Suchergebnisse

Senegal has launched a national strategic plan to extend universal health care and reach 70% coverage by 2022. This plan has three objectives: an enhancement of free health care initiatives, a reform of compulsory health insurance, and the development of community-based health insurance. This thesis comprises four chapters focusing on free health care programs (first and second chapters) and community-based health insurance (third chapter) on the one hand and the political economy of health financing reforms on the other hand (fourth chapter). The first chapter investigates inequalities in access to free health care for children under five. The second chapter has a particular focus on non-communicable diseases and analyses ethical principles of rationing dialysis care. The third chapter analyses the role of conditional cash transfers on community-based health insurance uptake and their impact on health service utilization and direct payments. The fourth chapter is a comparative analysis of health financing reforms undertaken in ten low and middle–income countries, including Senegal. ; Le Sénégal a lancé un plan stratégique national pour étendre les soins de santé universels et atteindre une couverture de 70 % d'ici 2022. Ce plan a trois objectifs : renforcer les initiatives de gratuité des soins de santé, réformer l'assurance maladie obligatoire et développer l'assurance maladie communautaire. Cette thèse s'articule autour de quatre chapitres portant sur la gratuité des soins (premier et deuxième chapitre) et l'assurance maladie communautaire (troisième chapitre) d'une part et l'économie politique des réformes du financement de la santé d'autre part (quatrième chapitre). Le premier chapitre examine les inégalités d'accès aux soins de santé gratuits pour les enfants de moins de cinq ans. Le deuxième chapitre est particulièrement axé sur les maladies non transmissibles et analyse les principes éthiques du rationnement de la dialyse. Le troisième chapitre analyse le rôle des transferts monétaires conditionnels dans ...

Senegal has launched a national strategic plan to extend universal health care and reach 70% coverage by 2022. This plan has three objectives: an enhancement of free health care initiatives, a reform of compulsory health insurance, and the development of community-based health insurance. This thesis comprises four chapters focusing on free health care programs (first and second chapters) and community-based health insurance (third chapter) on the one hand and the political economy of health financing reforms on the other hand (fourth chapter). The first chapter investigates inequalities in access to free health care for children under five. The second chapter has a particular focus on non-communicable diseases and analyses ethical principles of rationing dialysis care. The third chapter analyses the role of conditional cash transfers on community-based health insurance uptake and their impact on health service utilization and direct payments. The fourth chapter is a comparative analysis of health financing reforms undertaken in ten low and middle–income countries, including Senegal. ; Le Sénégal a lancé un plan stratégique national pour étendre les soins de santé universels et atteindre une couverture de 70 % d'ici 2022. Ce plan a trois objectifs : renforcer les initiatives de gratuité des soins de santé, réformer l'assurance maladie obligatoire et développer l'assurance maladie communautaire. Cette thèse s'articule autour de quatre chapitres portant sur la gratuité des soins (premier et deuxième chapitre) et l'assurance maladie communautaire (troisième chapitre) d'une part et l'économie politique des réformes du financement de la santé d'autre part (quatrième chapitre). Le premier chapitre examine les inégalités d'accès aux soins de santé gratuits pour les enfants de moins de cinq ans. Le deuxième chapitre est particulièrement axé sur les maladies non transmissibles et analyse les principes éthiques du rationnement de la dialyse. Le troisième chapitre analyse le rôle des transferts monétaires conditionnels dans ...

Senegal has launched a national strategic plan to extend universal health care and reach 70% coverage by 2022. This plan has three objectives: an enhancement of free health care initiatives, a reform of compulsory health insurance, and the development of community-based health insurance. This thesis comprises four chapters focusing on free health care programs (first and second chapters) and community-based health insurance (third chapter) on the one hand and the political economy of health financing reforms on the other hand (fourth chapter). The first chapter investigates inequalities in access to free health care for children under five. The second chapter has a particular focus on non-communicable diseases and analyses ethical principles of rationing dialysis care. The third chapter analyses the role of conditional cash transfers on community-based health insurance uptake and their impact on health service utilization and direct payments. The fourth chapter is a comparative analysis of health financing reforms undertaken in ten low and middle–income countries, including Senegal. ; Le Sénégal a lancé un plan stratégique national pour étendre les soins de santé universels et atteindre une couverture de 70 % d'ici 2022. Ce plan a trois objectifs : renforcer les initiatives de gratuité des soins de santé, réformer l'assurance maladie obligatoire et développer l'assurance maladie communautaire. Cette thèse s'articule autour de quatre chapitres portant sur la gratuité des soins (premier et deuxième chapitre) et l'assurance maladie communautaire (troisième chapitre) d'une part et l'économie politique des réformes du financement de la santé d'autre part (quatrième chapitre). Le premier chapitre examine les inégalités d'accès aux soins de santé gratuits pour les enfants de moins de cinq ans. Le deuxième chapitre est particulièrement axé sur les maladies non transmissibles et analyse les principes éthiques du rationnement de la dialyse. Le troisième chapitre analyse le rôle des transferts monétaires conditionnels dans ...

International audience ; Background: Since 2012, Senegal has conducted a national program to cover renal therapy (dialysis) expenses in public hospitals and social security-approved centers. Given the increasing demand for dialysis, national guidelines recommend explicit rationing through waiting lists, and hospitals have committees to determine whom to enroll. While national recommendations are known, criteria applied in hospitals to register patients remain unclear. Our study analyzes social justice principles used to ration renal therapy in government-owned centers and highlights inequalities caused by low access to treatment. Methods: We conduct a multivariate logit regression analysis using data collected from patients in public and private centers to identify which socioeconomic or sociodemographic factors determine enrollment. Based on the average marginal effects of these factors on program enrollment, we hypothesize the justice principles applied (or not) in hospitals. Results: We find that the duration of illness, insurance distribution, age, education, and involvement in patient associations influence program access. The duration of illness is the most robust predictor regardless of socioeconomic factors, which suggests the predominant application of egalitarian principles, notably the first-come-first-served rule. However, our findings indicate that the most impoverished patients do not have access to free dialysis. Conclusions: Although the national dialysis program aims to improve access to costly life-sustaining treatment, the first-come-first-served strategy is designed to suit patients who live longer, that is, those who can seek dialysis care in a private center. The program does not address inequalities in access, especially for the most impoverished patients recently diagnosed with end-stage kidney disease.

International audience ; Background: Since 2012, Senegal has conducted a national program to cover renal therapy (dialysis) expenses in public hospitals and social security-approved centers. Given the increasing demand for dialysis, national guidelines recommend explicit rationing through waiting lists, and hospitals have committees to determine whom to enroll. While national recommendations are known, criteria applied in hospitals to register patients remain unclear. Our study analyzes social justice principles used to ration renal therapy in government-owned centers and highlights inequalities caused by low access to treatment. Methods: We conduct a multivariate logit regression analysis using data collected from patients in public and private centers to identify which socioeconomic or sociodemographic factors determine enrollment. Based on the average marginal effects of these factors on program enrollment, we hypothesize the justice principles applied (or not) in hospitals. Results: We find that the duration of illness, insurance distribution, age, education, and involvement in patient associations influence program access. The duration of illness is the most robust predictor regardless of socioeconomic factors, which suggests the predominant application of egalitarian principles, notably the first-come-first-served rule. However, our findings indicate that the most impoverished patients do not have access to free dialysis. Conclusions: Although the national dialysis program aims to improve access to costly life-sustaining treatment, the first-come-first-served strategy is designed to suit patients who live longer, that is, those who can seek dialysis care in a private center. The program does not address inequalities in access, especially for the most impoverished patients recently diagnosed with end-stage kidney disease.

International audience ; Background: Since 2012, Senegal has conducted a national program to cover renal therapy (dialysis) expenses in public hospitals and social security-approved centers. Given the increasing demand for dialysis, national guidelines recommend explicit rationing through waiting lists, and hospitals have committees to determine whom to enroll. While national recommendations are known, criteria applied in hospitals to register patients remain unclear. Our study analyzes social justice principles used to ration renal therapy in government-owned centers and highlights inequalities caused by low access to treatment. Methods: We conduct a multivariate logit regression analysis using data collected from patients in public and private centers to identify which socioeconomic or sociodemographic factors determine enrollment. Based on the average marginal effects of these factors on program enrollment, we hypothesize the justice principles applied (or not) in hospitals. Results: We find that the duration of illness, insurance distribution, age, education, and involvement in patient associations influence program access. The duration of illness is the most robust predictor regardless of socioeconomic factors, which suggests the predominant application of egalitarian principles, notably the first-come-first-served rule. However, our findings indicate that the most impoverished patients do not have access to free dialysis. Conclusions: Although the national dialysis program aims to improve access to costly life-sustaining treatment, the first-come-first-served strategy is designed to suit patients who live longer, that is, those who can seek dialysis care in a private center. The program does not address inequalities in access, especially for the most impoverished patients recently diagnosed with end-stage kidney disease.