地域レベルでの保健医療費利用者負担制度の実施に関する考察

―イエメンにおける援助機関のプロジェクト事例から―

抄録

Health care financing has been a critical concern, especially in developing countries with large populations and disease burden. Medical services have been provided free of charge, however, it is impossible to sustain financing. In the Republic of Yemen, the government is planning to introduce use fees for health services (Yemen Cost Sharing Program) at the community level based on community ownership.

Several donors have previously experienced this scheme in their project cites. These cases were surveyed and compared. These experiences showed difficulties in management and getting the objectives. Main concerns were such as setting up ‘community committee’, approval from medical staffs, and quality improvement of medical services. Results revealed the risk and harm of the introduction of this scheme by reducing in supply and accessibility of health care services.

If user-fee schemes are introduced as Yemen policy, these points should be considered;

1) Formation of community committees that is to influence the needs and opinions of community peoples

2) Support and monitoring for activating community committee

3) To promote peoples' understanding and participation through training and advocacy

4) Transparency of collected money and adequate reinvestment by peoples' request

5) Monitoring and adjusting conflicts on interests especially between private and public health sector in services provision, and community committee and medical provider

6) Support for the improvement of the quality of medical services especially at the first stage.