Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria.
Medicine (Baltimore). 2024 Mar 15;103(11):e37488. doi: 10.1097/MD.0000000000037488.
Surgical access remains a pressing public health concern in African nations, with a substantial portion of the population facing challenges in obtaining safe, timely, and affordable surgical care. This paper delves into the impact of health insurance schemes on surgical accessibility in Africa, exploring the barriers, challenges, and future directions. It highlights how high out-of-pocket costs, reliance on traditional healing practices, and inadequate surgical infrastructure hinder surgical utilization. Financing mechanisms often need to be more effective, and health insurance programs face resistance within the informal sector. Additionally, coverage of the poor remains a fundamental challenge, with geographical and accessibility barriers compounding the issue. Government policies, often marked by inconsistency and insufficient allocation of resources, create further obstacles. However, strategic purchasing and fund integration offer avenues for improving the efficiency of health insurance programs. The paper concludes by offering policy recommendations, emphasizing the importance of inclusive policies, streamlined financing mechanisms, coverage expansion, and enhanced strategic purchasing to bridge the surgical access gap in Africa. Decoupling entitlement from the payment of contributions, broadening the scope of coverage for outpatient medicines and related expenses, and enhancing safeguards against overall costs and charges, especially for individuals with lower incomes. Ultimately, by addressing these challenges and harnessing the potential of health insurance schemes, the continent can move closer to achieving universal surgical care and improving the well-being of its people.
在非洲国家，手术通道仍然是一个紧迫的公共卫生问题，很大一部分人口在获得安全、及时和负担得起的手术护理方面面临挑战。本文深入探讨了医疗保险计划对非洲手术可及性的影响，探讨了其中的障碍、挑战和未来方向。它强调了高自付费用、对传统治疗方法的依赖以及手术基础设施不足如何阻碍了手术的利用。融资机制往往需要更加有效，医疗保险计划在非正规部门面临阻力。此外，对贫困人口的覆盖仍然是一个基本挑战，地理和可达性障碍使问题更加复杂。政府政策往往缺乏一致性，资源分配不足，这进一步造成了障碍。然而，战略采购和资金整合为改善医疗保险计划的效率提供了途径。本文最后提出了政策建议，强调了包容性政策、简化融资机制、扩大覆盖范围、以及加强战略采购的重要性，以缩小非洲手术可及性差距。取消与缴费挂钩的待遇，扩大门诊药品和相关费用的覆盖范围，并加强对总费用和收费的保障，特别是对低收入者。最终，通过应对这些挑战并利用医疗保险计划的潜力，非洲大陆可以更接近实现全民手术护理，改善人民的福祉。
