title: Design, implementation, and evaluation of a community financing scheme for hospital care in developing countries: a pre-paid health plan in the Bwamanda health zone, Zaire.
abstract: Unless scarce resources can be mobilized and used efficiently, health for all by the year 2000 will remain a vain attempt. Innovative financing schemes exploring increased cost recovery from the users of the health system are explored throughout the world. In Bwamanda, Zaire, a community financing scheme for hospital care was developed through the application of operations research. A preference heuristic with considerable involvement of health providers and the community was used to identify the type of financing scheme and resulted in a pre-paid health plan, while a mathematical model was developed to determine the premiums to charge. The implementation of the health plant is briefly described. An evaluation of the effects of the pre-paid plan on the accessibility and equity of health care, as well as on the financial sustainability of the hospital, is presented and discussed: a steadily increasing membership of the health plan illustrates its appropriateness, while a doubling of the cost recovery of the hospital's operating costs after two years seems promising; the hospitalization rate of members of the health plan was significantly higher than for non-members. These findings suggest that a health zone may be an appropriate level for the organization of a regional pre-paid health plan. Problems of equity, full cost recovery, and replicability of the financing scheme are discussed.
authors.affiliation: Centre de Developpement Integral, CDI Bwamanda, Gemena, Zaire.
authors.forename: F
authors.initials: F
authors.lastname: Moens
mesh_terms: D003153:Community Health Services / Q000191:economics*; D015023:Democratic Republic of the Congo; D003906:Developing Countries; D004469:Economics, Hospital; D006279:Health Maintenance Organizations / Q000191:economics*; D006285:Health Planning / Q000191:economics*; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D015233:Models, Statistical; D009874:Operations Research; D011907:Rate Setting and Review; D012423:Rural Health; D012959:Socioeconomic Factors