Criel B, Van der Stuyft P, Van Lerberghe W
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Soc Sci Med. 1999 Apr;48(7):897-911. doi: 10.1016/s0277-9536(98)00391-8.
The Bwamanda hospital insurance scheme in Zaire was launched in the mid-eighties and is one of the few well-established and documented initiatives in the field of district-based insurance schemes in sub-Saharan Africa. It was established that hospital utilization in Bwamanda is significantly higher among the insured population. A higher hospital utilization is however not a goal in itself: it is a positive phenomenon if it takes place for problems where the hospital's know-how and technology are needed to solve the patient's problem. This paper investigates the effect of the insurance scheme on hospital utilization patterns. More specifically, the distribution of this higher utilization over the different hospital departments, as well as its spatial distribution in the entire district area are analyzed. The impact of the insurance scheme on the effectiveness, equity and efficiency of hospital utilization are discussed. The relevance and possible implications of these findings on the design of the Bwamanda insurance scheme are discussed. Finally, it is argued that the methods used in the present study contribute to a coherent framework for the evaluation of similar initiatives.
扎伊尔的布瓦曼达医院保险计划于20世纪80年代中期启动，是撒哈拉以南非洲地区少数成熟且有文献记载的地区性保险计划之一。已确定布瓦曼达的参保人群中，医院利用率显著更高。然而，更高的医院利用率本身并非目标：如果是因需要医院的专业知识和技术来解决患者问题而出现这种情况，那才是一种积极现象。本文研究了保险计划对医院利用模式的影响。更具体地说，分析了这种更高利用率在不同医院科室的分布情况，以及其在整个地区的空间分布。讨论了保险计划对医院利用的有效性、公平性和效率的影响。探讨了这些研究结果对布瓦曼达保险计划设计的相关性及可能影响。最后指出，本研究中使用的方法有助于形成一个评估类似举措的连贯框架。
