Poletti Tim, Balabanova Dina, Ghazaryan Olga, Kocharyan Hasmik, Hakobyan Margarita, Arakelyan Karen, Normand Charles
London School of Hygiene and Tropical Medicine, London, UK.
Soc Sci Med. 2007 Feb;64(3):509-20. doi: 10.1016/j.socscimed.2006.09.005. Epub 2006 Nov 13.
There is growing evidence that community financing mechanisms can raise additional revenue, increase equitable access to primary health care (PHC), and improve social protection. More recently there has been interest in scaling up community financing as a step towards universal coverage either via tax-based systems or social health insurance. Using key informant interviews and focus group discussions, this study sought to assess the desirability and feasibility of scaling-up community health insurance in Armenia. The results suggest that there is broad-based political support for scaling up the schemes and that community financing is synergistic with major health sector reforms. High levels of social capital within the rural communities should facilitate scaling up. Existing schemes have increased access and quality of care, but expansion of coverage is constrained by affordability, poor infrastructure, and weak linkages with the broader health system. Long-term subsidies and system-building will be essential if the expanded schemes are to be financially viable and pro-poor. Overall, successfully scaling up community financing in Armenia would depend on addressing a range of obstacles related to legislation, institutional capacity, human resources and resistance to change among certain stakeholders.
越来越多的证据表明，社区融资机制能够筹集额外资金，增加获得初级卫生保健的公平性，并改善社会保护。最近，人们对扩大社区融资产生了兴趣，将其作为迈向全民覆盖的一步，无论是通过基于税收的系统还是社会医疗保险。本研究通过关键信息人访谈和焦点小组讨论，试图评估在亚美尼亚扩大社区医疗保险的可取性和可行性。结果表明，扩大这些计划得到了广泛的政治支持，并且社区融资与主要的卫生部门改革具有协同作用。农村社区的高度社会资本应有助于扩大规模。现有计划增加了医疗服务的可及性和质量，但覆盖范围的扩大受到可负担性、基础设施差以及与更广泛卫生系统联系薄弱的限制。如果扩大后的计划要在财务上可行且有利于穷人，长期补贴和制度建设将至关重要。总体而言，在亚美尼亚成功扩大社区融资将取决于克服一系列与立法、机构能力、人力资源以及某些利益相关者对变革的抵制相关的障碍。
