Low enrolment in Ugandan community health insurance schemes: underlying causes and policy implications
Low enrolment in Ugandan community health insurance schemes: underlying causes and policy implications
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DOI：
10.1186/1472-6963-7-105
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发表时间：
2007-07-09
影响因子：
2.8
通讯作者：
Van der Stuyft, Patrick
中科院分区：
文献类型：
--
作者：
Basaza, Robert;Criel, Bart;Van der Stuyft, Patrick
背景：尽管主要在外部援助组织的推动下，乌干达在90年代后半期促进了社区健康保险，但总体会员人数仍然很低。今天，约有3万人参加了位于乌干达中部和南部的十几个不同的计划。此外，这些计划大多是在大约10年前创建的，但自那时以来，只有一两个新计划启动。CHI的动态显然已经停止。方法：对两个选定的卫生保健计划：Ishaka计划和乌干达卫生储蓄计划（SHU）进行个案研究评价。本评估的目的是探讨CHI有限成功的原因。评估包括对计划记录的审查、对关键信息提供者的访谈以及对参保和未参保患者的出口民意调查。结果：我们的研究指出了一系列不相互排斥的解释，在医疗保健服务的需求和供给方面都取得了成就。在需求方面，我们发现了以下因素：缺乏有关计划设计和运作的基本资料、对健康保险的基本原则了解有限、社区参与有限和对计划的管理缺乏信任，以及最后但并非最不重要的是，人们支付保费的能力存在问题。在供应方面，我们确定了以下解释：卫生保健提供者和卫生保健管理者对卫生保健的兴趣和知识有限，以及缺乏发展卫生保健的连贯政策框架。结论：本研究的政策意涵是指政府需要为智障发展提供必要的立法、技术和监管支持。然而，主要的政策挑战是需要协调乌干达政府对促进卫生保健的兴趣与目前取消公共设施使用费的政策。
Background: Despite the promotion of Community Health Insurance (CHI) in Uganda in the second half of the 90's, mainly under the impetus of external aid organisations, overall membership has remained low. Today, some 30,000 persons are enrolled in about a dozen different schemes located in Central and Southern Uganda. Moreover, most of these schemes were created some 10 years ago but since then, only one or two new schemes have been launched. The dynamic of CHI has apparently come to a halt.Methods: A case study evaluation was carried out on two selected CHI schemes: the Ishaka and the Save for Health Uganda (SHU) schemes. The objective of this evaluation was to explore the reasons for the limited success of CHI. The evaluation involved review of the schemes' records, key informant interviews and exit polls with both insured and non-insured patients.Results: Our research points to a series of not mutually exclusive explanations for this underachievement at both the demand and the supply side of health care delivery. On the demand side, the following elements have been identified: lack of basic information on the scheme's design and operation, limited understanding of the principles underlying CHI, limited community involvement and lack of trust in the management of the schemes, and, last but not least, problems in people's ability to pay the insurance premiums. On the supply-side, we have identified the following explanations: limited interest and knowledge of health care providers and managers of CHI, and the absence of a coherent policy framework for the development of CHI.Conclusion: The policy implications of this study refer to the need for the government to provide the necessary legislative, technical and regulative support to CHI development. The main policy challenge however is the need to reconcile the government of Uganda's interest in promoting CHI with the current policy of abolition of user fees in public facilities.