Reforms for financial protection schemes towards universal health coverage, Senegal
Reforms for financial protection schemes towards universal health coverage, Senegal
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DOI：
10.2471/blt.19.239665
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发表时间：
2020-02-01
影响因子：
11.1
通讯作者：
Ngom, Mor
中科院分区：
文献类型：
--
作者：
Daff, Bocar Mamadou;Diouf, Serigne;Ngom, Mor
推进公共医疗保险制度是塞内加尔政府实现全民健康覆盖的关键战略之一。2013年，政府启动了一项全民健康财政保护方案，即全民健康保险方案。该方案的目标之一是为2013年以前基本上没有保险的非正规部门人员建立一个以社区为基础的健康保险计划。该计划通过非营利性社区组织提供覆盖，截至2016年底，全国已建立了676个组织。然而，这些组织正面临着挑战，例如低入学率和低可携性的福利方案。为了应对挑战并改善社区医疗保险计划的治理和运作，政府自2018年以来规划并部分实施了两项重大改革。第一项改革涉及一系列机构重组，以提高风险池。这些重组包括将风险分担和部分保险管理从个别组织转移到省工会，并将弱势群体免费保健倡议的运作和财务责任转移到社区计划。第二项改革是引入综合管理信息系统，以便对该计划进行高效率和有效的数据管理和操作。在这里，我们讨论目前的进展和未来发展的计划，以社区为基础的健康保险计划，以及讨论政府在努力实现全国全民健康覆盖方面应该解决的挑战。
Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country.