Utilization Of Health Facilities Research Articles

Improving access to and use of maternal health services during COVID-19: Experience from a health system strengthening project in Guinea.

The purpose of this study was to document the experience of health providers' capacity strengthening during health crises and the contribution of such to the health system and the population resilience in the face of the COVID-19 pandemic in Guinea. We conducted a cross-sectional study using routine data collected from 41 health facilities in the project intervention areas, including associative health centers, community health centers, and district hospitals,. These data covered the period between 2019 and 2021. Results showed that all the community health centers (CMCs) had a clean internal and external environment, compared to health centers (95.2%) and district hospitals (33.3%). Hand washing was systematic among visitors attending CMCs and district hospitals (HPs). However, 28.6% of visitors attending associative health centers (AHCs) did not wash their hands. Temperature taking for visitors was not carried out in all CMCs and in 90.5% of the AHCs; unlike in the HC and HP where the temperature of each patient was taken before entering the consultation room. The obligation to wear masks was higher in the HP and in the HC, compared to the CMC and AHC where the order of non-compliance with the wearing of masks was, respectively 36.4 and 19%. Non-compliance with social distancing in the waiting rooms and between users was observed in all facilities. The project's interventions mainly contributed to improving the utilization of prenatal consultation and institutional delivery services; the beginning of the interventions was marked by an increase of an average of 17 ANC1 per month in CMCs and 116 ANC1 in health centers. Ongoing training on capacity strengthening for providers in infection prevention and control, followed by the offering of delivery kits and materials during epidemics, would contribute to the improvement and utilization of health facilities by the population.

Accessibility of Public Healthcare Facilities and Their Distribution in Benin City, Edo State

Access to quality health services determines human health and well-being, especially in this pandemic era. The objective of the study is to examine the factors that affect the utilization and accessibility of public healthcare services within selected local government areas in Benin City. The study adopted the use of 400 questionnaires, which were administered to respondents within the study area. ArcGIS 10 was used to depict health facility disparities within the city, while Pearson’s Product Moment Correlation was used to test healthcare utilization. The results indicate that public healthcare facilities are clustered in distribution, having a 0.28 nearest neighbour ratio. The public healthcare facilities are accessible and there are no shortages of healthcare within the study area. Socio-demographic variables such as gender, age, marital status, education, and employment at a were positively related to healthcare accessibility. Approximately 73% of patronage and the type of public healthcare facility influence facility utilization in the study area. Factors influencing accessibility and utilization of healthcare facilities are means of transportation, travel distance, and challenges within healthcare facilities. The quality of services at 48% improves healthcare utilization. This study recommends that health care facilities need to be maintained to encourage more patronage and better service delivery that includes a policy framework for the regular maintenance and provision of necessary equipment and infrastructure that would encourage accessibility and utilization of public healthcare facilities.

ASSOCIATION OF EARLY CHILDHOOD CARIES AND NUTRITIONAL STATUS AMONG 5-YEAR-OLD CHILDREN IN INDONESIA

Oral health and nutrition problems in children cannot be separated. Both share the same risk factors. The high prevalence of malnutrition and Early childhood caries (ECC) in developing countries, especially in Indonesia, still needs attention. This study aims to analyze the relationship between ECC and the nutritional status of children aged five years in Indonesia based on the 2018 Riskesdas data. The study used a cross-sectional study using secondary data from Riskesdas 2018. A sample of 701 children aged five years was subjected to clinical examinations and questionnaires. ECC as the independent variable and other risk factors; self-reported oral health, gender, mother's education level, father's employment status, family economic status, children's dietary practices, and utilization of health facilities were analyzed against nutritional status based on weight/height categories converted by Z-score. Results showed that the chi-square test showed a significant correlation between ECC, maternal education level, family economic status and dietary practices at risk of children on nutritional status (p-value <0.05). Multinomial logistic regression test proved a significant correlation between ECC and wasting (OR = 1.352, 95% CI: 0.989 – 2.589). ECC is not correlated with obesity. The conclusion is ECC can cause wasting in children. Meanwhile, several risk factors for nutritional problems and dental caries were similar.

A spatial analysis of health care accessibility and utilization among rural households in Kogi State, Nigeria

This study was aimed at a Spatial Analysis of Health Care Accessibility and Utilization among Rural Households in Kogi State, Nigeria. Primary data employed in this study were obtained with the aid of well-structured questionnaires. A multi-stage sampling technique was employed in the selection of respondents. The analytical techniques used in this study included descriptive statistics and Healthcare Accessibility Index. Descriptive statistics such as frequencies and percentages were used to describe the sources and uses of healthcare facilities in relation to socio-economic characteristics as well as the level of utilization of health care services. Results obtained in this study revealed that 58% of the respondents had access to health care services while only 42.50% utilized these services. Findings in this study also revealed that 71% of the household heads were males while the remaining 29% were females. However, 41% of the male headed households have access to healthcare services compared to 17% of the female headed households. Furthermore, 71% of the respondents were in their economic active age (≤ 50 years). About 75.55% of the respondents within this age bracket accesses and utilizes healthcare service more than the elderly ones. Exactly 43.50% had no formal education while 6, 23.5, 11.5, and 15.5% had adult, primary, secondary and tertiary education respectively. Thirteen percent (13.0%) of those with primary education had access to health care services while 78.57% out of these utilized the healthcare services. Furthermore, 24.5% of those with no formal education had access to healthcare service while 69.23% of the respondents utilized healthcare services. Majority (40.5%) of the rural households lived 5 to 9 km to a public health center with 21% having access to healthcare facilities and 85.7% utilizing the facilities. Eleven percent of respondents living 4 km from the healthcare service provider have access to healthcare facilities while 90.09% of the respondents utilized it. About 13% of the respondent who lives 10 to 14 km from healthcare service had access while 61.11% utilized the services. Forty-three percent (43.75%) of respondents living more than 14 km to their healthcare providers makes use of the available healthcare facilities. The result, therefore, indicates that utilization of available health facilities increases with proximity to the health centers. Seven percent (7%) of respondents have family size of 1-4 members per household, whereas only 60% of the respondents within this group with access to healthcare facilities utilized it. Furthermore, those with household size above 14 members have the highest health service utilization with 85.71%. This study has shown that there is unequal distribution of health facilities as well as low level of accessibility of household to medical facilities in the study area. To this end, governments at all tiers should ensure equitable accessibility to health care delivery across the rural areas by deploying more medical and Para-medical staffs to the rural areas. Rural development policies should promote the creation of enabling environment to enhance participation in modern health care delivery in rural areas. There is also a serious need for sensitization programme to create awareness about the importance of using modern healthcare facilities among the rural dwellers.

Pregnant woman’s knowledge to the danger signs of pregnancy

Background: Based on World Health Organization (WHO,2019) Maternal Mortality Rate is the number of maternal deaths caused by pregnancy, childbirth and postpartum that become the indicator of women’s health level. Maternal mortality rate becomes one of the targets of Sustainable Development Goals (SDGs) in reducing maternal mortality rate to be 70 per 100.000 live birth in 2030. Aim: to review the evidence relate to the pregnant woman’s knowledge to the danger signs of pregnancy. Method: this scoping review used framework from Arksey and O’Malley consisting of conducting focus review by framework PEOS, conducting literature searching by using 3 databased by identifying scoping review question, identifying relevant article, selecting article, data charting, arranging as well as summarizing and reporting the result. Result: The scoping review of 10 article journal having Grade A and B that discuss about danger signs of pregnancy, category of knowledge, utilizing health facilities, the method to improve the knowledge. Conclusion: Based on scoping review result of primigravida’s knowledge is still low compared to multigravida, therefore it needs the alternative to improve pregnant women’s knowledge about danger signs of pregnancy through counselling and telemedicine.

Affordability, Preferences and the Utilization of Healthcare Facilities among the Rural Women Householders in Kerala

Affordability, Preferences and the Utilization of Healthcare Facilities among the Rural Women Householders in Kerala

Histopathological Predictors of Microsatellite Instability in Colorectal Cancer-a Tertiary Care Center Experience.

Microsatellite instability (MSI) has a therapeutic and prognostic implication in colorectal carcinomas (CRCs). It can be detected either by immunohistochemistry (IHC) or molecular studies. In developing countries, a significant proportion of the patients experience financial constraints limiting the utilization of healthcare facilities. We aimed to identify the possible clinicopathological variables which can be used as predictors of microsatellite instability in such patients. CRC cases received for MSI detection by IHC (for 1 and 1/2years) were included. A panel of four IHC markers (anti-MLH1, anti-PMS2, anti-MSH2, and anti-MSH6) was used. Confirmation by the molecular study was recommended in all the IHC-proven MSI cases. Various clinicopathological parameters were evaluated as predictors of MSI. Microsatellite instability was detected in 40.6% (30/74) cases with MLH1 and PMS2 dual loss in 27% cases, MSH2 and MSH6 dual loss in 6.8%, loss of all four MMR proteins in 2.7%, and isolated PMS2 loss in 4.1%. MSI-H expression was shown by 36.5% cases with only 4.1% cases showing MSI-L expression. The age cut-off value to differentiate both the study groups (MSI vs MSS) was 63years with a sensitivity of 47.7% and specificity of 86.7%. ROC curve showed an area under the curve of 0.65 (95% CI, 0.515-0.776; p-value = 0.03). On univariate analysis, age < 63years, colon site, and absence of nodal metastasis were significantly higher in the MSI group. However, on multivariate analysis, only the age < 63years was found to be significantly higher in the MSI group. Confirmation was molecular study could only be obtained in 12 cases and was completely concordant with MSI detection by IHC. MSI detection can be performed either by IHC or by molecular study. In this study, no histological parameter appeared to be the independent predictor of MSI status. The age < 63years might predict the microsatellite instability, yet larger studies are needed for its validation. Thus, we recommend that IHC testing should be performed in all CRC cases.

ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol

Snakebite is possibly the most neglected of the NTDs (Neglected Tropical Diseases). Half of the global deaths due to venomous snakebites, estimated at 100,000 per year, occur in India. The only representative data on snakebite available from India is the mortality data from the RGI-MDS study (Registrar General of India- 1 Million Death Study) and another study on mortality from the state of Bihar. Incidence data on snakebite is available for 2 districts of the state of West Bengal only. Hospital-based data on snakebite admissions and use of ASV are gross underestimates as most snakebite victims in rural India depend more on alternate treatment methods which do not get represented in National registries. The proposed study is a multi-centric study to determine the incidence, morbidity, mortality and economic burden of snakebites in India covering all 5 geographical zones of the country. A community level surveillance for snakebite covering 31 districts in 13 states of India in order to obtain annual incidence of snakebites from the community. Frontline health workers will be trained to gather information on new cases of snakebite over the study period of 1-year, from "wards "(smallest administrative subunit of a village or town) that they represent in the study districts. Dedicated field officers would collect data on snakebites, victim characteristics, outcomes, utilization of health facilities on a questionnaire sheet designed for this purpose. The study duration is for 18 months from April 2022 to October 2023. The study would be the first of its kind in India looking prospectively at the incidence of snakebite covering 13 states in 5 zones of India and a population of 84 million. Our study covers 6.12% of the total population of the country as compared to the incidence study conducted in Sri Lanka which covered 1% of the total population.

Quality of intrapartum care at Public Health Institutions of North Achefer District, North West Ethiopia: a mixed method study

BackgroundEnding preventable maternal, and neonatal morbidity and mortality cannot be achieved without quality care interventions during the intrapartum and postpartum period. Poor quality care during the intrapartum and postpartum period contributes high burden of maternal and neonatal morbidity. Therefore, the current study aimed to assess the quality of intrapartum care and its associated factors in public health facilities in North Achefer District, North West Ethiopia.MethodA mixed-type institution-based cross-sectional study design was conducted from November 7 to December 6, 2019. Simple random sampling and purposive sampling were used to select study participants for quantitative and qualitative studies respectively. Data were coded and entered into Epi data version 4.4.2 software and exported to SPSS version 25 for analysis. Variables with a p-value of less than and equal to 0.25 were entered into multivariable regression analysis and variables with p values < 0.05 were considered statistically significant factors of the quality of intrapartum care. The qualitative data were analyzed by using thematic content analysis. Finally, qualitative findings were used to supplement the quantitative result.ResultThe finding showed that, 27.3% (95% CI: 26.6–28) of mothers received good quality intrapartum care. Presence of long-distance (AOR = 0.19; 95% CI = 0.06, 0.66), health care facility (AOR = 0.07; 95% CI = 0.02, 0.20), and partograph utilization (AOR = 4.9; 95% CI = 1.82, 13.14) were factors associated with the quality of intrapartum care.ConclusionThe proportion of intrapartum quality care was low. Distance, partograph utilization, and type of health facility were factors associated with quality of intrapartum care. The district, zonal health offices, and regional health bureau should provide capacity building and follow up on partograph utilization, and increase the accessibility of ambulances.

Heart failure disease management program: A review.

Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient satisfaction. This had led to an overall reduction in healthcare costs. Longer life expectancy has led to increased utilization of healthcare facilities, which may lead to a rise in costs. DMPs are an effective means of improving care and compliance and ultimately curbing inappropriate resource utilization. The present study reviews different definitions proposed for disease management, its components, the evidence behind it, and the conditions for success. It also examines heart failure management as an example of a DMP, exploring the complexity surrounding implementation of guideline-based approaches in patient care. A literature search on DMPs was conducted using PubMed, MEDLINE, and Google Scholar, including heart failure management programs from articles published from 2000 to 2020. This reviewed emphasized on the management of important biomarkers and cardiovascular indicators such as glycemic levels, urine output to improve efficacy of disease management programme during patient treatment.The review concluded that diseases like heart failure can be combat by improving the quality of care for patients and reducing the burden on the public healthcare system. Moreover, DMPs have proved to be an effective way of improving care and compliance with treatment.

The Influence of Community Behavior in Disposing of Garbage on the Spread of Malaria

The existence of garbage in everyday life can not be separated from human behavior that litters. Lack of public awareness in disposing of waste results in an unhealthy environment. An unhealthy environment triggers the emergence of various diseases, one of which is a disease caused by mosquito bites, namely malaria. Malaria is one of the most deadly diseases. This study aims to see how far the influence of community behavior in disposing of waste on the spread of malaria outbreaks. The data used in this study is data from the 2018 Village Potential data collection with 83,931 villages in Indonesia. The analytical method used is Ordinary Least Square (OLS). The results obtained in this study are people's behavior in disposing of waste has a significant effect on the spread of malaria. The better the behavior of the community in waste disposal and management, the lower the spread of malaria will occur. In addition, access to and utilization of health facilities and services is also important in the process of treating malaria. The results of this study also concluded that the farther the distance to health care facilities, the greater the risk of suffering from malaria. Government participation is needed to improve public health promotion.

Social and Regional Disparities in Utilization of Maternal and Child Healthcare Services in India: A Study of the Post-National Health Mission Period.

BackgroundIndia has enjoyed enhanced economic growth, but has fared poorly in human development indicators and health outcomes, over the last two decades. Significant health inequities and access to healthcare continue to exist and have widened within communities across states. This study examine the changes and disparities in maternal and child healthcare (MCH) among disadvantaged and advanced social groups in three states of India.Data and MethodsFour rounds of National Family Health Survey data were used to measure infant mortality rate (IMR) and under-five mortality rate (U5MR) according to the social groups for the selected states. This study investigates the socio-economic inequities manifested into caste and class differentials and inequities in availability, utilization, and affordability of maternal and healthcare services. Descriptive statistics and the logistic regression model were used. Individual- and household-level covariates were employed to understand the differentials in healthcare utilization.ResultsThe probability of not receiving full antenatal care (ANC) or full immunization for the children was highest among the Scheduled Caste/Scheduled Tribe (SC/ST) families, followed by economic class, mother's education and residence. Tamil Nadu showed the highest utilization of public health facilities, while Bihar was the poorest in terms of health outcomes and utilization of MCH care services even after the pre-National Health Mission (NHM) period. Bihar and West Bengal also showed private healthcare dependence.ConclusionThis study detected the presence of significant caste/tribe differentials in the utilization of MCH care services in the selected states of India. Limited accessibility and unavailability of complete healthcare were the foremost reasons for the under-utilization of these services, especially for people from disadvantaged social groups. The result also suggested that it is perilous to confirm “Health for All” immediately. It will be the efficiency with which India addresses inequities in providing healthcare services and guarantees quality care of health services.

An investigation of the factors influencing the choice of healthcare facility in South Africa

The objective of the study was to assess the factors that motivate or demotivate households to choose among the three healthcare facilities, public healthcare, private health care and traditional healthcare facilities in South Africa as revealed by Statistics South Africa . The utilisation of healthcare facilities in South Africa is such that more households prefer public healthcare facilities more than other healthcare facilities. The multinomial logit model was used, with traditional/self-medication category as the reference or baseline category. The results indicated that gender, income and access to grants were significant in influencing the probability of a household choosing a public healthcare facility, while age, income, grants, salaries/wages/commission and pensions were significant in influencing the choice of private healthcare institutions. Therefore the study recommends that due to a large portion of households that are using public health facilities compared to private and traditional facilities, the government must invest more in public healthcare facilities in South Africa.

Factors affecting access to health care facilities in a rural Community: The case of Bali-Nyonga Sub-Division, Cameroun

Adequate and equitable distribution of health care facilities in rural areas is critical to human capital development. The study determines distance as a factor influencing utilization of health facilities in Bali-Nyonga. The main objective of the research is to evaluate the socio-economic effect of distance to health care in Bali-Nyonga. Data for this were gathered through field observation, face to face interview and questionnaires. Data from secondary sources included publish and unpublished material which was presented in form of related literature review. The data were analyzed using descriptive measures and presented in the form of tables, chart, percentages and graphs. In Bali-Nyonga, where the condition of roads is very poor, distance from the nearest health facility emerges as the most important factor influencing utilization. The vulnerable groups of women, the age, sickly, the illiterate and the poor were not found to be more strongly affected by distance decay. The policy implication arising from this study suggest that distance to improve health care needs to be reduce to enhance accessibility and to improved health service by various socio-economic groups in the area. It was recommended to strengthen the efforts to improve accessibilities of health care facilities in the rural areas by increasing the number of health facilities, transport and sensitization of the rural indigenes.

Determinant factors behind changes in health-seeking behaviour before and after implementation of universal health coverage in Indonesia

BackgroundThe health insurance system in Indonesia was transformed in 2014 to achieve universal health coverage (UHC). The effective implementation of essential primary health services through UHC has resulted in efficient healthcare utilisation, which is reflected in the health-seeking behaviour of the community. Our study aimed to examine the changes in health-seeking behaviour before and after the implementation of UHC in Indonesia and to identify what factors determine these changes.MethodsWe conducted a retrospective cohort study using the recall method and data collected through questionnaire-based interviews in Bandung, Indonesia. We used a two-step sampling technique—randomised sampling and purposive sampling, and a total of 579 respondents with acute or chronic episodes were recruited. {chi }^{2} tests were used to identify the association between factors. Difference in difference model and a logistic regression model for binary outcomes were used to estimate the effect of the implementation of UHC on the health-seeking behaviour.ResultsUtilisation of public health facilities increased significantly after implementation of UHC, from 34.9% to 65.4% among the respondents with acute episodes and 33.7% to 65.8% among those with chronic episodes. The odds of respondents going to health facilities when they developed an acute episode increased after the implementation of UHC (OR = 1.22, p = 0.05; AOR = 1.42, p < 0.001). For respondents experiencing chronic episodes, the implementation of UHC increased the odds ratio (OR = 1.74, p < 0.001; AOR = 1.64, p < 0.001) that they would use health facilities. Five years after the implementation of UHC, we still found respondents who did not have health insurance (26 and 19 respondents among those with acute episode and chronic episode, respectively).ConclusionsThe effect of the implementation of UHC seemed greater for those experiencing chronic episodes than for those with an acute episode. Although the implementation of UHC has improved utilisation of public health facilities, the presence of people who are not covered by health insurance is a potential problem that could threaten future improvements in healthcare access and utilisation.

Mothers’ Satisfaction Towards Maternal and Child Healthcare Services Rendered at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State

Patient satisfaction has been identified as a major index in the assessment of quality of healthcare globally. Mothers judge the quality of maternal and child healthcare services received based on their satisfaction with the services provided, thus influencing their utilization of healthcare facilities. The aim of this cross-sectional study is to determine the satisfaction of mothers towards maternal and child healthcare services rendered at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State. Two research questions and three research hypotheses guided the study. Using Taro Yamane’s formula for calculating sample size, a total number of four hundred (400) women were recruited, using convenient sampling techniques. The instrument for data collection was the questionnaire which was validated by three experts and a reliability coefficient of 0.99. Frequency counts and percentages were used to answer the research questions. Findings revealed that the respondents’ satisfaction with the maternal and child health services was above average as 41.5% were very satisfied with the antenatal care services received while 53% identified health providers’ attitude as one of the factors affecting their satisfaction. An association was found to exist between maternal age and satisfaction with quality of care and subsequently utilization of the services. There is no statistically significant relationship between maternal education and parity, and satisfaction with maternal and child health services. The null hypothesis was accepted at P&gt;0.05. Though the overall maternal satisfaction on the maternal and child healthcare services provided was very good, the few domains of dissatisfaction identified need to be addressed by healthcare professionals and policymakers to sustain and improve utilization of orthodox healthcare services amongst mothers, thereby contributing to achieving the third Sustainable Development Goal. Hence, midwives should pay attention to women’s needs and provide opportunities for them to state how they feel and be carried along with their care.

An Assessment of Major Factors Contributing towards Choosing Alternate Healers (Hakeem, Dispenser, Spiritual Healer) over Registered Medical Practitioner (RMP)

Background: Malpractice is characterized as "careless, unsuitable, or illegal activity while performing a professional task" by Oxford Learner's Dictionaries (1). Prevalence of alternate healers is a problem of nearly all less economically underdeveloped countries. Pakistan is also one of the victims of malpractice. Factors that contribute to malpractice are proximity, affordable fee, availability, family pressure, and the strong opinion of the community. The objective of the study was to analyze why people choose alternate healers and to evaluate the misconception and myths regarding registered medical practitioners. Methods: A Descriptive cross-sectional study was conducted on a sample size of 319 with participants from Gujranwala’s rural and urban areas in 2021. Both the male and female population of Gujranwala was included. Data was entered and analyzed in SPSS version 21. Results: The socio-economic and demographic variables considerably effect the choice of health care provider. More people in rural areas visit alternate healers as compared to urban areas. Lack of information and misconceptions about physicians were also the factors effecting health seeking behavior of people. Conclusion: There is a potential to improve the health-seeking behavior and utilization of health facilities by addressing the demand side (community) factors i.e., socio-economic factors, cultural beliefs, by shutting down all unlicensed practitioners and educating the community to avoid visiting them to reduce the probability of exposure to unsafe healthcare practices.

Geographic Space and the Issues of Utilization of Primary Health Facilities in Isiala-Mbano, Imo, Nigeria

Primary Health Care is the first point of contact for most Nigerians with respect to the health care system, but the level of clients’ access and utilization are mostly plagued with distinct problems across geographic locations, thereby impeding sustainable development of rural communities. The aim of this study is to evaluate the intriguing relationships existing among location, distance, and the utilization of government-owned primary health care facilities (PHCF) by residents in Isiala-Mbano, Imo State. A stratified random sampling method was used to select a sample population of 475. Questionnaire and interviews were used to elicit information from the respondents, while geospatial tools were used for mapping the spatial distributions of three Health Posts and fourteen Health Centers. Analyses of data using descriptive statistics, geographic information system, nearest neighbour analysis, Pearson product moment correlation coefficient, and student’s t-test revealed that: (i) PHCF’s are randomly distributed within the study area as indicated by the Nearest Neighbour Index of R = 1.164. (ii) Estimated Euclidean distances from users’ houses to nearest PHCFs showed that 66.5 percent of the users live within 1 km and 33.5 percent live between 1 km to 2.3 km from the nearest PHCFs. (iii) Average Nearest Neighbour Distance gave 1.3708 km with good topography. (iv) The ratio of population to health center gave 11,972:1, implying that Isiala-Mbano is adequately served by primary health care centers, but the levels of utilizations were generally very low due to lack of doctors and valid drugs for patients. A test of Hypothesis showed that there is no significant relationship between the distance of primary health care facilities and the level of utilization in the study area. Hence, this study recommended timely health care facility reform through the supply of essential drugs and employment of specialized manpower sustainably to attend to patients in the study area.

ANALYSIS OF SOCIOECONOMIC FACTORS ON HEALTHCARE FACILITIES UTILIZATION FOR INPATIENT CARE IN INDONESIA

In 2014-2018 the utilization of health facilities for inpatient treatment in Indonesia has ups and downs. according to data from the National Social Security Council (DJSN) and Social Security Administrator for Health (BPJS Kesehatan) in 2020, the average unit cost of claims per first-level inpatient admission nationally in 2014-2018 were Rp420,543, Rp323,687, Rp412,512, Rp531,496, and Rp472,984, respectively. The purpose of this study was to determine the socioeconomic factors that influence the utilization of health facilities for inpatient treatment in Indonesia. This study uses secondary data from the National Socio-Economic Survey (Susenas) in 2020. The research respondents were individuals who were randomly selected as many as 1,258,328 in Indonesia. The method used in this study uses an econometric approach using the Binary Regression method, namely the logit and probit models. The results of this study found that age, education, occupation, income, and health insurance, with income assumed from the level of expenditure, all of these variables had a significant effect on the utilization of health facilities for inpatients.

Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam's Household Living Standard Survey 2006-2018.

Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam's social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006-2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.