哥伦比亚的全民健康覆盖计划招募了98%的人口,从而改善财政保护和健康结果。1991年《哥伦比亚宪法》规定了参与医疗保健组织的权利。一种参与机制是法律和监管规定,公民可以组成用户协会。这项研究考察了健康保险用户协会的功能及其对公民赋权和健康保险响应能力的影响。
混合方法研究包括文件审查(n=72),受益人调查(n=1311),对用户协会成员的调查(n=27),以及采访(n=19),与用户协会成员的焦点小组讨论(n=6)和利益相关者协商(n=6),政府官员,和保险公司的代表,制药业,和患者协会。分析使用内容-流程-上下文框架来了解用户关联如何根据策略内容进行设计。它们实际上是如何工作的,公众意识,成员,和有效性,和上下文的影响。
哥伦比亚的用户协会有权代表公民的利益,能够参与保险公司的决策,“保护用户”并监督优质服务。保险公司必须确保其登记者创建用户协会,但不需要提供资源来支持他们的工作。因此,我们发现用户协会已经在全国范围内形成,但是公众普遍不知道它们的存在。许多协会很弱,被动或完全不活跃。有限的市场竞争和有关用户协会的无牙政策使保险公司对社区参与无动于衷。
目前,该倡议的意识低和参与程度低,很难导致有能力的参保人和反应更灵敏的健康保险计划。然而,大多数利益相关者都重视参与的空间,并且仍然看到该计划的潜力。这保证了一系列政策建议,以加强用户协会,并真正使他们能够实现变革。
Colombia\'s universal health coverage programme has enrolled 98% of the population, thereby improving financial protection and health outcomes. The right to participate in the organisation of healthcare is enshrined in the 1991 Colombian Constitution. One participatory mechanism is the legal and regulatory provision that citizens can form user associations. This study examines the functionality of health insurance user associations and their influence on citizen empowerment and health insurance responsiveness.
The mixed methods study includes document review (n=72), a survey of beneficiaries (n=1311), a survey of user associations members (n=27), as well as interviews (n=19), focus group discussions (n=6) and stakeholder consultations (n=6) with user association members, government officials, and representatives from insurers, the pharmaceutical industry, and patient associations. Analysis used a content-process-context framework to understand how user associations are designed to work according to policy content, how they actually work in terms of coverage, public awareness, membership, and effectiveness, and contextual influences.
Colombia\'s user associations have a mandate to represent citizens\' interests, enable participation in insurer decision-making, \'defend users\' and oversee quality services. Insurers are mandated to ensure their enrollees create user associations, but are not required to provide resources to support their work. Thus, we found that user associations had been formed throughout the country, but the public was widely unaware of their existence. Many associations were weak, passive or entirely inactive. Limited market competition and toothless policies about user associations made insurers indifferent to community involvement.
Currently, the initiative suffers from low awareness and low participation levels that can hardly lead to empowered enrollees and more responsive health insurance programmes. Yet, most stakeholders value the space to participate and still see potential in the initiative. This warrants a range of policy recommendations to strengthen user associations and truly enable them to effect change.