دورية أكاديمية
أعرض في EDS

Making health insurance responsive to citizens: the management of members' complaints by mutual health organisations in Kinshasa, Democratic Republic of Congo.

التفاصيل البيبلوغرافية
العنوان: Making health insurance responsive to citizens: the management of members' complaints by mutual health organisations in Kinshasa, Democratic Republic of Congo.
المؤلفون: Ngo Bebe D; School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the) ngobebed@gmail.com., Kwilu FN; School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)., Mavila A; School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)., Mafuta EM; School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)., Mangalu JM; Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)., Jessani NS; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.; Department of GlobalHealth, Stellenbosch University, Stellenbosch, South Africa., Criel B; Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
المصدر: BMJ global health [BMJ Glob Health] 2023 Sep; Vol. 7 (Suppl 6).
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101685275 Publication Model: Print Cited Medium: Print ISSN: 2059-7908 (Print) Linking ISSN: 20597908 NLM ISO Abbreviation: BMJ Glob Health Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group Ltd, [2016]-
مواضيع طبية MeSH: Insurance, Health* , Communication*, Humans ; Democratic Republic of the Congo ; Focus Groups ; Health Expenditures
مستخلص: Introduction: In moving towards universal health coverage, a number of low-income and middle-income countries have adopted community-based health insurance (CBHI) as a means to reduce both the inequity in healthcare access and the burden of catastrophic health expenditures linked to user fees. However, organisations managing CBHIs face many challenges, including a poor relationship with their members. In the Democratic Republic of the Congo, CBHI schemes are managed by mutual health organisations (MHOs) and are in the process of enhancing their accountability and responsiveness to members' needs and expectations. This study assessed how MHOs have managed member complaints and their performance in grievance redressal.
Methods: Using a sequential mixed-methods approach, we drew insights from four types of sources: review of approximately 50 relevant documents, 25 in-depth interviews (IDIs) with CBHI managers, 9 IDIs with health facility managers, 1063 surveys of MHO members and 15 focus group discussions (FGDs) comprising an additional 153 MHO members. MHO members in this study belonged to three different MHOs (Lisanga, La Borne and Mutuelle de santé des Enseignants de l'Enseignement Primaire, Secondaire et Professionnel) in the capital, Kinshasa.
Results: The document review showed that there were no clear administrative processes for the implementation of the grievance redressal arrangement measures resulting in low member awareness of these measures. These results were confirmed by the IDIs. Of 1044 members surveyed, only 240 (23%) were aware of the complaint measures, and 201 (84%) of these declared they had used the measures at some point in time, 181/201 (90%) users who had used the measures declared being satisfied with the response provided. The FGDs confirmed that most members lack knowledge on the grievance redressal procedures, but those who were aware had made use of them and were often satisfied with the response provided.
Conclusion: MHOs should urgently improve communication with their members on the range of redressal measures put in place to address grievances. Attention should be given to properly monitor existing arrangements, and possibly adapt them with well-documented and communicated standard operating procedures.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
References: BMC Health Serv Res. 2018 Jun 15;18(1):451. (PMID: 29903000)
Trop Med Int Health. 2005 Aug;10(8):799-811. (PMID: 16045467)
Trop Med Int Health. 1997 Jul;2(7):654-72. (PMID: 9270733)
Health Policy Plan. 2015 Dec;30(10):1296-306. (PMID: 25616670)
Health Policy Plan. 2004 Nov;19(6):371-9. (PMID: 15459162)
PLoS One. 2021 Jan 25;16(1):e0245952. (PMID: 33493240)
BMC Res Notes. 2016 Aug 30;9(1):424. (PMID: 27576468)
Health Policy Plan. 2017 Nov 1;32(9):1337-1344. (PMID: 28981658)
Soc Sci Med. 2014 Apr;107:78-88. (PMID: 24607669)
Int J Gynaecol Obstet. 2016 Dec;135(3):345-357. (PMID: 27802869)
Clinicoecon Outcomes Res. 2021 May 03;13:343-348. (PMID: 33976557)
Health Policy Plan. 2016 Nov;31(9):1143-51. (PMID: 26758540)
Glob Health Action. 2013 Dec 06;6:20791. (PMID: 24314344)
Clinicoecon Outcomes Res. 2021 May 11;13:359-375. (PMID: 34007193)
Health Policy Plan. 2012 Oct;27(7):541-54. (PMID: 22279082)
PLoS One. 2019 May 13;14(5):e0216411. (PMID: 31083706)
BMC Health Serv Res. 2020 Jul 17;20(1):662. (PMID: 32680506)
BMC Health Serv Res. 2012 Oct 19;12:363. (PMID: 23082967)
Trop Med Int Health. 2009 May;14(5):586-96. (PMID: 19389037)
Bull World Health Organ. 2000;78(6):811-20. (PMID: 10916918)
PLoS One. 2022 Aug 18;17(8):e0272959. (PMID: 35980888)
PLoS One. 2020 Apr 16;15(4):e0231660. (PMID: 32298341)
Bull World Health Organ. 2010 Jun;88(6):402. (PMID: 20539847)
Int J Equity Health. 2018 Jan 29;17(1):13. (PMID: 29378585)
BMC Health Serv Res. 2017 Jan 25;17(1):81. (PMID: 28122552)
Bull World Health Organ. 2012 Sep 1;90(9):685-92. (PMID: 22984313)
Glob Health Action. 2015 Jan 05;8:25480. (PMID: 25563450)
فهرسة مساهمة: Keywords: Health economics; Health insurance; Health policy; Public Health
تواريخ الأحداث: Date Created: 20230904 Date Completed: 20230906 Latest Revision: 20230924
رمز التحديث: 20230924
مُعرف محوري في PubMed: PMC10514665
DOI: 10.1136/bmjgh-2022-011438
PMID: 37666577
قاعدة البيانات: MEDLINE
الوصف
تدمد:2059-7908
DOI:10.1136/bmjgh-2022-011438