Health insurance systems in five Sub-Saharan African countries: Medicine benefits and data for decision making
Health insurance systems in five Sub-Saharan African countries: Medicine benefits and data for decision making
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DOI：
10.1016/j.healthpol.2010.11.009
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发表时间：
2011-03-01
期刊：
影响因子：
3.3
通讯作者：
Wagner, Anita K.
中科院分区：
文献类型：
--
作者：
Carapinha, Joao L.;Ross-Degnan, Dennis;Wagner, Anita K.
通过医疗保险计划提供的医药福利有可能改善获得负担得起的高质量药物的机会，并促进更有效地使用这些药物。缺乏有关撒哈拉以南非洲健康保险计划提供的医疗福利的信息。我们描述了加纳、肯尼亚、尼日利亚、坦桑尼亚和乌干达的33个医疗保险项目的医疗福利结构和常规决策数据。几乎所有项目都提供住院和门诊医疗福利，所有项目的成员都分担医药费用。一些项目使用高收入国家常见的策略来管理药品福利，如处方集、仿制药政策、报销限额或价格谈判。在大多数计划中，基本数据可以用来监测提供医疗福利的绩效，但关键数据元素和资源需要从现有的数据中生成有用的管理信息通常是missing.Many问题仍然没有答案的设计，实施和特定的药物政策的影响，在新兴的和不断扩大的健康保险计划在撒哈拉以南非洲地区。这些问题包括：鉴于不同的公司和组织结构及资源，最有效的药品政策选择;具体福利设计对保健和健康成果的质量和可负担性的影响;以及促进使用常规数据进行监测的方式。需要技术能力建设、强有力的政府承诺和国际捐助者的支持，以实现撒哈拉以南非洲新兴和不断扩大的医疗保险计划中的药品覆盖效益。(C)2010爱思唯尔爱尔兰有限公司版权所有。
Medicine benefits through health insurance programs have the potential to improve access to and promote more effective use of affordable, high quality medicines. Information is lacking about medicine benefits provided by health insurance programs in Sub-Saharan Africa. We describe the structure of medicine benefits and data routinely available for decision-making in 33 health insurance programs in Ghana, Kenya, Nigeria, Tanzania and Uganda.Most programs surveyed were private, for profit schemes covering voluntary enrollees, mostly in urban areas. Almost all provide both inpatient and outpatient medicine benefits, with members sharing the cost of medicines in all programs. Some programs use strategies that are common in high-income countries to manage the medicine benefits, such as formularies, generics policies, reimbursement limits, or price negotiation. Basic data to monitor performance in delivering medicine benefits are available in most programs, but key data elements and the resources needed to generate useful management information from the available data are typically missing.Many questions remain unanswered about the design, implementation, and effects of specific medicines policies in the emerging and expanding health insurance programs in Sub-Saharan Africa. These include questions about the most effective medicines policy choices, given different corporate and organizational structures and resources: impacts of specific benefit designs on quality and affordability of care and health outcomes: and ways to facilitate use of routine data for monitoring. Technical capacity building, strong government commitment, and international donor support will be needed to realize the benefits of medicines coverage in emerging and expanding health insurance programs in Sub-Saharan Africa. (C) 2010 Elsevier Ireland Ltd. All rights reserved.