Department of Tropical Hygiene and Public Health, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, Germany.
Health Soc Care Community. 2010 Jul;18(4):363-8. doi: 10.1111/j.1365-2524.2009.00905.x. Epub 2010 Feb 18.
Access to health-care is low in developing countries. Poor people are less likely to seek care than those who are better off. Community-based health insurance (CBI) aims to improve healthcare utilisation by removing financial barriers, unfortunately CBI has been less effective in securing equity than expected. Poor people, who probably require greater protection from catastrophic health expenses, are less likely to enrol in such schemes. Therefore, it is important to implement targeted interventions so that the most in need are not left out. CBI has been offered to a district in Burkina Faso, comprising 7762 households in 41 villages and the district capital of Nouna since 2004. Community wealth ranking (CWR) was used in 2007 to identify the poorest quintile of households who were subsequently offered insurance at half the usual premium rate. The CWR is easy to implement and requires minimal resources such as interviews with local informants. As used in this study, the agreement between the key informants was more (37.5%) in the villages than in Nouna town (27.3%). CBI management unit only received nine complaints from villagers who considered that some households had been wrongly identified. Among the poorest, the annual enrolment increased from 18 households (1.1%) in 2006 to 186 (11.1%) in 2007 after subsidies. CWR is an alternative methodology to identify poor households and was found to be more cost and time efficient compared to other methods. It could be successfully replicated in low-income countries with similar contexts. Moreover, targeted subsidies had a positive impact on enrolment.
在发展中国家，人们获得医疗保健的机会较少。与富裕人群相比，贫困人群寻求医疗服务的可能性较低。社区为基础的健康保险（CBI）旨在通过消除经济障碍来提高医疗服务的利用率，但不幸的是，CBI 在确保公平性方面的效果不如预期。那些可能需要更大程度的灾难性医疗支出保护的贫困人口，不太可能参加这种计划。因此，实施有针对性的干预措施非常重要，以确保最需要的人不被排除在外。自 2004 年以来，CBI 已在布基纳法索的一个地区实施，该地区包括 41 个村庄和首府努纳的 7762 户家庭。2007 年，采用社区财富排名（CWR）来确定最贫困的五分之一家庭，随后为他们提供通常保费的一半的保险。CWR 易于实施，所需资源最少，例如对当地知情者进行访谈。在本研究中，关键知情者之间的一致性在村庄（37.5%）比在努纳镇（27.3%）更高。CBI 管理部门仅收到九名村民的投诉，他们认为一些家庭被错误识别。在最贫困的家庭中，在补贴后，2006 年的注册家庭数量为 18 户（1.1%），2007 年增加到 186 户（11.1%）。CWR 是一种识别贫困家庭的替代方法，与其他方法相比，它的成本和时间效率更高。它可以在具有类似背景的低收入国家成功复制。此外，有针对性的补贴对注册产生了积极影响。
