The "Universal" in UHC and Ghana's National Health Insurance Scheme: policy and implementation challenges and dilemmas of a lower middle income country.
The "Universal" in UHC and Ghana's National Health Insurance Scheme: policy and implementation challenges and dilemmas of a lower middle income country.
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DOI：
10.1186/s12913-016-1758-y
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发表时间：
2016-09-21
影响因子：
2.8
通讯作者：
Asenso-Boadi F
中科院分区：
文献类型：
--
作者：
Agyepong IA;Abankwah DN;Abroso A;Chun C;Dodoo JN;Lee S;Mensah SA;Musah M;Twum A;Oh J;Park J;Yang D;Yoon K;Otoo N;Asenso-Boadi F
尽管全民覆盖和公平是国家卫生系统的既定政策目标，但自2003年通过第一部法律以来的十多年里，加纳仍在为如何实现这一目标而苦苦挣扎。主要（约70%）由税收资助的国家卫生保健系统目前的积极入学率徘徊在40%左右。本研究深入探讨了国家健康保险制度的促进因素和障碍，为加纳和其他低收入和中等收入国家（LMIC）实现全民健康覆盖（UHC）的普及目标提供了经验教训和见解。我们对加纳南部一个地区的城市和农村地区进行了一项横断面混合方法研究。数据来自文件审查、注册常规数据分析、与地方政府、区域和地区保险计划和提供者工作人员以及社区成员进行深入访谈的关键信息提供者以及焦点小组讨论。在研究地区，由于许多曾经注册过的人没有按照国家卫生健康计划政策的要求每年定期更新，因此国家卫生健康计划的人口覆盖率没有向接近普遍的方向增长。促进和使招生成为可能的因素是由方案的设计细节驱动的，这些细节来自国家层面的政策和项目制定、一线采购人员和供应商员工的实施安排以及环境因素。这些因素相互关联并共同影响客户对计划的体验，而这些因素并不总是与所宣布的政策意图相同。这也影响了入学和继续就读的决定。全民健康覆盖政策和规划设计需要使报名实际上是强制性的。它还需要仔细关注和响应实际和潜在的订户、购买者和提供者（利益相关者）的激励和在执行层面产生的相关行为。本文的在线版本（doi:10.1186/s12913-016-1758-y）包含补充材料，可供授权用户使用。
Despite universal population coverage and equity being a stated policy goal of its NHIS, over a decade since passage of the first law in 2003, Ghana continues to struggle with how to attain it. The predominantly (about 70 %) tax funded NHIS currently has active enrolment hovering around 40 % of the population. This study explored in-depth enablers and barriers to enrolment in the NHIS to provide lessons and insights for Ghana and other low and middle income countries (LMIC) into attaining the goal of universality in Universal Health Coverage (UHC). We conducted a cross sectional mixed methods study of an urban and a rural district in one region of Southern Ghana. Data came from document review, analysis of routine data on enrolment, key informant in-depth interviews with local government, regional and district insurance scheme and provider staff and community member in-depth interviews and focus group discussions. Population coverage in the NHIS in the study districts was not growing towards near universal because of failure of many of those who had ever enrolled to regularly renew annually as required by the NHIS policy. Factors facilitating and enabling enrolment were driven by the design details of the scheme that emanate from national level policy and program formulation, frontline purchaser and provider staff implementation arrangements and contextual factors. The factors inter-related and worked together to affect client experience of the scheme, which were not always the same as the declared policy intent. This then also affected the decision to enrol and stay enrolled. UHC policy and program design needs to be such that enrolment is effectively compulsory in practice. It also requires careful attention and responsiveness to actual and potential subscriber, purchaser and provider (stakeholder) incentives and related behaviour generated at implementation levels. The online version of this article (doi:10.1186/s12913-016-1758-y) contains supplementary material, which is available to authorized users.
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