Evidence map›Paper›PMID 28402420›Full record

ArticleHealth policy and planning2017

The effect of health insurance and health facility-upgrades on hospital deliveries in rural Nigeria: a controlled interrupted time-series study.

Daniëlla Brals, Sunday A Aderibigbe, Ferdinand W Wit, Johannes C M van Ophem, Marijn van der List, Gordon K Osagbemi, Marleen E Hendriks, Tanimola M Akande, Michael Boele van Hensbroek, Constance Schultsz

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Article in Health policy and planning, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Daniëlla BralsAcademic Medical Center, Department of Global Health, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Sunday A AderibigbeDepartment of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Ferdinand W WitAcademic Medical Center, Department of Global Health, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Johannes C M van OphemFaculty of Economics and Business, Section Quantitative Economics, University of Amsterdam, Amsterdam, The Netherlands.
Marijn van der ListDepartment of Economics, Vrije Universiteit Amsterdam, Amsterdam Institute for International Development, Amsterdam, The Netherlands.
Gordon K OsagbemiDepartment of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Marleen E HendriksAcademic Medical Center, Department of Global Health, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Tanimola M AkandeDepartment of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Michael Boele van HensbroekAcademic Medical Center, Department of Global Health, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Constance SchultszAcademic Medical Center, Department of Global Health, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAccess to quality obstetric care is considered essential to reducing maternal and new-born mortality. We evaluated the effect of the introduction of a multifaceted voluntary health insurance programme on hospital deliveries in rural Nigeria.

methodsWe used an interrupted time-series design, including a control group. The intervention consisted of providing voluntary health insurance covering primary and secondary healthcare, including antenatal and obstetric care, combined with improving the quality of healthcare facilities. We compared changes in hospital deliveries from 1 May 2005 to 30 April 2013 between the programme area and control area in a difference-in-differences analysis with multiple time periods, adjusting for observed confounders. Data were collected through household surveys. Eligible households ( n = 1500) were selected from a stratified probability sample of enumeration areas. All deliveries during the 4-year baseline period ( n = 460) and 4-year follow-up period ( n = 380) were included.

findingsInsurance coverage increased from 0% before the insurance was introduced to 70.2% in April 2013 in the programme area. In the control area insurance coverage remained 0% between May 2005 and April 2013. Although hospital deliveries followed a common stable trend over the 4 pre-programme years ( P = 0.89), the increase in hospital deliveries during the 4-year follow-up period in the programme area was 29.3 percentage points (95% CI: 16.1 to 42.6; P < 0.001) greater than the change in the control area (intention-to-treat impact), corresponding to a relative increase in hospital deliveries of 62%. Women who did not enroll in health insurance but who could make use of the upgraded care delivered significantly more often in a hospital during the follow-up period than women living in the control area ( P = 0.04).

conclusionsVoluntary health insurance combined with quality healthcare services is highly effective in increasing hospital deliveries in rural Nigeria, by improving access to healthcare for insured and uninsured women in the programme area.

Indexed as

Insurance CoverageInsurance, HealthAdolescentAdultDelivery, ObstetricFemaleHealth FacilitiesHospitalsHumansMaternal Health ServicesMiddle AgedNigeriaPregnancyQuality of Health CareRural PopulationAccess to careglobal healthhealth insurancehealth system strengtheninghospital deliveryimpact evaluationmaternal and new-born health and survivalNigeriapublic healthquality of caresub-Saharan Africa

Identifiers

PMID28402420
PMCPMC5886299

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.