Institute of Statistical, Social and Economic Research (ISSER), University of Ghana , Accra, Ghana.
Centre for Global Health Security, Chatham House, The Royal Institute of International Affairs , London, UK.
Glob Health Action. 2021 Jan 1;14(1):1868054. doi: 10.1080/16549716.2020.1868054.
: Universal Health Coverage has become a political priority for many African countries yet there are clear challenges in achieving this goal. Though social health insurance is considered a mechanism for providing financial protection, less well documented in the literature is evidence from countries in Africa who are at various stages of adopting this financing strategy as a way to improve health insurance coverage for their populations. : The study investigates whether social health insurance schemes are effectively and efficiently covering all groups. The objective is to provide evidence of how these schemes have been implemented and whether the fundamental goals are met. The selected countries are Ghana, Rwanda, Tanzania, Kenya and Ethiopia. The study draws lessons from the literature about how policy tools can be used to reduce financial barriers whilst ensuring a broad geographic coverage in Africa. : The study relies primarily on a review of literature, both documented and grey matter, which include key documents such as government health policy documents, strategic plans, health financing policy documents, Universal Health Coverage policy documents, published literature, unpublished documents, media reports and National Health Accounts reports. : The results show that each of the selected countries relies on a plurality of health insurance schemes with each targeting different groups. Additionally, many of the Social Health Insurance programs start by covering the formal sector first, with the hope of covering other groups in the informal sector at a later stage. Health insurance coverage for poor groups is very low, with targeting mechanisms to cover the poor in the form of exemptions and waivers achieving no desirable results. : The ability for Social Health Insurance programs to cover all groups has been limited in the selected countries. Hence, relying solely on social health insurance schemes to achieve Universal Health Coverage may not be plausible in Africa. Also, highly fragmented risk pools impede efforts to widen the insurance pools and promote cross-subsidies.
全民健康覆盖已成为许多非洲国家的政治优先事项，但实现这一目标仍面临明显挑战。尽管社会医疗保险被认为是提供财务保障的一种机制，但在文献中，有关非洲国家在采用这种融资策略以提高其人口医疗保险覆盖范围方面的证据却鲜为人知，这些国家处于不同的实施阶段。
本研究调查了社会医疗保险计划是否有效地覆盖了所有群体。其目的是提供证据，说明这些计划是如何实施的，以及基本目标是否得到了实现。选定的国家是加纳、卢旺达、坦桑尼亚、肯尼亚和埃塞俄比亚。本研究借鉴了文献中的经验，了解政策工具如何用于减少财政障碍，同时确保在非洲实现广泛的地域覆盖。
本研究主要依赖于对文献的回顾，包括已记录和灰色文献，其中包括政府卫生政策文件、战略计划、卫生融资政策文件、全民健康覆盖政策文件、已发表的文献、未发表的文件、媒体报道和国家卫生账户报告等关键文件。
结果表明，选定的每个国家都依赖于多种医疗保险计划，每种计划都针对不同的群体。此外，许多社会医疗保险计划首先覆盖正规部门，希望在稍后阶段覆盖非正规部门的其他群体。贫困群体的医疗保险覆盖率非常低，针对贫困群体的目标机制（豁免和豁免）并未取得理想的效果。
在选定的国家，社会医疗保险计划覆盖所有群体的能力有限。因此，仅依靠社会医疗保险计划实现全民健康覆盖在非洲可能是不可行的。此外，高度分散的风险池阻碍了扩大保险池和促进交叉补贴的努力。
