"We charge them; otherwise we cannot run the hospital" front line workers, clients and health financing policy implementation gaps in Ghana
"We charge them; otherwise we cannot run the hospital" front line workers, clients and health financing policy implementation gaps in Ghana
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DOI：
10.1016/j.healthpol.2010.09.018
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发表时间：
2011-03-01
期刊：
影响因子：
3.3
通讯作者：
Nagai, Richard A.
中科院分区：
文献类型：
--
作者：
Agyepong, Irene Akua;Nagai, Richard A.
本论文审查了在为加纳五岁以下儿童提供初级临床护理的财政机会方面，用户费用加上豁免和健康保险的政策执行差距。方法：方法包括常规资料分析、焦点小组讨论、深度访谈和结构化问卷调查。结果：供应商修改豁免政策实施安排，有时给予部分豁免或不给予豁免。知道或怀疑豁免权利的客户由于害怕提供者的负面反应而没有提出豁免要求。提供者将其对执行安排的修改和消极反应归因于偿还不确定和延误对其机构的财务生存能力构成的威胁。在研究期间，保险覆盖率很低，一线工作人员没有明显地修改实施安排。然而，潜在的目标冲突、资源稀缺、工作条件以及一线工人与客户之间的关系，这些因素助长了豁免政策的实施差距，并没有改变。因此，医疗保险政策仍有可能像豁免政策那样在执行方面出现差距。结论：如果政策没有考虑到一线员工遵守的激励措施，并将其与政策目标更好地结合起来，可能会出现实施差距。2010爱思唯尔爱尔兰有限公司版权所有。
Objectives This paper examines policy implementation gaps of user fees plus exemptions and health insurance in providing financial access to primary clinical care for children under five in Ghana.Methods: Methods included analysis of routine data, focus group discussions, in-depth interviews, and administration of a structured questionnaire.Results: Providers modified exemptions policy implementation arrangements, sometimes giving partial or no exemptions. Clients who knew or suspected exemption entitlements failed to request them because of fear of negative reactions from providers. Providers attributed their modification of implementation arrangements and negative reactions to the threat posed to the financial viability of their institutions by reimbursement uncertainty and delays. At the time of the study insurance coverage was low and frontline workers were not noticeably modifying implementation arrangements. However, the underlying goal conflicts, resource scarcity, conditions of work and relationships between frontline workers and clients that fueled the exemptions policy implementation gaps were unchanged. The potential for the health insurance policy to stumble over implementation gaps as happened with the exemptions policy therefore remained.Conclusions: Policies that do not take into account the incentives for frontline worker adherence and align them better with policy objectives may experience implementation gaps. (C) 2010 Elsevier Ireland Ltd. All rights reserved.