健康保险与卫生系统（不）响应性：坦桑尼亚农村老年人的定性研究。
Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania.
机构信息
Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
Epidemiology and Global Health, Umeå University, Umeå, Sweden.
出版信息
BMC Health Serv Res. 2021 Oct 22;21(1):1140. doi: 10.1186/s12913-021-07144-2.
BACKGROUND
Health insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania.
METHOD
An explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems' responsiveness. Qualitative content analysis was used to analyse the data.
RESULTS
Elderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare.
CONCLUSIONS
The national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients´ communication skills and care rights is highly recommended.
背景
健康保险（HI）已越来越多地被视为在中低收入国家促进获得医疗保健的一种机制。然而，健康保险的参保人，尤其是撒哈拉以南非洲的参保人，报告称其在卫生系统中的响应度较低。本研究旨在从坦桑尼亚农村地区参保和未参保的老年人的角度探讨他们对医疗服务的体验和看法。
方法
在坦桑尼亚中西部的伊古恩加和恩扎加农村地区进行了一项解释性定性研究。进行了 8 次焦点小组讨论，参与者是 78 名有保险和无保险的 60 岁及以上的老年男女，他们是根据过去 12 个月内使用过医疗服务而被特意挑选出来的。访谈问题的灵感来自于卫生系统响应性的各个领域。采用定性内容分析法对数据进行分析。
结果
老年参与者认为 HI 促进了他们获得医疗保健的机会，并保护他们免受某些费用的影响。但他们也抱怨说，由于服务福利有限，以及计划内服务的使用受限，HI 未能提供公平的获取途径。尽管老年人在响应性的各个领域的观点差异很大，但参保人普遍对他们的医疗保健表示不满。
结论
需要重新审视国家健康保险政策，以改善其实施情况并扩大服务覆盖范围。需要做出战略决策来改善医疗保健基础设施，增加医疗保健工作者的数量，确保医疗中心提供药品和检测设施，并减少与 HI 相关的冗长行政程序。强烈建议为医疗保健工作者制定一项注重患者沟通技巧和护理权利的持续培训计划。
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