Extending voluntary health insurance to the informal sector: experiences and expectations of the informal sector in Kenya.
Extending voluntary health insurance to the informal sector: experiences and expectations of the informal sector in Kenya.
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DOI：
10.12688/wellcomeopenres.12656.1
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发表时间：
2017-01-01
影响因子：
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通讯作者：
Andrawes, Ledia
中科院分区：
文献类型：
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作者：
Barasa, Edwine W;Mwaura, Njeri;Andrawes, Ledia
背景：肯尼亚已做出政策决定，将缴费型医疗保险作为其主要的预付费医疗融资机制之一。国家医院保险基金（NHIF）是肯尼亚主要的健康保险公司。虽然 NHIF 迄今为止的重点是为正规部门的个人提供健康保险，但最近它的重点范围扩大到包括非正规部门的个人。本文分析了肯尼亚非正规部门个人对加入 NHIF 的看法和经验。方法：我们通过对两个特意选择的县的主要知情人访谈 (39) 收集数据。研究参与者来自 NHIF 签约的医疗机构以及现任、前任和未来的非正规部门成员。我们使用扎根的方法分析数据。结果：参与者认为 NHIF 提供的有关注册和会员流程以及福利权利的信息不充分。 NHIF 的沟通存在变化且不一致。官方福利方案与会员实际获得的福利也存在差异。 NHIF 注册要求和流程为获得会员资格设置了行政障碍。 NHIF 保费水平和缴费机制给现有和潜在会员带来了财务障碍。与现金支付者或私人保险持有者相比，医疗保健提供者歧视 NHIF 成员。结论：NHIF 可以通过以下方式提高非正规部门人员的入学率和保留率： 1) 使用有效的沟通策略来接触非正规部门，2) 提高保险费率的承受能力，3) 简化注册要求和流程，以及 4) 加强其与医疗机构之间的问责机制，以确保注册会员获得他们应得的福利，并确保客户在医疗机构的体验令人满意。
Background:Kenya has made a policy decision to use contributory health insurance as one of its key pre-payment health financing mechanisms. The National Hospital Insurance Fund (NHIF) is the main health insurer in Kenya. While the NHIF has hitherto focused its efforts on providing health insurance coverage to individuals in the formal sector, it has recently broadened its focus to include individuals in the informal sector. This paper provides an analysis of the perceptions, and experiences of informal sector individuals in Kenya with regard to enrolment with the NHIF. Methods:We collected data through key informant interviews (39) in two purposefully selected counties. Study participants were drawn from healthcare facilities contracted by the NHIF, and current, former, and prospective informal sector members. We analyzed data using a grounded approach. Results:Participants felt that the NHIF provided inadequate information about the registration and membership processes as well as benefit entitlements. There was variable and inconsistent communication by the NHIF. There was also variance between the official benefit package and the actual benefits received by members. The NHIF registration requirements and processes presented an administrative barrier to obtaining membership. The NHIF premium level and contribution mechanism presents a financial barrier to current and prospective members. Healthcare providers discriminated against NHIF members compared to cash-payers or private insurance holders. Conclusions:The NHIF could improve enrolment and retention of informal sector individuals by; 1) using communication strategies that are effective at reaching the informal sector, 2) improving the affordability of the premium rates, 3) simplifying the enrolment requirements and process, and 4) strengthening accountability mechanisms between itself and healthcare facilities to ensure that enrolled members receive the benefits that they are entitled to, and that client experience at healthcare facilities are satisfactory.