AI Article Synopsis
- The study assesses the confidence and endorsement of health systems in 12 low- and middle-income countries, finding that these measures are crucial indicators of system performance but often overlooked.
- Out of nearly 13,500 respondents, only 32% felt very confident in receiving effective care if seriously ill, while 30% believed the health system required only minor changes, highlighting low levels of trust.
- Positive experiences with healthcare significantly improved confidence and endorsement, while health insurance was linked to higher confidence, and experiences of discrimination negatively affected users' perceptions of the system.
Article Abstract
Introduction: People's confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries.
Methods: We conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system. We used multivariable logistic regression to assess the association between confidence/endorsement and self-reported quality of recent healthcare.
Results: Of 13 489 respondents, 62% reported a health visit in the past year. Applying population weights, 32% of these users were very confident that they could receive effective care if they were to 'become very sick tomorrow'; 30% endorsed the health system, that is, agreed that it 'works pretty well and only needs minor changes'. Reporting high quality in the last visit was associated with 4.48 and 2.69 greater odds of confidence (95% CI 3.64 to 5.52) and endorsement (95% CI 2.33 to 3.11). Having health insurance was positively associated with confidence and endorsement (adjusted odds ratio (AOR) 1.68, 95% CI 1.49 to 1.90 and AOR 1.34, 95% CI 1.22 to 1.48), while experiencing discrimination in healthcare was negatively associated (AOR 0.67, 95% CI 0.56 to 0.80 and AOR 0.63, 95% CI 0.53 to 0.76).
Conclusion: Confidence and endorsement of the health system were low across 12 LMICs. This may hinder efforts to gain support for universal health coverage. Positive patient experience was strongly associated with confidence in and endorsement of the health system.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454186 | PMC |
| http://dx.doi.org/10.1136/bmjgh-2019-002205 | DOI Listing |
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