肯尼亚西部农村地区公民参与国家医疗保险的情况。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Beryl Maritim, Adam D Koon, Allan Kimaina, Jane Goudge
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引用次数: 0

摘要

有效的公民参与对社会医疗保险的成功至关重要,然而,人们对低收入和中等收入国家公民参与的机制知之甚少。本文探讨了国家医疗保险基金(NHIF)的公民参与工作及其对肯尼亚西部农村非正式工人家庭医疗保险覆盖率的影响。我们的研究采用了混合方法设计,包括横断面家庭调查(1773 人)、深度家庭访谈(36 人)、与社区利益相关者进行的 6 次焦点小组讨论,以及与决策者进行的关键信息提供者访谈(11 人)。调查结果显示,国家健康保险基金得到了广泛认可,但对其服务、反馈机制和问责制度的了解有限。受访者中参加国家健康保险基金的比例较低(11%)。大多数受访者(63%)了解国家医疗保险基金,但只有 32% 的受访者了解一揽子福利计划。与未参加国家医疗保险基金的受访者(28%)相比,参加国家医疗保险基金的受访者对一揽子福利的了解程度较高(60%)。只有 48% 的投保人对 NHIF 的福利计划表示满意。几乎所有受访者(93%)都不知道向 NHIF 提供反馈或提出投诉的机制。在了解情况的受访者中,大多数(57%)提到前往 NHIF 办事处寻求帮助。大多数受访者(97%)对 NHIF 的绩效报告机制缺乏了解,并表示希望学习。媒体对 NHIF 业绩的负面报道削弱了人们对其的信任,导致参保率低和成员流失。我们的研究强调了优先考虑公民参与以解决低注册率和自然减员率问题的紧迫性。我们建议对当前的公民参与程序进行评估,以加强公民问责制并将他们的意见纳入其中。同样重要的是,需要培养医疗机构工作人员处理 NHIF 客户的能力,以提供信息和处理投诉。透明度和信息的可获取性,包括绩效报告的共享,将促进对保险公司的信任。最后,针对不同受众,尤其是农村非正规劳动者的标准化信息传递和翻译至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Citizen engagement in national health insurance in rural western Kenya.

Effective citizen engagement is crucial for the success of social health insurance, yet little is known about the mechanisms used to involve citizens in low- and middle-income countries. This paper explores citizen engagement efforts by the National Health Insurance Fund (NHIF) and their impact on health insurance coverage within rural informal worker households in western Kenya. Our study employed a mixed methods design, including a cross-sectional household survey (n = 1773), in-depth household interviews (n = 36), six focus group discussions with community stakeholders and key informant interviews (n = 11) with policymakers. The findings reveal that NHIF is widely recognized, but knowledge of its services, feedback mechanisms and accountability systems is limited. NHIF enrolment among respondents is low (11%). The majority (63%) are aware of NHIF, but only 32% know about the benefit package. There was higher awareness of the benefit package (60%) among those with NHIF compared to those without (28%). Satisfaction with the NHIF benefit package was expressed by only 48% of the insured. Nearly all respondents (93%) are unaware of mechanisms to provide feedback or raise complaints with NHIF. Of those who are aware, the majority (57%) mention visiting NHIF offices for assistance. Most respondents (97%) lack awareness of NHIF's performance reporting mechanisms and express a desire to learn. Negative media reports about NHIF's performance erode trust, contributing to low enrolment and member attrition. Our study underscores the urgency of prioritizing citizen engagement to address low enrolment and attrition rates. We recommend evaluating current citizen engagement procedures to enhance citizen accountability and incorporate their voices. Equally important is the need to build the capacity of health facility staff handling NHIF clients in providing information and addressing complaints. Transparency and information accessibility, including the sharing of performance reports, will foster trust in the insurer. Lastly, standardizing messaging and translations for diverse audiences, particularly rural informal workers, is crucial.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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