保健核查对加快布隆迪全民健康覆盖实施的重要性和局限性

Alexandre Nimubona
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摘要

作为实现全民健康覆盖的途径之一,为卫生设施提供资金的卫生保健核查正受到越来越多的关注。验证是确保向用户提供的医疗保健服务满足预定的计费和支付标准的过程。本文的目的是研究布隆迪卫生系统在卫生保健核查为卫生设施融资方面的做法,以确定全民健康覆盖实施方面的优势、局限性和潜在解决方案。方法:采用批判性案例研究作为总体方法方法,并采用叙述性回顾设计来得出有关案例的结论。结果:结果表明,验证有助于可视化该国在实施全民健康覆盖方面的进展水平。虽然它允许支付高质量的医疗保健服务,从而提高了医疗保健服务报销的效率,但事实证明,在医疗保健服务的需求和供应方面,核查是一种抵御欺诈、滥用和浪费的功能。然而,核查在服务和人口目标以及核查小组的技术有效性方面有一些限制。确定的缓解这些限制的最重要方法是将医疗保健服务的需求和供应分开。结论:需要更多的研究投资,以认识到验证是全民健康覆盖实施卫生筹资的一个重要子功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Importance and Limitations of Healthcare Verification for Accelerating Implementation of Universal Health Coverage in Burundi
Introduction: As one of the avenues for implementing universal health coverage, healthcare verification for financing health facilities is receiving increased attention. Verification is the process of ensuring that healthcare services provided to users meet the predetermined criteria for billing and payment. The objective of this article was to examine the Burundi health system practices in healthcare verification for financing health facilities in order to identify strengths, limitations, and potential solutions for more advancement in universal health coverage implementation. Methods: A critical case study was used as the overall methodological approach and a narrative review design to draw conclusions about the case. Results: The results show that verification helps visualise the country’s level of progression in implementation of universal health coverage. While it promotes efficiency in healthcare service reimbursement by allowing payment for quality care services, verification has proven to be a resilient function to fraud, abuse, and waste in the demand for, and supply of, healthcare services. However, verification has some limitations in terms of services and population targeting, and technical effectiveness of the verification team. The most important way identified for alleviating these limitations is to separate the demand for, and supply of, healthcare services. Conclusions: More investments in research are required to recognise verification as an essential sub-function of health financing for universal health coverage implementation.
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