Criel B, Van Dormael M, Lefèvre P, Menase U, Van Lerberghe W
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Trop Med Int Health. 1998 Aug;3(8):640-53. doi: 10.1046/j.1365-3156.1998.00286.x.
An insurance scheme covering hospital care in the rural district of Bwamanda in the North-west of the Democratic Republic of Congo, which locally is called the mutuelle, was conceived and developed in 1986 on the initiative of Belgian doctors working in the district under the arrangements for bilateral Belgian aid. After more than 10 years of operation the Bwamanda scheme has achieved a high rate of coverage, contributed to a significant improvement in access to hospital-based in-patient care, and constitutes a stable source of revenue for the operation of the hospital. We present an investigation conducted through focus groups in 1996 of the population's social perceptions of this risk-sharing scheme to identify ways to improve it. The findings pertain to the reasons for people to subscribe to the scheme; to the perception of its redistribution effects; to people's frustrations and questions; and finally to the relationships between the insurance scheme and traditional mutual aid arrangements. The difference between a hospital insurance scheme (a logic of contract) and the traditional systems of mutual aid (a logic of alliance) is highlighted, and the impact of the hospital insurance scheme on social inequalities is discussed. The implications of this study on the management of the Bwamanda health insurance scheme are reviewed, and this study may be useful to health managers working in similar contexts.
1986年，在比利时双边援助安排下，在刚果民主共和国西北部布瓦曼达农村地区开展工作的比利时医生倡议并制定了一项涵盖医院护理的保险计划，当地称为互助会。经过10多年的运作，布瓦曼达计划实现了高覆盖率，为大幅改善住院护理服务的可及性做出了贡献，并成为医院运营的稳定收入来源。我们展示了1996年通过焦点小组对该风险分担计划进行的一项调查，以确定改进该计划的方法。调查结果涉及人们加入该计划的原因；对其再分配效果的看法；人们的挫折感和疑问；最后是保险计划与传统互助安排之间的关系。文中强调了医院保险计划（契约逻辑）与传统互助系统（联盟逻辑）之间的差异，并讨论了医院保险计划对社会不平等的影响。文中回顾了本研究对布瓦曼达健康保险计划管理的启示，本研究可能对在类似环境中工作的卫生管理人员有用。
