Community health insurance in Uganda: Why does enrolment remain low? A view from beneath
Community health insurance in Uganda: Why does enrolment remain low? A view from beneath
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DOI：
10.1016/j.healthpol.2007.12.008
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发表时间：
2008-08-01
期刊：
影响因子：
3.3
通讯作者：
Van der Stuyft, Patrick
中科院分区：
文献类型：
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作者：
Basaza, Robert;Criel, Bart;Van der Stuyft, Patrick
尽管乌干达卫生部门有兴趣将社区健康保险 (CHI) 作为一个完善的卫生部门融资机制，但乌干达的社区健康保险 (CHI) 的参与率仍然较低。所有政府机构都取消了使用费，乌干达的 CHI 仅限于私营非营利部门，主要是与教会相关的乡村医院。在本研究中，通过两种不同的 CHI 模型调查了入学率低的原因。我们对 CHI 计划的成员和非成员进行了焦点小组讨论和深入访谈，以便更深入地了解和了解人们对 CHI 的看法、加入和不加入的原因以及他们认为增加入学率的可能性。这项研究在东非是史无前例的，它清楚地表明人们对 CHI 的基本原则和该计划的日常运作存在不同的理解。许多人提到缺乏良好的信息。支付保费的能力问题、医疗质量差、入会要求方面的严格设计以及信任问题是人们不加入的其他重要原因。我们的研究结果与在西非进行的类似研究的结果非常一致，即使已经发现了一些具体情况的问题。该研究为乌干达和其他撒哈拉以南非洲国家的 CHI 国家政策设计提供了相关要素。 (c) 2007 Elsevier Ireland Ltd. 保留所有权利。
Community Health Insurance (CHI) in Uganda faces low enrolment despite interest by the Ugandan health sector to have CHI as an elaborate health sector financing mechanism. User fees have been abolished in all government facilities and CHI in Uganda is limited to the private not for profit sub-sector, mainly church-related rural hospitals. In this study, the reasons for the low enrolment are investigated in two different models of CHI. Focus group discussions and in-depth interviews were carried out with members and non-members of CHI schemes in order to acquire more insight and understanding in people's perception of CHI, in their reasons for joining and not joining and in the possibilities they see to increase enrolment. This study, which is unprecedented in East Africa, clearly points to a mixed understanding on the basic principles of CHI and on the routine functioning of the schemes. The lack of good information is mentioned by many. Problems in ability to pay the premium, poor quality of health care, the rigid design in terms of enrolment requirements and problems of trust are other important reasons for people not to join. Our findings are grossly in line with the results of similar studies conducted in West Africa even if a number of context-specific issues have been identified. The study provides relevant elements for the design of a national policy on CHI in Uganda and other sub-Saharan countries. (c) 2007 Elsevier Ireland Ltd. All rights reserved.