Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil 4123, Switzerland.
University of Basel, Petersplatz 1, Basel 4001, Switzerland.
Health Policy Plan. 2023 Jun 16;38(6):681-688. doi: 10.1093/heapol/czad022.
Improving the quality of care is essential for progress towards universal health coverage. Health financing arrangements offer opportunities for governments to incentivize and reward improvements in the quality of care provided. This study examines the extent to which the purchasing arrangements established within Zambia's new National Health Insurance can improve equitable access to high-quality care. We adopt the Strategic Purchasing Progress and the Lancet Commission for High-Quality Health Systems frameworks to critically examine the broader health system and the purchasing dimensions of this insurance scheme and its implications for quality care. We reviewed policy documents and conducted 31 key-informant interviews with stakeholders at national, subnational and health facility levels. We find that the new health insurance could boost financial resources in higher levels of care, improve access to high-cost interventions, improve care experiences for its beneficiaries and integrate the public and private sectors. Our findings also suggest that health insurance will likely improve some aspects of structural quality but may not be able to influence process and outcome measures of quality. It is also not clear if health insurance will improve the efficiency of service delivery and whether the benefits realized will be distributed equitably. These potential limitations are attributable to the existing governance and financial challenges, low investments in primary care and shortcomings in the design and implementation of the purchasing arrangements of health insurance. Although Zambia has made progress in a short span, there is a need to improve its provider payment mechanisms, and monitoring and accounting for a higher quality of care.
提高医疗服务质量对于实现全民健康覆盖至关重要。卫生筹资安排为政府提供了激励和奖励提供医疗服务质量改进的机会。本研究考察了赞比亚新的国家健康保险中建立的采购安排在多大程度上可以改善公平获得高质量医疗服务的机会。我们采用了战略采购进展和 Lancet 高质量卫生系统委员会的框架，批判性地审查了更广泛的卫生系统以及该保险计划的采购维度及其对高质量医疗服务的影响。我们审查了政策文件，并在国家、次国家和卫生机构各级与利益攸关方进行了 31 次重点访谈。我们发现，新的健康保险可以增加较高层次护理的财政资源，改善获得高成本干预措施的机会，改善受益人的护理体验，并整合公共和私营部门。我们的研究结果还表明，健康保险可能会改善结构质量的某些方面，但可能无法影响质量的过程和结果措施。也不清楚健康保险是否会提高服务提供的效率，以及所实现的利益是否会公平分配。这些潜在的局限性归因于现有的治理和财务挑战、对初级保健的低投资以及健康保险采购安排的设计和实施中的缺陷。尽管赞比亚在短时间内取得了进展，但仍需要改进其提供者支付机制，并对更高质量的医疗服务进行监测和核算。
