Bennett Sara
Abt Associates, Bethesda, MD 20814, USA.
Health Policy Plan. 2004 May;19(3):147-58. doi: 10.1093/heapol/czh018.
There is increasing advocacy for community-based health insurance (CBHI) schemes as part of a broader solution to health care financing problems in low-income countries, but to date there is very limited understanding of how CBHI schemes interact with other elements of a health care financing system. This paper aims to set out a preliminary conceptual framework for understanding such interactions, and highlights the kind of research questions raised by such a framework. A basic conceptual map of a CBHI scheme is developed, and extensions added to this map that incorporate (1). effects upon non-members of schemes, (2). government subsidies to providers, (3). government subsidies to schemes, and (4). issues raised by the existence of multiple risk-pooling schemes in a particular context. The utility of a broader approach to analyzing/assessing CBHI schemes is illustrated through examination of two policy issues, namely (1). coordination of CBHI risk pools and government risk pools, and (2). equity implications of CBHI schemes and the role of government subsidies in such schemes. It is concluded that there is a strong need for empirical work to explore how CBHI schemes and the broader health care financing system interact, and that even if individual schemes achieve their own objectives (in terms of equity, efficiency etc.), this does not necessarily imply that such objectives will be achieved at the system level.
作为低收入国家医疗保健融资问题更广泛解决方案的一部分，基于社区的医疗保险（CBHI）计划得到了越来越多的倡导，但迄今为止，对于CBHI计划如何与医疗保健融资系统的其他要素相互作用，人们的了解非常有限。本文旨在阐述一个用于理解此类相互作用的初步概念框架，并突出该框架所引发的各类研究问题。绘制了CBHI计划的基本概念图，并对该图进行扩展，纳入了以下内容：（1）对计划非成员的影响；（2）政府对提供者的补贴；（3）政府对计划的补贴；以及（4）特定背景下多个风险共担计划的存在所引发的问题。通过审视两个政策问题，即（1）CBHI风险池与政府风险池的协调，以及（2）CBHI计划的公平影响和政府补贴在此类计划中的作用，说明了采用更广泛方法分析/评估CBHI计划的效用。得出的结论是，迫切需要开展实证研究，以探索CBHI计划与更广泛的医疗保健融资系统如何相互作用，并且即使个别计划实现了自身目标（在公平、效率等方面），这并不一定意味着此类目标将在系统层面得以实现。
