Background
The National Hospital Insurance Fund (NHIF)
Methods
Hypothesis and study setting
Study design and variables
Statistical analysis
Heterogeneous effects
Results
Descriptive statistics and association between NHIF and access to care
Mean Values | Study Sample | Institutional Delivery Sample | Skilled Birth Attendant Sample | |||
---|---|---|---|---|---|---|
NHIF | Uninsured | NHIF | Uninsured | NHIF | Uninsured | |
Outcome at Baseline (%) | 86.52 (34.35) | 68.77 (46.37) | 94.12 (23.70) | 73.09 (44.37) | ||
Current Age | 31.26 (0.08) | 31.83 (0.02) | 30.75 (0.53) | 30.97 (0.16) | 31.97 (0.55) | 31.00 (0.16) |
Age at Enrollment | 29.51 (5.61) | 29.03 (5.86) | 26.91 (4.47) | 27.42 (5.02) | 27.41 (4.24) | 27.43 (5.04) |
Age First Pregnant @ AMPATH | 30.43 (5.92) | 29.80 (6.15) | 27.53 (4.74) | 28.05 (5.32) | 28.34 (4.76) | 28.14 (5.39) |
# of Children | 2.25 (1.64) | 3.01 (1.86) | 2.09 (1.43) | 2.74 (1.68) | 2.18 (1.46) | 2.85 (1.73) |
Piped Water (%) | 39.29 (47.35) | 12.84 (35.89) | 35.96 (48.26) | 12.68 (33.31) | 25.00 (43.62) | 10.70 (30.94) |
Electricity (%) | 36.91 (46.88) | 10.54 (33.72) | 38.20 (48.86) | 11.23 (31.58) | 30.90 (46.54) | 10.10 (30.16) |
Ever Attended School (%) | 97.82 (16.29) | 92.17 (0.35) | 98.87 (10.6) | 99.30 (8.29) | 94.10 (23.7) | 93.15 (25.28) |
Previous # of Pregnancies | 2.84 (1.72) | 3.47 (1.96) | 2.79 (1.29) | 3.37 (1.76) | 2.75 (1.23) | 3.45 (1.80) |
CD4 @ Enrollment | 338.24 (247.14) | 359.24 (307.48) | 410.40 (255.90) | 396.49 (327.03) | 381.72 (307.80) | 349.47 (328.14) |
Lost to Follow-up During Pregnancy (%) | 1.71 (16.67) | 1.00 (15.06) | 5.62 (23.16) | 1.55 (12.38) | 0.00 (0) | 1.50 (11.99) |
Travel Time (Hours) | 1.97 (0.99) | 2.05 (0.98) | 1.89 (0.94) | 2.00 (0.95) | 1.96 (1.00) | 2.011 (0.95) |
Urban Clinic (%) | 70.06 (47.59) | 44.80 (50.0) | 69.70 (46.23) | 42.06 (49.39) | 69.12 (46.54) | 37.53 (48.44) |
Observations N | 1997 (15.86%) | 10,596 (84.14%) | 89 (7.14%) | 1158 (92.86%) | 68 (5.51%) | 1167 (94.49%) |
Overall N | 12,593 | 1247 | 1235 |
Mean Values | Institutional Delivery Sample | Skilled Birth Attendant Sample | ||||
---|---|---|---|---|---|---|
Yes | No | P Values | Yes | No | P Values | |
Current Age | 30.80 (0.18) | 31.35 (0.30) | 0.11 | 30.90 (0.18) | 31.49 (0.32) | 0.10 |
Age at Enrollment | 27.19 (0.16) | 27.87 (0.27) | 0.03** | 27.24 (0.16) | 27.96 (0.30) | 0.03** |
Age First Pregnant @ AMPATH | 27.87 (0.18) | 28.37 (0.29) | 0.12 | 28.02 (0.18) | 28.50 (0.31) | 0.17 |
# of Children | 2.56 (0.05) | 3.03 (0.09) | 0.00*** | 2.66 (0.05) | 3.25 (0.10) | 0.00*** |
Piped Water (%) | 0.16 (0.01) | 0.11 (0.02) | 0.02** | 0.13 (0.01) | 0.06 (0.01) | 0.00*** |
Electricity (%) | 0.16 (0.01) | 0.06 (0.01) | 0.00*** | 0.14 (0.01) | 0.02 (0.01) | 0.00*** |
Ever Attended School (%) | 0.99 (0.00) | 0.99 (0.01) | 0.34 | 0.94 (0.01) | 0.90 (0.02) | 0.01** |
Previous # of Pregnancies | 3.21 (0.06) | 3.6 (0.09) | 0.00*** | 3.28 (0.06) | 3.77 (0.11) | 0.00*** |
CD4 @ Enrollment | 388.28 (9.45) | 419.02 (21.00) | 0.12 | 346.35 (9.43) | 365.35 (23.81) | 0.37 |
Lost to Follow-up During Pregnancy (%) | 0.01 (0.00) | 0.03 (0.01) | 0.06* | 0.01 (0.00) | 0.03 (0.01) | 0.04** |
Travel Time (Hours) | 1.96 (0.03) | 2.08 (0.05) | 0.04** | 1.97 (0.03) | 2.11 (0.05) | 0.02** |
Urban Clinic (%) | 0.45 (0.02) | 0.43 (0.03) | 0.60 | 0.39 (0.02) | 0.40 (0.03) | 0.88 |
Observations N | 874 (70.09%) | 373 (29.91%) | 917 (74.25%) | 318 (25.75%) | ||
Overall N | 1247 | 1235 |
Main results
Panel A: Institutional Delivery Sample | |||
---|---|---|---|
Block | Insured | Uninsured | P-Value |
Block 1 | 0.033 | 0.026 | 0.0395 |
Block 2 | 0.066 | 0.062 | 0.1060 |
Block 3 | 0.090 | 0.085 | 0.0305 |
Block 4 | 0.153 | 0.139 | 0.0208 |
Block 5 | 0.280 | 0.269 | 0.4175 |
Block 6 | 0.457 | 0.480 | 0.6198 |
N = 1137 | 89 | 1048 | |
Panel B: Skilled Birth Attendant Sample | |||
Block | Insured | Uninsured | P-Value |
Block 1 | 0.028 | 0.025 | 0.3297 |
Block 2 | 0.073 | 0.070 | 0.4539 |
Block 3 | 0.135 | 0.138 | 0.5857 |
Block 4 | 0.256 | 0.250 | 0.7342 |
Block 5 | 0.462 | 0.492 | 0.4877 |
N = 1017 | 68 | 949 |
Institutional Delivery | Skilled Birth Attendant | |||||||
---|---|---|---|---|---|---|---|---|
1 Linear Unadjusted | 2 Linear Adjusted | 3 Logistic Unadjusted [Odds Ratio] | 4 Logistic Adjusted [Odds Ratio] | 5 Linear Unadjusted | 6 Linear Adjusted | 7 Logistic Unadjusted [Odds Ratio] | 8 Logistic Adjusted [Odds Ratio] | |
NHIF | 0.177*** (0.039) | 0.118*** (0.05) | 2.91*** (0.921) | 2.34*** (0.832) | 0.21*** (0.03) | 0.161*** (0.037) | 5.89*** (3.06) | 5.08*** (2.80) |
95% CI | 0.10–0.25 | 0.04–0.20 | 1.56–5.41 | 1.16–4.70 | 0.15–0.27 | 0.09–0.23 | 2.13–16.3 | 1.73–14.97 |
N | 1247 | 1247 | 1247 | 1247 | 1235 | 1235 | 1235 | 1233 |
Constant | 0.688*** (0.014) | −1.06 (4.163) | 2.21 (0.921) | 0.001 (0.011) | 0.731* (0.013) | 0.907 (4.074) | 2.72 (0.179) | 0.51 (11.17) |
R Squared | 0.01 | 0.08 | 0.009 | 0.07 | 0.012 | 0.084 | 0.014 | 0.083 |
Heterogeneous effects by HIV disease severity
Discussion
Institutional Delivery | Skilled Birth Attendant | |||||||
---|---|---|---|---|---|---|---|---|
1 Stratified | 2 Radius | 3 Kernel | 4 IPW [OR] | 5 Stratified | 6 Radius | 7 Kernel | 8 IPW [OR] | |
Coefficients (ATT) | 0.102** | 0.155*** | 0.113** | 2.14** | 0.143*** | 0.205*** | 0.168*** | 5.17*** |
Std. Errors | 0.042 | 0.040 | 0.046 | 0.82 | 0.034 | 0.034 | 0.034 | 3.19 |
T/Z- Statistic | 2.416 | 3.835 | 2.437 | 1.99 | 4.221 | 6.063 | 4.984 | 2.67 |
N | ||||||||
Analytic Sample | 1247 | 1247 | 1247 | 852 | 1235 | 1235 | 1235 | 744 |
Treatment | 89 | 87 | 89 | 67 | 64 | 68 | ||
Control | 1017 | 1002 | 1017 | 928 | 919 | 927 |
Panel A: Institutional Delivery | ||||||||
---|---|---|---|---|---|---|---|---|
HIV DISEASE | ||||||||
CD4 ≤ 350 | CD4 > 350 | |||||||
1 Stratified | 2 Radius | 3 Kernel | 4 IPW [OR] | 5 Stratified | 6 Radius | 7 Kernel | 8 IPW [OR] | |
Coefficients (ATT) | 0.124** | 0.18*** | 0.142** | 4.09** | 0.094 | 0.126 | 0.099 | 2.54* |
Stand Errors | 0.053 | 0.06 | 0.058 | 2.71 | 0.067 | 0.065 | 0.068 | 1.22 |
T/Z- Statistic | 2.326 | 2.977 | 2.437 | 2.12 | 1.414 | 1.919 | 1.447 | 1.94 |
N | ||||||||
Analytic Sample | 640 | 640 | 640 | 640 | 607 | 607 | 607 | 607 |
Treatment | 40 | 40 | 40 | 49 | 42 | 49 | ||
Control | 523 | 505 | 523 | 384 | 373 | 384 | ||
Panel B: Skilled Birth Attendant | ||||||||
CD4 ≤ 350 | CD4 > 350 | |||||||
Coefficients (ATT) | 0.116*** | 0.192*** | 0.154*** | 11.82** | 0.177*** | 0.215*** | 0.187*** | 8.12** |
Stand Errors | 0.043 | 0.052 | 0.046 | 9.24 | 0.056 | 0.057 | 0.062 | 7.00 |
T/Z- Statistic | 2.685 | 3.725 | 3.87 | 3.16 | 3.191 | 3.809 | 3.004 | 2.43 |
N | ||||||||
Analytic Sample | 705 | 705 | 705 | 705 | 530 | 530 | 530 | 530 |
Treatment | 36 | 34 | 36 | 31 | 29 | 32 | ||
Control | 525 | 521 | 525 | 376 | 365 | 375 |