Tandwa Lizeka Amanda, Dhai Ames
School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BMC Public Health. 2020 Jul 31;20(1):1191. doi: 10.1186/s12889-020-09270-8.
The National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system. Public involvement in policy making is important and it is a constitutional requirement in the legislation development process in South Africa. Patients are key stakeholders and should be engaged in NHI policy process. Before patients can be engaged, they need to be provided with sufficient information about the NHI. Therefore, the aim of this exploratory study was to examine the levels of patient awareness of the NHI, which is a requisite for meaningful engagement.
This was a cross sectional study of 244 patients from the follow-up clinics at the Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital in the Gauteng Province, South Africa. The patients were interviewed using a structured interview process and a questionnaire. Descriptive statistics and logistic regression analyses were conducted.
The majority (79.51%) of the participants were not aware of the proposed National Health Insurance (NHI) in South Africa even though the NHI policy process commenced in 2011. Of the participants who were aware of the NHI, 86% responded that they had not been provided with an opportunity to be involved in the policy making process of the NHI. The odds of awareness were higher for male (OR: 2.08, 95% CI: 1.11-3.9, p value: 0.02) than female participants; White (OR: 2.36, 95% CI: 1.06-5.26, p value: 0.04) and Indian (OR: 2.76, 95% CI: 0.10-7.60, p value: 0.05) participants when compared to Black participants; and retired (OR: 3.13, 95% CI: 1.35-7.25, p value: 0.008) than unemployed participants.
The levels of awareness of the NHI were low among the participants from Department of Internal Medicine, CMJAH. Without the awareness and information about the NHI, patients are not equipped to be involved in the NHI policy process in a meaningful way. Public patients are the intended beneficiaries of universal health coverage, therefore they should be prioritized in the NHI community engagement process to ensure that the NHI is community and patient centred.
国家医疗保险（NHI）是南非一项拟议的卫生政策，旨在改变当前卫生系统的结构。公众参与政策制定很重要，这是南非立法制定过程中的一项宪法要求。患者是关键利益相关者，应参与国家医疗保险政策制定过程。在患者能够参与之前，需要向他们提供有关国家医疗保险的充分信息。因此，这项探索性研究的目的是调查患者对国家医疗保险的认知水平，这是进行有意义参与的必要条件。
这是一项对来自南非豪登省约翰内斯堡夏洛特·马克西克学术医院内科随访诊所的244名患者进行的横断面研究。通过结构化访谈流程和问卷对患者进行访谈。进行了描述性统计和逻辑回归分析。
尽管国家医疗保险政策制定过程于2011年启动，但大多数（79.51%）参与者并不知晓南非拟议的国家医疗保险。在知晓国家医疗保险的参与者中，86%的人表示他们没有机会参与国家医疗保险的政策制定过程。男性参与者知晓的几率（比值比：2.08，95%置信区间：1.11 - 3.9，p值：0.02）高于女性参与者；与黑人参与者相比，白人（比值比：2.36，95%置信区间：1.06 - 5.26，p值：0.04）和印度裔（比值比：2.76，95%置信区间：0.10 - 7.60，p值：0.05）参与者知晓的几率更高；退休人员（比值比：3.13，95%置信区间：1.35 - 7.25，p值：0.008）知晓的几率高于失业人员。
约翰内斯堡夏洛特·马克西克学术医院内科的参与者对国家医疗保险的认知水平较低。如果没有对国家医疗保险的认知和相关信息，患者就无法以有意义的方式参与国家医疗保险政策制定过程。公立患者是全民医保的预期受益者，因此在国家医疗保险社区参与过程中应优先考虑他们，以确保国家医疗保险以社区和患者为中心。
