Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria.
Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria.
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DOI：
10.1186/1478-4505-11-20
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发表时间：
2013-06-13
影响因子：
4
通讯作者：
Ezumah NN
中科院分区：
文献类型：
--
作者：
Onoka CA;Onwujekwe OE;Uzochukwu BS;Ezumah NN
尼日利亚于2005年启动了国家健康保险计划，作为联邦政府利用金融风险保护机制实现全民覆盖的努力的一部分。然而，目前只有4%的人口，主要是联邦政府雇员，享有医疗保险，这主要是通过国家医疗保险系统的正规部门社会医疗保险方案提供的。本研究旨在了解为什么不同的州（次国家）政府决定是否采用FSSHIP为他们的员工。本研究采用了比较案例研究的方法。通过文件审查和与决策者、方案管理人员、保健提供者和公务员领导人进行的48次深入访谈收集了数据。虽然该方案的好处似乎为州决策者和预期受益人（雇员）所接受，但雇主缴款的可行性、对国家健康保险制度透明度的关切、州在家庭社会保障和健康保险方案中的作用、州长等政策倡导者的作用以及雇员对缴款的抵制，都影响了州政府关于采用该方案的决定。总的来说，州政府对州一级医疗改革的权力，归因于政府的现行制度，允许州审议某些国家一级的政策，由NHIS立法加强，使采用自愿，使州能够采用或不采用该计划。这项研究表明，并支持的意见，即使当一个方案的内容是普遍可以接受的，背景下，演员的角色，以及更广泛的影响，方案设计对演员的利益可以解释政策通过的决定。参与扩大NHIS方案的政策执行者需要考虑当前的背景因素，并有效地让政策倡导者克服已知的挑战，以鼓励国家以下各级政府采用。在扩大医疗保险覆盖面的国家，政策制定者和执行者应尽早制定战略，克服扩大覆盖面过程中固有的政治挑战，以避免延误或阻碍这一进程。他们还应该考虑首先关注公务员的改革的潜在陷阱，特别是当公共资金的使用可能损害其他公民的保险时。
The National Health Insurance Scheme (NHIS) in Nigeria was launched in 2005 as part of efforts by the federal government to achieve universal coverage using financial risk protection mechanisms. However, only 4% of the population, and mainly federal government employees, are currently covered by health insurance and this is primarily through the Formal Sector Social Health Insurance Programme (FSSHIP) of the NHIS. This study aimed to understand why different state (sub-national) governments decided whether or not to adopt the FSSHIP for their employees. This study used a comparative case study approach. Data were collected through document reviews and 48 in-depth interviews with policy makers, programme managers, health providers, and civil servant leaders. Although the programme’s benefits seemed acceptable to state policy makers and the intended beneficiaries (employees), the feasibility of employer contributions, concerns about transparency in the NHIS and the role of states in the FSSHIP, the roles of policy champions such as state governors and resistance by employees to making contributions, all influenced the decision of state governments on adoption. Overall, the power of state governments over state-level health reforms, attributed to the prevailing system of government that allows states to deliberate on certain national-level policies, enhanced by the NHIS legislation that made adoption voluntary, enabled states to adopt or not to adopt the program. The study demonstrates and supports observations that even when the content of a programme is generally acceptable, context, actor roles, and the wider implications of programme design on actor interests can explain decision on policy adoption. Policy implementers involved in scaling-up the NHIS programme need to consider the prevailing contextual factors, and effectively engage policy champions to overcome known challenges in order to encourage adoption by sub-national governments. Policy makers and implementers in countries scaling-up health insurance coverage should, early enough, develop strategies to overcome political challenges inherent in the path to scaling-up, to avoid delay or stunting of the process. They should also consider the potential pitfalls of reforms that first focus on civil servants, especially when the use of public funds potentially compromises coverage for other citizens.
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影响因子：
3.2
作者：
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通讯作者：
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3.2
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影响因子：
3.2
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影响因子：
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作者：
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