基西济医院健康保险计划的制定：经验教训及对全民健康覆盖的启示。
Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage.
机构信息
Department of Health Policy, Planning and Management, Makerere University College of Health Sciences, School of Public Health, P. O. Box 7072, Kampala, Uganda.
Kisiizi Hospital Health Insurance Scheme, Kisiizi Hospital, P. O. Box 109, Kabale, Uganda.
出版信息
BMC Health Serv Res. 2018 Jun 15;18(1):455. doi: 10.1186/s12913-018-3266-8.
BACKGROUND
Kisiizi Hospital Health Insurance scheme started in 1996 to; improve access to health services, and provide a stable source of funding and reduce bad debts to Kisiizi hospital. Objectives of this study were; to describe Kisiizi Hospital Health Insurance scheme and to document lessons learned and implications for universal health coverage.
METHODS
This was a descriptive cross-sectional study. Data from different sources were triangulated and thematically analysed.
RESULTS
Most households (96%) were organized in Engozi societies (e-Societies), met monthly, and made financial contributions. Cultural solidarity in e-Societies provided a platform for the Kisiizi hospital health insurance scheme establishment, operation and made it compulsory for members. e-Societies disciplinary measures and fear of high out-of-pocket payment for health care enforced enrolment, retention and increased membership. Community sensitisation and community participation in setting premiums and co-payments provided for better understanding of health insurance and rendered them acceptable, affordable and equitable. Membership increased from 330 in 1996 to 38,400 families in 2017. Kisiizi hospital health insurance scheme covered only health services obtained from Kisiizi hospital. Kisiizi hospital health insurance scheme offered no exemption, credit and referral facilities. e-Societies sometimes paid premiums for members from savings and offered them loans to. Kisiizi hospital provided good quality health services, which were easily accessed by insured members. Kisiizi hospital got a stable source of funding and reduced debt burden.
CONCLUSIONS
Kisiizi hospital health insurance scheme improved access to health services, provided a stable source of funding and reduced bad debts to the hospital. Internal and external factors to e-Society enforced enrolment and retention of members in Kisiizi hospital health insurance scheme. Good quality health services at Kisiizi hospital demonstrated value for money and offered incentives for enrolment and retention, and coverage expansion. Community sensitization and participation in setting premiums and co-payments rendered Kisiizi hospital health insurance scheme acceptable, affordable and catered for equity. Insured members enjoyed benefits; protection against catastrophic health spending, impoverishment, and easy access to quality health care.
背景
基西济医院健康保险计划于 1996 年启动，旨在改善医疗服务的可及性，为基西济医院提供稳定的资金来源，并减少呆账。本研究的目的是描述基西济医院健康保险计划，并记录经验教训及其对全民健康覆盖的影响。
方法
这是一项描述性的横断面研究。来自不同来源的数据进行了三角测量和主题分析。
结果
大多数家庭（96%）组织成恩戈齐协会（e-协会），每月开会并缴纳会费。e-协会中的文化团结为基西济医院健康保险计划的建立、运营提供了平台，并使其成为强制性的。e-协会的纪律措施和对高额自付医疗费用的恐惧，强制了成员的加入、保留和增加。社区宣传和社区参与设定保费和共付额，增进了对健康保险的理解，使保费可负担、公平。成员从 1996 年的 330 人增加到 2017 年的 38400 个家庭。基西济医院健康保险计划仅涵盖从基西济医院获得的医疗服务。基西济医院健康保险计划不提供豁免、信贷和转诊设施。e-协会有时会从储蓄中为成员支付保费，并向他们提供贷款。基西济医院提供了高质量的医疗服务，参保成员很容易获得这些服务。基西济医院获得了稳定的资金来源，并减轻了债务负担。
结论
基西济医院健康保险计划改善了医疗服务的可及性，为医院提供了稳定的资金来源，并减少了呆账。e-协会的内部和外部因素强制了成员的加入和保留。基西济医院提供的高质量医疗服务体现了物有所值，并为参保和扩大覆盖范围提供了激励。社区宣传和参与设定保费和共付额使基西济医院健康保险计划具有可接受性、可负担性，并体现了公平性。参保成员享有以下福利：防止灾难性医疗支出、贫困和获得高质量医疗保健的机会。
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