Sante Publique. 2021 Nov 22;Vol. 33(4):569-577. doi: 10.3917/spub.214.0569.
Some African countries have initiated mutual health insurance to improve access to health care, However, most of these initiatives have not succeeded in covering the majority of the population, nor in securing long-term loyalty. Considering that very few studies, if not none, allude to the Democratic Republic of Congo (DRC), this study aims to determine the explanatory factors for both loyalty and non-loyalty within the Kisantu health mutual insurance in DRC and to identify any specific factors in the urban-rural Congolese context.
We conducted a five-year prospective study, starting in 2013, among 320 households, selected among a cohort of 2202 households. Using the SPSS® 21.0 software, the association between loyalty and socio-demographic, socioeconomic variables and the degree of satisfaction with insurance products, as well as the motivations with respect to targeted loyalty, was sought.
Thus, we found that the sociodemographic characteristics were not associated with loyalty of payments. In contrast, statistically significant relations were found between loyalty and socioeconomic characteristics, including occupation, estimated income, as the motivations expressed with regard to loyalty (P ≤ 0.001). In a logistic regression model, occupation, estimated household income of $100 or above were twice more likely to be loyal than those with an income below $100. Protection by income has not been identified as a predictor in the studies included in our survey of the literature, but it proved to be significantly associated with loyalty in the present study. On the other hand, beyond the fidelity factors observed in this study, aspects relating to the management of mutual health insurance, which have appeared as predictors in other contexts, are not identified as such in our community.
In an urban - rural context in DR Congo where the majority of the population has a low and unstable income, and considering the low amount of contribution to the Kisantu health mutual, 4.2% of the median household income, it will be necessary therefore rethink the place of health spending in households and the extension of solidarity in the form of uniform or income-based contributions.
一些非洲国家已启动互助医疗保险以改善医疗服务的可及性。然而，这些举措大多未能成功覆盖大多数人口，也未能确保长期的忠诚度。鉴于很少有研究（如果有的话）提及刚果民主共和国（DRC），本研究旨在确定刚果民主共和国基桑图健康互助保险中忠诚度和不忠诚度的解释因素，并确定刚果城乡背景下的任何特定因素。
我们从2013年开始对2202户家庭中的320户家庭进行了为期五年的前瞻性研究。使用SPSS® 21.0软件，研究了忠诚度与社会人口统计学、社会经济变量以及对保险产品的满意度之间的关联，以及目标忠诚度的动机。
因此，我们发现社会人口统计学特征与缴费忠诚度无关。相比之下，在忠诚度与社会经济特征之间发现了具有统计学意义的关系，包括职业、估计收入，以及与忠诚度相关的动机（P≤0.001）。在逻辑回归模型中，职业、估计家庭收入100美元或以上的人比收入低于100美元的人忠诚的可能性高出两倍。在我们的文献综述中纳入的研究中，收入保障并未被确定为一个预测因素，但在本研究中它被证明与忠诚度显著相关。另一方面，除了本研究中观察到的忠诚度因素外，在其他背景下作为预测因素出现的与互助医疗保险管理相关的方面，在我们的社区中并未被确定为如此。
在刚果民主共和国的城乡背景下，大多数人口收入低且不稳定，考虑到对基桑图健康互助保险的缴费金额较低，仅为家庭收入中位数的4.2%，因此有必要重新思考家庭健康支出的地位以及以统一或基于收入的缴费形式扩大团结互助。
