尼日利亚东南部埃努古实施社会健康保险计划中健康维护组织的作用：混合方法研究。
The roles of health maintenance organizations in the implementation of a social health insurance scheme in Enugu, Southeast Nigeria: a mixed-method investigation.
机构信息
Health Policy Research Group, Department of Pharmacology/Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
出版信息
Int J Equity Health. 2020 Mar 12;19(1):33. doi: 10.1186/s12939-020-1146-4.
BACKGROUND
In Nigeria, health maintenance organizations (HMOs) are the purchasers of health insurance with a social National Health Insurance Scheme for civil servants. However the roles of HMOs in implementation of social health insurance are not clear. This study determined the roles of HMOs in implementation of the national social health insurance scheme in Enugu, Southeast Nigeria.
METHODS
A partially mixed sequential dominant status design was employed in the study. Quantitative data were collected from 613 Federal Government employees that are registered with the National Health Insurance Scheme (NHIS) as part of the Formal Sector Social Health Insurance Program (FSSHIP) using an interviewer-administered questionnaire. Test for sampling adequacy was ensured (KMO, 0.701) and likewise the sphericity of the data using Bartlett's test (Chi [1] 796.72, p-value < 0.001). For the qualitative study, there was document review and in-depth interviews. A total of 28 in-depth interviews were conducted with key stakeholders comprising of managers of HMOs, NHIS manager, providers of health care and personnel in the State Ministry of Health among others. Thematic analysis was used for the qualitative data.
RESULTS
One-third (31.5%) of respondents said that roles of HMOs were very important, while 23% said that their roles were not important. More than half (57.70%) ranked HMOs very low in their roles, while 24.10% ranked them highest. Concentration index shows that the poor were satisfied (-.10), while the rich were highly satisfied (0.13) with roles of HMOs. The qualitative data analysis showed that most of the respondents were not satisfied with the roles of HMOs based on the themes that were developed and analyzed.
CONCLUSION
There is clear understanding of the functions of HMOs among respondents in the study although they generally think that HMOs are not meeting the expectations of the scheme. There is need for the Federal Government through the National Health Insurance Scheme to provide more effective guidelines for HMOs, supervise and monitor the implementation of such guidelines for HMOs to improve on their roles.
背景
在尼日利亚，健康维护组织（HMO）是医疗保险的购买者，其为公务员提供社会国家健康保险计划。然而，HMO 在实施社会健康保险方面的作用尚不清楚。本研究旨在确定在东南尼日利亚埃努古的国家社会健康保险计划中，HMO 的作用。
方法
采用部分混合顺序主导地位设计进行研究。从登记在国家健康保险计划（NHIS）下的 613 名联邦政府雇员中收集了定量数据，这些数据是联邦政府雇员作为正式部门社会健康保险计划（FSSHIP）的一部分，使用访谈者管理的问卷收集。确保了抽样充分性的测试（KMO，0.701），以及使用 Bartlett 检验（Chi [1] 796.72，p 值<0.001）对数据的球形度进行测试。对于定性研究，进行了文件审查和深入访谈。总共对 HMO 经理、NHIS 经理、医疗保健提供者和州卫生部人员等关键利益攸关方进行了 28 次深入访谈。对定性数据进行了主题分析。
结果
三分之一（31.5%）的受访者表示 HMO 的作用非常重要，而 23%的受访者表示其作用不重要。超过一半（57.70%）的人认为 HMO 的作用非常低，而 24.10%的人认为 HMO 的作用最高。集中指数显示，穷人对 HMO 的作用感到满意（-.10），而富人则非常满意（0.13）。定性数据分析表明，根据开发和分析的主题，大多数受访者对 HMO 的作用不满意。
结论
尽管受访者普遍认为 HMO 没有达到计划的期望，但他们对 HMO 的功能有明确的了解。联邦政府有必要通过国家健康保险计划为 HMO 提供更有效的指导方针，监督和监测 HMO 实施这些指导方针，以改善其作用。
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