Social movements and health insurance: a critical evaluation of voluntary, non-profit insurance schemes with case studies from Ghana and Cameroon
Social movements and health insurance: a critical evaluation of voluntary, non-profit insurance schemes with case studies from Ghana and Cameroon
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DOI：
10.1016/s0277-9536(98)00390-6
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发表时间：
1999-04-01
影响因子：
5.4
通讯作者：
Atim, C
中科院分区：
文献类型：
--
作者：
Atim, C
本文评估了加纳和喀麦隆这两个非洲国家自愿、非营利性健康保险计划的绩效及其对健康的潜在贡献。基于 1996 年主要雨季（6 月至 7 月）在两国进行的实地调查，本文研究了社会运动成分的存在或不存在是否以及以何种方式影响自愿性非营利保险计划的绩效，以实现改善目标人群获得医疗保健的机会以及实现公平、效率和财务可行性的一些关键目标。本文根据社会运动、效率、公平、准入和财务业绩。基于加纳社区融资保险计划和喀麦隆互助保险协会的案例研究，该研究得出的结论是，证据不足以证实这种社会运动动态的存在或不存在本身可以解释这两个计划的感知绩效。然而，也有人认为，社会运动的动态可以增强计划的设计和绩效，特别是医疗保健的效率和质量。只要该计划的制定方式能够从运动组成部分的具体贡献中受益，这种增强是可能的，特别是如果该计划与提供者就护理的价格和质量进行直接谈判，并与这些提供者签订直接付款合同。因此，良好的方案设计是成功的真正关键之一。此外，有争议的是，基于非社会运动的计划随着时间的推移可以纳入社会运动的要素（例如更大的社区参与、问责制和自治）。有人认为，这一过程将提高非移动计划的成功率。研究最后提出了方案审查中的一些经验教训和建议，可为类似方案的设计、实施和评估提供参考。 (C) 1999 Elsevier Science Ltd. 保留所有权利。
This paper assesses the performance of voluntary, non-profit health insurance schemes and their potential contribution to health in the two African countries of Ghana and Cameroon. Based on fieldwork conducted in the two countries during the main rainy season (June-July) of 1996, the paper examines whether and in which way the presence or absence of a social movement component might affect the performance of voluntary, non-profit insurance schemes in attaining some key objectives of improving access to health care among the target population, as well as achieving equity, efficiency and financial viability.The paper makes this assessment by examining the performances of each of two case studies according to the criteria of social movement, efficiency, equity, access and financial results. Based on case studies of a community financing insurance scheme in Ghana and a mutual aid insurance association in Cameroon, the study concludes that the evidence is not sufficient to confirm that the presence or absence of such a social movement dynamic per se accounts for the perceived performance of either of the schemes. However,:it is also argued that the dynamic of social movement could enhance the design and performance of a scheme, especially the efficiency and quality of health care.Such enhancement is possible provided that the scheme is set up in such a way as to benefit from the specific contribution of a movement component, in particular, if the scheme engages in direct negotiations with providers over the price and quality of care and makes direct payment contracts with such providers. A good scheme design is therefore one of the real keys to success. Moreover, it is arguable that a non-social movement based scheme can incorporate elements of a social movement (such as greater community participation, accountability and autonomy) in the course of time. It is argued that this process would enhance the success of a non-movement-based scheme. The study finally presents some lessons and suggestions from the examination of the schemes which could be of benefit in the design, implementation and evaluation of similar schemes. (C) 1999 Elsevier Science Ltd. All rights reserved.