African Institute for Health Policy Foundation, Nairobi, Kenya; Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands.
I-TECH, Gaborone, Botswana.
Ann Glob Health. 2016 Sep-Oct;82(5):903-911. doi: 10.1016/j.aogh.2016.09.008.
A majority of health systems in the sub-Saharan Africa region are faced with multiple competing priorities amid pressing resource constraints. Health financing reforms, characterized by expansion of health insurance coverage, have been proposed as promising in the quest to improve health sustainably. However, in many countries where these measures are being attempted, their broader implications have not been fully appreciated.
This study was based on perspectives of 37 health system stewards from Botswana who were interviewed in order to understand opportunities and challenges that would result in the quest to expand health insurance coverage in the country. Thematic synthesis of their perspectives, focusing on the key aspects of the health systems, was done in order to draw informative lessons that could be applicable to a broader set of low- and middle-income countries.
Health systems attempting to expand health insurance coverage would be faced with various opportunities and challenges that have implications on performance. By increasing the pool of resources available to spend on health, health insurance would afford health systems the opportunity to increase population access to and use of health services. However, if unchecked, this could also translate to uncontrolled demand for expensive medicines and other health technologies, leading to cost escalation and inefficiencies within the system. Therefore, the success of any health financing reform is dependent on embracing sound policies, regulations, and accountability measures.
Health financing reforms have broader implications to health system performance that should be fully appreciated and anticipated before implementation. Therefore, health system leaders who are keen to improve health must view any health financing reforms through the broader framework of the health system framework in order to make progress.
撒哈拉以南非洲地区的大多数卫生系统在资源紧张的情况下面临着多项相互竞争的优先事项。健康融资改革，以扩大医疗保险覆盖范围为特征，被认为是可持续改善健康的有希望的措施。然而，在许多尝试这些措施的国家，其更广泛的影响尚未得到充分认识。
本研究基于来自博茨瓦纳的 37 名卫生系统管理者的观点，他们接受了采访，以了解在扩大该国医疗保险覆盖范围的过程中可能出现的机遇和挑战。对他们的观点进行主题综合分析，重点关注卫生系统的关键方面，以汲取可适用于更广泛的低收入和中等收入国家的有益经验。
试图扩大医疗保险覆盖范围的卫生系统将面临各种机遇和挑战，这些机遇和挑战对绩效有影响。通过增加可用于卫生支出的资源池，医疗保险将使卫生系统有机会增加人口获得和使用卫生服务的机会。然而，如果不加控制，这也可能导致对昂贵药物和其他卫生技术的需求不受控制，从而导致系统成本上升和效率低下。因此，任何健康融资改革的成功都取决于采取健全的政策、法规和问责措施。
健康融资改革对卫生系统绩效有更广泛的影响，在实施之前应充分认识和预期这些影响。因此，热衷于改善健康的卫生系统领导者必须通过卫生系统框架的更广泛框架来看待任何健康融资改革，以取得进展。
