Ridde Valéry, Belaid Loubna, Samb Oumar Mallé, Faye Adama
Sante Publique. 2014 Sep-Oct;26(5):715-25.
As a step towards universal health coverage, African countries need to develop funding systems that are effective, equitable, and tailored to national circumstances. To support policy makers in Burkina Faso, we present a review of research on interventions related to user fees, prepayment plans, and user fee subsidies. We compiled a narrative summary of articles published in scientific journals between 1980 and 2012. In all, 64 articles were selected. A thematic analysis was performed. User fees are a barrier to access to care; they curtail the use of health services and exclude the worst-off. People prefer prepayment plans in which each household pays an annual premium. However, the insurance premium remains a barrier to membership. Insurance does not benefit the poor but increases the use of health services by the insured. The subsidy for facility-based deliveries was not sufficiently well planned and difficulties have been observed in its implementation. While it helps reduce costs and improves access to care, it has not reduced inequalities. Community-based and participatory interventions have been useful for identifying the worst-off in order to exempt them from user fees. While prepayment is being promoted internationally as a financing model for universal health coverage, the evidence in favour of this system in Burkina Faso is still very limited. Further studies, more representative of the national context, must be conducted on this option, while at the same time, continuing efforts must be made to identify solutions for the poor who are unable to pay.
作为迈向全民健康覆盖的一步,非洲国家需要建立有效、公平且符合国情的筹资体系。为了支持布基纳法索的政策制定者,我们对与使用者付费、预付计划和使用者付费补贴相关的干预措施研究进行了综述。我们编写了1980年至2012年间发表在科学期刊上的文章的叙述性总结。总共筛选出64篇文章,并进行了主题分析。使用者付费是获得医疗服务的障碍;它限制了医疗服务的使用,并将最贫困人群排除在外。人们更喜欢每户支付年度保费的预付计划。然而,保险费仍然是参保的障碍。保险并未使穷人受益,但增加了参保者对医疗服务的使用。基于设施分娩的补贴规划不够完善,在实施过程中出现了困难。虽然它有助于降低成本并改善医疗服务的可及性,但并未减少不平等现象。基于社区和参与性的干预措施有助于识别最贫困人群,以便免除他们的使用者付费。虽然预付作为全民健康覆盖的一种筹资模式在国际上得到推广,但在布基纳法索支持这一体系的证据仍然非常有限。必须针对这一选项开展更能代表国家情况的进一步研究,同时,必须继续努力为无力支付费用的穷人找到解决办法。