services access among Chinese migrants in Kenya.MethodsThirteen in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among Chinese migrants (n = 32) and healthcare-related stakeholders (n = 3) in Nairobi and Kisumu, Kenya. Data was collected, transcribed, translated, and analyzed for themes.ResultsChinese migrants in Kenya preferred self-treatment by taking medicines from China. When ailments did not improve, they then sought care at clinics providing Traditional Chinese Medicine (TCM) or received treatment at Kenyan private healthcare facilities. Returning to China for care was also an option depending on the perceived severity of disease. The main supply-side barriers to local healthcare utilization by Chinese migrants were language and lack of health insurance. The main demand-side barriers included ignorance of available healthcare services and distrust of local medical care.ConclusionsProviding information on quality healthcare services in Kenya, which includes Chinese language translation assistance, may improve utilization of local healthcare facilities by Chinese migrants in the country.

Socio-cultural factors favoring home delivery in Afar pastoral community, northeast Ethiopia: A Qualitative Study

BackgroundDespite expanding the number of health facilities, Ethiopia has still the highest home delivery services utilization. Health care service utilization varies between regions within the country. This study explored the socio-cultural factors influencing health facility delivery in a pastoralist region of Afar, Ethiopia.MethodsAn explorative qualitative study was conducted in October–December 2015. A total of 18 focus group discussions were conducted separately with mothers, male tribal leaders and religious leaders. In addition, 24 key informant interviews were conducted with Women’s Affairs Bureau and district health office experts and traditional birth attendants and all were selected purposively. Data were coded and categorized using open code software and analyzed based on a thematic approach.ResultsThe social factors that affect the choice of delivery place include workload, lack of independence and decision-making power of women, and lack of substitute for childcare and household chores during pregnancy and childbirth. The cultural and spiritual factors include assuming delivery as natural process ought to happen at home, trust in traditional birth attendants, traditional practices during and after delivery and faithful to religion practice, besides, denial by health facilities to benign traditional and spiritual practices such as prayers and traditional food preparations to be performed over there.ConclusionSocio-cultural factors are far more than access to health centers as barriers to the utilization of health facilities for child birth. The provision of a maternity waiting home around the health facilities can alleviate some of these socio-cultural barriers.

Choice of birth place among antenatal clinic attendees in rural mission hospitals in Ebonyi State, South-East Nigeria.

BackgroundLow utilization of health facilities for delivery by pregnant women poses a public health challenge in Nigeria.AimTo determine the factors that influence the choice of birth place among antenatal clinic attendees.MethodologyThis was a cross-sectional study of the eligible antenatal clinic attendees recruited at Mater Misericordiae Hospital, Afikpo and Saint Vincent Hospital, Ndubia in Ebonyi State from February 1, 2016 to June 30, 2016. Analysis was done using EPI Info 7.21 software (CDC Atlanta Georgia).ResultsA total of 397(99.3%) completely filled questionnaires were collated and analysed. Approximately 71% of the health facilities closest to the respondents had maternity services. It took at least 1 hour for 80.9% of the respondents to access health facilities with maternity services. Most (60.2%) of the respondents had at least one antenatal clinic attendance and majority of them did so at public hospitals. Approximately 43.8% of the respondents were delivered by the skilled birth attendants. The respondents’ age and the couple’s educational level, history of antenatal clinic attendance, distance of the health facility and availability of transport fare had a significant effect on delivery by skilled birth attendants. The common determinants of birth place were nearness of the health facilities, familiarity of healthcare providers, improved services, sudden labour onset and cost. Also 61.7% of the respondents chose to deliver in public health facilities due to favourable reasons but this could be hampered by the rudeness of some healthcare providers at such facilities. A significant proportion of private health facilities had unskilled manpower and shortage of drugs.ConclusionA greater proportion of women will prefer to deliver in health facilities. However there are barriers to utilization of these facilities hence the need to address such barriers.

Migration status and healthcare seeking behaviours among the Chinese labor-force: a nationally representative study

ObjectivesWe aimed to analyse the healthcare seeking behaviours (HSB) of populations with different migration status and examine the relationship between migration status and HSB.DesignA secondary analysis of cross-sectional data of...

P1946Hypertension prevalence, awareness, treatment and control and 10-year estimated CVD risk in East and West Africa: pooled analysis of data from 4 African countries

Abstract Background Though the prevalence of hypertension is rising in Sub-Saharan Africa, few studies have characterized the epidemiology and management of hypertension across many heterogeneous communities. We assessed prevalence, awareness, treatment and control of hypertension and estimated the 10-year cardiovascular risk across six sites in East and West Africa. Methods Between June and August 2018, we conducted household-based surveys in 6 rural, semi-urban and urban settings in Kenya, Nigeria, Tanzania and Uganda to enroll community-dwelling adults (aged &gt;18 years) collect data including age, gender, smoking, anthropometric measures, health insurance, utilization of health care facilities. We defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use. We used country specific Globorisk prediction equations to estimate 10-year CVD risk. Results A total 3,150 participants with a mean age of 40 years (SD 15), 61% of whom were women, 8% had ever smoked, and 33% were overweight/obese. About 23.7% (95% CI 22.2, 25.2) of the entire sample had hypertension, of whom 60.6% (56.8, 64.3) were diagnosed. Among diagnosed, 61.7% (57.2, 66.1) were taking antihypertensives, and 27.7% (22.7, 33.1) had controlled BP. The prevalence of hypertension was 38.6% in Ikire-Nigeria, 25.1% Ukonga-Tanzania, 23.3% in Oyo-Nigeria, 21.6% in Okpok-Nigeria, 20.4% in Soroti-Uganda, and 9.7% in Viwandani-Kenya. The overall median estimated 10-yr CVD risk was low 4.6% IQR (2.3, 9.6) and 8.6% had 10-yr CVD risk &gt;10%. (Figure 1) Conclusion Among African adults aged &gt;18 years, nearly a quarter have hypertension, three in 5 being treated, and fewer than three in ten had BP under control. The low number of people in control is ubiquitous in all sites and warrants greater prevention strategies, better screening and more effective and affordable treatment options than what is currently available.

The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review.

BackgroundExpanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years.MethodsWe reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status.Findings8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies).InterpretationIncreased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.