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Biomedical subjects

Bart Criel

Publications and source records attributed to Bart Criel.

9 recordsLinked to original sources
PubMed2005

The landscape of community health insurance in India: an overview based on 10 case studies.

The Indian health system is mainly funded by out-of-pocket payments. More than 80% of health care expenditure is borne by individual households. Only about 3% of the population, mostly those in the formal sector, benefit from some form of health insurance. Several Indian Non-Governmental Organisations (NGOs) have initiated Community Health Insurance (CHI) schemes within their existing development programmes. This article describes the principal features of the design and functioning of a selection of 10 CHI schemes and presents a brief overview of the current landscape of CHI in India. The schemes explicitly target the poorest and most vulnerable households in Indian society-scheduled tribes, scheduled castes and poor women. Three CHI management models can be distinguished. The first model consists of local NGOs acting as both insurer and provider. In the second model, the NGO is the insurer but does not itself provide care, which is then purchased from a private provider. In the third model, the NGO neither does provide health care nor acts as an insurer: the NGO, on behalf of a community, links with an insurer and purchases health care from a provider. The benefit packages generally include both primary and secondary care and most of the providers are in the private sector. Most of the schemes require external resources for financial sustainability. There is currently little information on the impact of CHI schemes on the performance of local health systems and more research is warranted in that respect.

Community Networks↗
PubMed2005

[Difficulties in partnerships between health professionals and Mutual Health Organisations: the case of Maliando in Guinea-Conakry].

In 1998, a Mutual Health Organization (MHO) was created in the region of Guinee forestiere in Guinea-Conakry, West Africa, in the context of the action-research project PRIMA (Projet de recherche sur le partage du risque maladie). The aim of the project was to test whether, and under which conditions, an MHO can improve the access to quality health care. The specificity of the model is double-sided: on the one hand, the wish to integrate the organization into the local health system through a partnership between MHO and health services; on the other hand, the systematic efforts by the local research team to involve health professionals, at both the operational and managerial level of the system, in the planning and implementation of the MHO. We present the results of a study that investigates the health professionals' perception of this model. In April 2000, semi-structured interviews were held with 16 health professionals working at the different operational, managerial and administrative levels of the Guinean health system. The professionals perceive the MHO as an effective strategy to overcome financial accessibility problems. However, the interviews highlight the uncertainties and worries of the health professionals, their lack of understanding of the model, their reluctance even to fully accept it. The partnership approach was not internalized. They understand the technical instrument, but are confused and uncomfortable in their dialogue with the population. This study illustrates the difficulties of establishing a real partnership between population and health services, as well as the need for proper training and coaching of the health workers in the set-up of MHOs. The importance of this aspect was insufficiently recognized by the research team, despite its good intentions and its huge investment in organizing exchange between stakeholders. An important lesson of this experience is the need for promoters to conceive and operate MHO systems in which the expectations and fears of the health care providers are better identified and better taken into account.

Attitude of Health Personnel↗
PubMed2005

Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems.

We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.

Developing Countries↗
PubMed2004

A framework for analysing the relationship between disease control programmes and basic health care.

In this paper, we present a framework for analysing the complex relationship between disease control programmes and basic health care systems. Many of the ideas and concepts presented in this paper were developed by the staff of the Public Health Department of the Antwerp Institute of Tropical Medicine (ITM) over the last 20 years. They are thus the product of the reflection of an entire team.

Attitude of Health Personnel↗
PubMed2004

[Profile of members and non members of mutual health insurance system in Rwanda: the case of the health district of Kabutare].

The establishment of mutual health insurance systems is one of the priorities of the Rwandan government. Pilot studies have been conducted in three districts of the country. Nonetheless, after 4 years of implementation (1999-2003), the population coverage by these insurance systems remains relatively low. A cross-sectional study of 1042 households in the Kabutare health district allowed for a comparison of socio-economic and demographic variables, and the medical, surgical, gynaecological, and obstetrical history of health insurance scheme members and non-members. The results of the study demonstrate that the distribution of members and non-members is similar in terms of sex, marital status, professional status and medical history. However, larger households (more than five members) and those having a relatively higher income (more than USD 230 per annum) are more likely to be insured than other households. Members of the mutual health insurance use more the health services than non-members, spend less on health care and increasingly maintain membership. The study emphasizes the relevance to further promote mutual health insurance, but also points to the need for mechanisms to ensure financial access for the poor rural population.

Cross-Sectional Studies↗
PubMed2003

Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?

Mutual Health Organisations (MHOs) are a type of community health insurance scheme that are being developed and promoted in sub-Saharan Africa. In 1998, an MHO was organised in a rural district of Guinea to improve access to quality health care. Households paid an annual insurance fee of about US$2 per individual. Contributions were voluntary. The benefit package included free access to all first line health care services (except for a small co-payment), free paediatric care, free emergency surgical care and free obstetric care at the district hospital. Also included were part of the cost of emergency transport to the hospital. In 1998, the MHO covered 8% of the target population, but, by 1999, the subscription rate had dropped to about 6%. In March 2000, focus groups were held with members and non-members of the scheme to find out why subscription rates were so low. The research indicated that a failure to understand the scheme does not explain these low rates. On the contrary, the great majority of research subjects, members and non-members alike, acquired a very accurate understanding of the concepts and principles underlying health insurance. They value the system's re-distributive effects, which goes beyond household, next of kin or village. The participants accurately point out the sharp differences that exist between traditional financial mechanisms and the principle of health insurance, as well as the advantages and disadvantages of both. The ease with which risk-pooling is accepted as a financial mechanism which addresses specific needs demonstrates that it is not, per se, necessary to build health insurance schemes on existing or traditional systems of mutual aid. The majority of the participants consider the individual premium of 2 US dollars to be fair. There is, however, a problem of affordability for many poor and/or large families who cannot raise enough money to pay the subscription for all household members in one go. However, the main reason for the lack of interest in the scheme, is the poor quality of care offered to members of the MHO at the health centre.

Attitude to Health↗
PubMed2003

Iatrogenic poverty.

Explore the source record for details and available documents.

Developing Countries↗
PubMed2002

A plea for an initiative to strengthen family medicine in public health care services of developing countries.

An analysis of standards for the best practice of family medicine in Northern European countries provides a framework for identifying the difficulties and deficiencies in the health services of developing countries, and offers strategies and criteria for improving primary health care practice. Besides well-documented socioeconomic and political problems, poor quality of care is an important factor in the weaknesses of health services. In particular, a patient-centered perspective in primary care practice is barely reflected in the medical curriculum of developing countries. Instead, public sector general practitioners are required to concentrate on preventive programs that tackle a few well-defined diseases and that tend to be dominated by quantitative objectives, at the expense of individually tailored prevention and treatment. Reasons for this include training oriented to hospital medicine and aspects of GPs' social status and health care organization that have undermined motivation and restricted change. A range of strategies is urgently required, including training to improve both clinical skills and aspects of the doctor-patient interaction. More effective government health policies are also needed. Co-operation agencies can contribute by granting political protection to public health centers and working to orient the care delivered at this level toward patient-centered medicine.

Benchmarking↗