南非豪登省家庭医生对国民健康保险的看法。

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL
Shane D Murphy, Klaus Von Pressentin, Shabir A Moosa
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引用次数: 0

摘要

背景: 全民医保(UHC)在改善国民健康状况的同时,也解决了在获得优质医疗服务方面存在的社会不平等问题。在南非,地区卫生系统(DHS)是通过国家医疗保险(NHI)计划成功实现全民医保的关键。家庭医生(FPs)作为初级保健的倡导者,对地区卫生系统的运作和国家医疗保险(NHI)的实施至关重要: 这是一项定性探索性研究,采用半结构化访谈的方式,探讨家庭医生对其所在地区的国家健康保险政策和实施情况的看法和参与情况。通过有目的的抽样,纳入了 10 名计生协员: 大多数受访的计生协都没有参与政策制定或战略规划。国家医疗保险法案被视为一种缺乏明确计划的理论思想。家庭医生对政府机构中的腐败现象表达了一些担忧,这些腐败现象可能会在国家医疗保险的实施过程中显现出来。家庭医生认为他们在地区机构中得不到支持,也没有权力参与推广战略。由于家庭医生培训计划的设计以及他们在初级医疗层面的经验,他们能够为医疗系统面临的挑战提供有用的解决方案: 结论:南非的医疗保健管理仍由国家和省级机构负责。要想成功实施 NHI,就必须将管理权下放到 DHS。需要让初级保健人员参与到国家医疗保险战略中来,将计划转化为初级保健层面的可行目标:本研究强调,在下放的人口与健康调查管理层面上,有必要让家庭保健人员作为主要行动者参与到国家健康保险战略的实施中来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The views of family physicians on National Health Insurance in Gauteng Province, South Africa.

Background:  Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI.

Methods:  This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling.

Results:  Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level.

Conclusion:  Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.

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来源期刊
South African Family Practice
South African Family Practice MEDICINE, GENERAL & INTERNAL-
CiteScore
1.50
自引率
20.00%
发文量
79
审稿时长
25 weeks
期刊介绍: South African Family Practice (SAFP) is a peer-reviewed scientific journal, which strives to provide primary care physicians and researchers with a broad range of scholarly work in the disciplines of Family Medicine, Primary Health Care, Rural Medicine, District Health and other related fields. SAFP publishes original research, clinical reviews, and pertinent commentary that advance the knowledge base of these disciplines. The content of SAFP is designed to reflect and support further development of the broad basis of these disciplines through original research and critical review of evidence in important clinical areas; as well as to provide practitioners with continuing professional development material.
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