Agasha Doreen Birungi, Edwin Birungi Mutahunga R, Baine Sebastian Olikira
Hospice Africa Uganda, Kampala, Uganda.
Church of Uganda, Bwindi Community Hospital, Kanungu, Uganda.
Front Public Health. 2019 Apr 4;7:71. doi: 10.3389/fpubh.2019.00071. eCollection 2019.
eQuality Health Bwindi (eQHB), a Community Based Health Insurance (CBHI) scheme was launched in March 2010 with the aim of generating income to maintain high quality care as well as increasing access to and utilization of health services at Bwindi Community Hospital (BCH). The main objective of this study was to explore evidence showing that eQHB scheme affected access and utilization of health services at BCH. The evidence generated would be used to inform decision making, policy and scale up of the scheme. This study applied qualitative and quantitative research methods. It involved a review of hospital records for the period July 2009-June 2014, a survey of 272 households, four focus group discussions, and six key informant interviews. Both quantitative and qualitative analysis techniques were applied for the analysis. Outpatient attendance, inpatient admissions, and deliveries at the hospital increased by 65, 73, and 27%, respectively between FY 2009/10 and FY 2012/13. Utilization of health services by sick children from insured participants was greater than that of the uninsured members of the community (-value = 0.0038). BCH services became more affordable. However, opting out of the scheme at a later stage in the review period was attributed to rising unaffordable premiums and co-payments. Failure to afford scheme membership, residing far from BCH and limited understanding of health insurance led to reduced BCH service utilization. eQHB has potential to increase access and utilization of health services at BCH. The challenges are; limited understanding of the concept of health insurance and unaffordable premiums and co-payments set to enable provision of high quality services. Based on these findings, intensified community sensitization on health insurance, establishment of satellite health facilities by BCH to bring services closer to members and transformation of eQHB to a savings/credit society in order to grow savings and subsequently reduce premiums are recommended. Government of Uganda should engage CBHIs countrywide to discuss achievement of UHC and establishment of a national health insurance scheme. A further study to guide setting of affordable premiums and copayments for eQHB is also recommended.
布温迪平等健康组织（eQHB）是一项基于社区的健康保险（CBHI）计划，于2010年3月启动，旨在创收以维持高质量医疗服务，并增加布温迪社区医院（BCH）的医疗服务可及性和利用率。本研究的主要目的是探索证据，证明eQHB计划对BCH的医疗服务可及性和利用率产生了影响。所产生的证据将用于为决策、政策制定以及该计划的推广提供参考。本研究采用了定性和定量研究方法。研究内容包括回顾2009年7月至2014年6月期间的医院记录、对272户家庭进行调查、开展四次焦点小组讨论以及进行六次关键 informant访谈。分析过程中同时应用了定量和定性分析技术。在2009/10财政年度至2012/13财政年度期间，医院的门诊就诊人次、住院人数和分娩人数分别增加了65%、73%和27%。参保儿童的患病成员对医疗服务的利用率高于社区未参保成员（-值 = 0.0038）。BCH的服务变得更具可负担性。然而，在审查期后期选择退出该计划的原因是保费和共付费用不断上涨，令人难以承受。无力承担计划成员资格、居住距离BCH较远以及对健康保险的了解有限，导致BCH的服务利用率降低。eQHB有潜力增加BCH的医疗服务可及性和利用率。面临的挑战包括：对健康保险概念的理解有限，以及为提供高质量服务而设定的保费和共付费用过高，令人难以承受。基于这些发现，建议加强对健康保险的社区宣传，BCH设立卫星医疗设施，使服务更贴近成员，并将eQHB转变为储蓄/信贷协会，以增加储蓄并随后降低保费。乌干达政府应与全国范围内的CBHI进行合作，讨论实现全民健康覆盖和建立国家健康保险计划的问题。还建议开展进一步研究，以指导为eQHB设定可负担的保费和共付费用。
