Moens F
Centre de Developpement Integral, CDI Bwamanda, Gemena, Zaire.
Soc Sci Med. 1990;30(12):1319-27. doi: 10.1016/0277-9536(90)90312-g.
Unless scarce resources can be mobilized and used efficiently, health for all by the year 2000 will remain a vain attempt. Innovative financing schemes exploring increased cost recovery from the users of the health system are explored throughout the world. In Bwamanda, Zaire, a community financing scheme for hospital care was developed through the application of operations research. A preference heuristic with considerable involvement of health providers and the community was used to identify the type of financing scheme and resulted in a pre-paid health plan, while a mathematical model was developed to determine the premiums to charge. The implementation of the health plant is briefly described. An evaluation of the effects of the pre-paid plan on the accessibility and equity of health care, as well as on the financial sustainability of the hospital, is presented and discussed: a steadily increasing membership of the health plan illustrates its appropriateness, while a doubling of the cost recovery of the hospital's operating costs after two years seems promising; the hospitalization rate of members of the health plan was significantly higher than for non-members. These findings suggest that a health zone may be an appropriate level for the organization of a regional pre-paid health plan. Problems of equity, full cost recovery, and replicability of the financing scheme are discussed.
除非能够调集并有效利用稀缺资源，否则到2000年实现人人享有健康仍将是徒劳之举。世界各地都在探索创新的融资方案，以提高从卫生系统使用者那里收回成本的比例。在扎伊尔的布瓦曼达，通过运筹学的应用制定了一项医院护理社区融资方案。采用了一种让卫生服务提供者和社区大量参与的偏好启发式方法来确定融资方案的类型，结果形成了一项预付健康计划，同时还开发了一个数学模型来确定收费标准。简要介绍了该健康计划的实施情况。对预付计划在医疗服务可及性和公平性以及医院财务可持续性方面的效果进行了评估并展开讨论：健康计划的会员人数稳步增加，说明该计划是合适的；两年后医院运营成本的成本回收率翻了一番，似乎前景乐观；健康计划会员的住院率明显高于非会员。这些结果表明，一个卫生区可能是组织区域预付健康计划的合适层面。还讨论了公平性、完全成本回收以及融资方案的可复制性等问题。
