edoc

Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia

Osei Afriyie, D. and Masiye, F. and Tediosi, F. and Fink, G.. (2023) Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia. Social science & medicine, 321. p. 115750.

[img] PDF - Published Version
Available under License CC BY (Attribution).

1558Kb

Official URL: https://edoc.unibas.ch/93860/

Downloads: Statistics Overview

Abstract

BACKGROUND: To improve equitable access to quality essential services and reduce financial hardship, low-and-middle-income countries are increasingly relying on prepayment strategies such as health insurance schemes. Among the informal sector population, confidence in the health system to provide effective treatment and trust in institutions can play an important role in health insurance enrollment. The objective of this study was to examine the extent to which confidence and trust affect enrollment into the recently introduced Zambia National Health insurance. METHODS: We conducted a regionally representative cross-sectional household survey in Lusaka, Zambia collecting information on demographics, health expenditure, ratings of last health facility visit, health insurance status and confidence in the health system. We used multivariable logistic regression to assess the association between enrollment and confidence in the private and public health sector as well as trust in the government in general. RESULTS: Of the 620 respondents interviewed, 70% were enrolled or planning to enroll in the health insurance. Only about one-fifth of respondents were very confident that they would receive effective care in the public health sector 'if they became sick tomorrow' while 48% were very confident in the private health sector. While confidence in the public system was only weakly associated with enrollment, confidence in the private health sector was strongly associated with enrollment (Adjusted odds ratio (AOR) 3.40 95% CI 1.73 - 6.68). No association was found between enrollment and trust in government or perceived government performance. CONCLUSIONS: Our results suggest that confidence in the health system, particularly in the private health sector, is strongly associated with health insurance enrollment. Focusing on achieving high quality of care across all levels of the health system may be an effective strategy to increase enrollment in health insurance.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Former Units within Swiss TPH > Household Economy (Fink)
UniBasel Contributors:Osei Afriyie, Doris and Tediosi, Fabrizio and Fink, G√ľnther
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:0037-7856
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Related URLs:
Identification Number:
edoc DOI:
Last Modified:06 Mar 2023 09:28
Deposited On:06 Mar 2023 09:28

Repository Staff Only: item control page