Kiwara Angwara D
Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
East Afr J Public Health. 2007 Apr;4(1):28-32.
The main objective was to assess how group premiums can help poor people in the informal economy prepay for health care services.
A comparative approach was adopted to study four groups of informal economy operators (cobblers, welders, carpenters, small scale market retailers) focusing on a method of prepayment which could help them access health care services. Two groups with a total of 714 operators were organized to prepay for health care services through a group premium, while the other two groups with a total of 702 operators were not organized to prepay through this approach. They prepaid through individual premium, each operator paying from his or her sources. Data on the four groups which lived in the same city was collected through a questionnaire and focus group discussions. Data collected was focused on health problems, health seeking behaviour and payment for health care services. Training of all the groups on prepaid health care financing based on individual based premium payment and group based premium payment was done. Groups were then free to choose which method to use in prepaying for health care. Prepayment through the two methods was then observed over a period of three years. Trends of membership attrition and retention were documented for both approaches.
Data collected showed that the four groups were similar in many respects. These similarities included levels of education, housing, and social services such as water supplies, health problems, family size and health seeking behaviour. At the end of a period of three years 76% of the members from the two groups who chose group premium payment were still members of the prepayment health scheme and were receiving health care. For the two groups which opted for individual premium payment only 15% of their members were still receiving health care services at the end of three years.
Group premium is a useful tool in improving accessibility to health care services in the poorer segments of the population especially the informal economy operators
主要目的是评估团体保费如何帮助非正规经济部门的贫困人口预付医疗服务费用。
采用比较研究方法，以一种有助于非正规经济部门经营者获得医疗服务的预付方式，对四组非正规经济部门经营者（鞋匠、焊工、木匠、小规模市场零售商）展开研究。两组共714名经营者通过团体保费预付医疗服务费用，而另外两组共702名经营者未采用这种方式预付费用，他们通过个人保费预付，每位经营者自行支付费用。通过问卷调查和焦点小组讨论收集了居住在同一城市的这四组人群的数据。收集的数据聚焦于健康问题、就医行为和医疗服务支付情况。针对所有组进行了基于个人保费支付和团体保费支付的预付医疗融资培训。然后各小组可自由选择使用哪种方法预付医疗费用。之后对这两种预付方法进行了为期三年的观察。记录了两种方法下成员流失和留存的趋势。
收集的数据表明，这四组在很多方面具有相似性。这些相似之处包括教育水平、住房情况以及诸如供水等社会服务、健康问题、家庭规模和就医行为等。三年期满时，选择团体保费支付的两组中的76%的成员仍是预付医疗计划的成员并享受医疗服务。而选择个人保费支付的两组在三年期满时只有15%的成员仍在接受医疗服务。
团体保费是一种有用的工具，有助于改善贫困人口尤其是非正规经济部门经营者获得医疗服务的机会。
