唯一标识符是管理全民医保的重要工具之一,摩洛哥的案例

IF 0.3 4区 医学 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Sante Publique Pub Date : 2024-04-05 DOI:10.3917/spub.241.0121
Abdellatif Moustatraf, Fatima Touhami
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引用次数: 0

摘要

导言摩洛哥正在开展多项行动,以普及基本强制性医疗保险(CHI)。管理这一项目需要协调、信息共享以及所有参与者对额外覆盖 2200 万人这一目标的承诺。研究目的研究目的是分析现有情况和实施统一登记系统的可行性,并描述统一登记系统对扩大 CHI 潜在的积极影响。它借鉴了法律框架、所有可获得的文件和数字,并在现有文献的支持下进行了分析解读。结果表明,由于缺乏适当的法律依据,各管理机构都有自己的登记制度。缺乏统一的制度造成了一些制约因素。这些制约因素包括:(i) 计划之间或计划内部的流动性,这种流动性会导致重新登 记,因而无法顺利开展工作;(ii) 由于反欺诈行动不够充分和犹豫不决,对双重福利申请的监 督不足,不止一个计划存在这种情况;(iii) 可靠数据的共享和使用,这妨碍了决策、评估和监 督工作。结论:必须通过法律文本,为建立一个统一的系统奠定基础,并制定条例,使所有 利益相关者都能参与进来,从而有效和高效地指导共同健康保险的推广工作。
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L’identifiant unique comme un des instruments indispensables au pilotage de la couverture sanitaire universelle, le cas du Maroc
INTRODUCTION Morocco is carrying out several actions to generalize basic compulsory health insurance (CHI). Managing this project requires coordination, information sharing, and the commitment of all actors to the goal of covering an additional 22 million people. One of the key factors for achieving this objective is the implementation of a unified registration system. PURPOSE OF THE RESEARCH The aim is to analyze the existing situation and the feasibility of implementing a unified registration system, and to describe the potential positive impact of the latter on the extension of CHI. RESULTS This work is based on a diagnosis of the current situation. It draws on the legal framework, all available documents and figures, and on an analytical reading supported by existing literature. It reveals that due to the inadequacy or even the absence of an appropriate legal basis, each managing body has its own registration system. The lack of a unified system has given rise to a number of constraints. These concern, among other things: (i) mobility between or within schemes, which does not operate smoothly because it leads to re-registration (ii) inadequate monitoring of double benefit claims, which is the case for more than one scheme, due to insufficient and hesitant anti-fraud action (iii) the sharing and use of reliable data, which hinders decision making, evaluation, and monitoring. CONCLUSIONS It is essential to adopt legal texts that will provide the basis for a unified system with regulations enabling the participation of all stakeholders, with the aim of steering the roll-out of CHI effectively and efficiently.
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来源期刊
Sante Publique
Sante Publique PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
0.40
自引率
33.30%
发文量
252
审稿时长
>12 weeks
期刊介绍: La revue Santé Publique s’adresse à l’ensemble des acteurs de santé publique qu’ils soient décideurs, professionnels de santé, acteurs de terrain, chercheurs, enseignants ou formateurs, etc. Elle publie des travaux de recherche, des évaluations, des analyses d’action, des réflexions sur des interventions de santé, des opinions, relevant des champs de la santé publique et de l’analyse des services de soins, des sciences sociales et de l’action sociale. Santé publique est une revue à comité de lecture, multidisciplinaire et généraliste, qui publie sur l’ensemble des thèmes de la santé publique parmi lesquels : accès et recours aux soins, déterminants et inégalités sociales de santé, prévention, éducation pour la santé, promotion de la santé, organisation des soins, environnement, formation des professionnels de santé, nutrition, politiques de santé, pratiques professionnelles, qualité des soins, gestion des risques sanitaires, représentation et santé perçue, santé scolaire, santé et travail, systèmes de santé, systèmes d’information, veille sanitaire, déterminants de la consommation de soins, organisation et économie des différents secteurs de production de soins (hôpital, médicament, etc.), évaluation médico-économique d’activités de soins ou de prévention et de programmes de santé, planification des ressources, politiques de régulation et de financement, etc
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