Repackaging exemptions under National Health Insurance in Ghana: how can access to care for the poor be improved?
Repackaging exemptions under National Health Insurance in Ghana: how can access to care for the poor be improved?
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DOI：
10.1093/heapol/czs098
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发表时间：
2013-09-01
影响因子：
3.2
通讯作者：
van der Geest, Sjaak
中科院分区：
文献类型：
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作者：
Derbile, Emmanuel Kanchebe;van der Geest, Sjaak
在过去10年中，加纳政府一直试图以全面的健康保险计划取代旧的使用者付费制度，但旧制度的一个问题继续困扰着新政策：免除穷人的费用。本文介绍了来自实证调查的数据，并提出了自己的看法。它讨论了过去对穷人免除用户费用的经验如何能够为新的“国民健康保险计划"下的免除提供信息，作为确保保健公平的一种手段。根据对加纳北方三个地区的豁免情况进行的研究，并利用定性和定量方法和数据，研究结果表明，豁免的适用有利于五岁以下儿童、产前护理、老年人和公务员，而不利于穷人。因此，穷人很少有机会获得豁免。因此，豁免未能解决保健方面的公平问题，而这正是实行豁免的原因。因此，尽管该文件承认，规定穷人加入国家医疗保险是朝着正确方向迈出的一步，但它强调，有效的入学对于实现该政策的公平目标至关重要。本文针对过去国民健康保险制度中，减免制度的公平性目标被破坏的经验，提出三项政策建议，以改善国民健康保险制度下的贫困者减免制度。这些是：（1）开展有效的社区教育，促进缴纳保费的国家医疗保险注册人数增加，同时开展关于穷人豁免的教育;（2）审查和澄清政策指导方针，指导地方一级根据社区自身对贫困的理解确定穷人;（3）提供必要的资源，使社会福利部能够履行其确定穷人以获得豁免的核心任务。
For the past 10 years the Ghana Government has been trying to replace the old user fee system with an overall health insurance scheme, but one problem of the old system continues to bedevil the new policy: exemption of the poor. This paper presents data from empirical fieldwork and also puts forward an opinion. It discusses how past experiences of user fee exemptions for the poor can inform exemptions under the new 'National Health Insurance Scheme' (NHIS) as a means to ensuring equity in health care. Drawing on a study of exemptions in the three regions of northern Ghana, and utilizing both qualitative and quantitative methods and data, the findings show that exemptions were applied in favour of under-fives, antenatal care, the aged and public servants to the disadvantage of the poor. As a result, the poor had very little access to exemptions. Exemptions therefore failed to address equity concerns in health care, the very reason for which they were introduced. Thus, although the paper acknowledges that provision for the enrolment of the poor into the NHIS is a step in the right direction, it underscores that effective enrolment will be essential for attaining the equity goal of the policy. Informed by past experiences that undermined the equity goal of exemptions, three policy recommendations are put forward for improving exemptions for the poor under the NHIS. These are: (1) effective community education for enhancing premium paying enrolments into the NHIS alongside education on exemptions for the poor; (2) reviewing and clarifying policy guidelines for guiding local-level identification of the poor based on communities' own understanding of poverty; and (3) providing the requisite resources to enable the Department of Social Welfare to discharge its core mandate of identifying the poor for exemptions.