Paul Elisabeth, Sambiéni N'koué Emmanuel, Wangbe Jean-Pierre, Fecher Fabienne, Bourgeois Marc
Université libre de Bruxelles, Campus Erasme, Route de Lennik 808, CP 594, 1070, Bruxelles, Belgium.
University of Liège, Tax Institute, Quartier Agora, Bat. B3, 4000, Liège, Belgium.
Health Econ Rev. 2020 Sep 5;10(1):28. doi: 10.1186/s13561-020-00286-9.
In its pursuance of universal health coverage (UHC), the government of Benin is piloting a project of mandatory social insurance for health entitled "ARCH".
We analysed budget data and ARCH documents, and conducted four observation missions in Benin between March 2018 and January 2020. Results are presented in terms of the three classical objectives of public expenditure management.
The government of Benin faces important budgeting challenges when it comes to implementing the ARCH social insurance project: (i) the fiscal space is quite limited, there is a limited potential for new taxes and these may not benefit the ARCH funding, hence the need to prioritise fiscal resources without jeopardising other areas; (ii) the purchasing of health services should be more strategic so as to increase allocative efficiency and equity; (iii) the efficiency of the expenditure process needs to be improved, and more autonomy needs to be devoted to the operational level, so as to ensure that health facilities are reimbursed in a timely fashion in order to meet insured people's health costs, in such a way as to avoid jeopardizing the financial equilibrium of these facilities.
The important budgeting challenges faced by Benin when it comes to implementing its UHC policy are also faced by many other African countries. It is important to avoid a situation in which the resources dedicated by the government to the social health insurance system are at the expense of a reduction in the financing of preventive and promotional primary healthcare services.
为实现全民健康覆盖（UHC），贝宁政府正在试点一个名为“ARCH”的强制性健康社会保险项目。
我们分析了预算数据和ARCH文件，并于2018年3月至2020年1月期间在贝宁开展了四次观察任务。结果根据公共支出管理的三个经典目标进行呈现。
贝宁政府在实施ARCH社会保险项目时面临重大预算挑战：（i）财政空间相当有限，新增税收潜力有限，且这些税收可能无法惠及ARCH资金，因此需要在不危及其他领域的情况下对财政资源进行优先排序；（ii）卫生服务采购应更具战略性，以提高配置效率和公平性；（iii）支出流程的效率需要提高，运营层面需要更多自主权，以确保卫生设施及时得到报销，从而支付参保人员的医疗费用，避免危及这些设施的财务平衡。
贝宁在实施其全民健康覆盖政策时面临的重大预算挑战，许多其他非洲国家也同样面临。必须避免政府用于社会医疗保险系统的资源以牺牲预防性和促进性初级卫生保健服务的资金为代价的情况。
