Obse Amarech, Hailemariam Damen, Normand Charles
School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethopia.
Centre for Global Health, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
BMC Health Serv Res. 2015 Aug 11;15:318. doi: 10.1186/s12913-015-0988-8.
The Ethiopian health system has been undergoing through reforms. One of the reforms stipulated in policy documents is the introduction of health insurance at national level. Having the majority of the population without any experience of health insurance, investigating preferences and knowledge of the essence of health insurance among potential enrolees will provide vital information for policy makers. This formative study seeks to explore the knowledge and the preference for health insurance among formal sector employees in Addis Ababa.
Six focus group discussions with formal sector employees and five key informant interviews were conducted in Addis Ababa. A thematic analysis is used to analyse the results.
The findings suggest that there is little knowledge about the concept and elements of health insurance. Some concepts such as, risk pooling and sharing are not well understood. The participants of the study considered health insurance as only a prepayment mechanism without risk sharing among members of the scheme. Regarding preference for health insurance, they have revealed quality of care as the most important factor. Comprehensiveness of benefit packages and the amount of premium level are also found to be concerns related to health insurance. However, a trade-off is also observed among premium level, comprehensive benefit packages, and healthcare facilities.
Improvements on availability and quality of services need to precede the introduction of social health insurance. There is also a need to work on awareness creation regarding concepts of health insurance. Further studies may explore if the knowledge gap is real or appeared due to reservations of the participants on the introduction of health insurance.
埃塞俄比亚的卫生系统一直在进行改革。政策文件中规定的一项改革是在国家层面引入医疗保险。由于大多数人口没有任何医疗保险经验，调查潜在参保者对医疗保险本质的偏好和了解情况将为政策制定者提供重要信息。这项形成性研究旨在探索亚的斯亚贝巴正规部门员工对医疗保险的了解和偏好。
在亚的斯亚贝巴与正规部门员工进行了六次焦点小组讨论，并进行了五次关键信息人访谈。采用主题分析法对结果进行分析。
研究结果表明，对医疗保险的概念和要素了解甚少。一些概念，如风险共担和分担，没有得到很好的理解。研究参与者认为医疗保险只是一种预付款机制，而该计划的成员之间不存在风险分担。关于对医疗保险的偏好，他们认为医疗服务质量是最重要的因素。福利套餐的全面性和保费水平也被认为是与医疗保险相关的问题。然而，在保费水平、全面的福利套餐和医疗设施之间也存在权衡。
在引入社会医疗保险之前，需要先提高服务的可及性和质量。还需要开展关于医疗保险概念的宣传工作。进一步的研究可以探讨知识差距是真实存在的，还是由于参与者对引入医疗保险有所保留而出现的。
