Background In its pursuance of universal health coverage (UHC), the government of Benin is piloting a project of mandatory social insurance for health entitled “ARCH”. Methods We analysed budget data and ARCH documents, and conducted four observation missions in Benin between March 2018 and January 2020. Results are presented in terms of the three classical objectives of public expenditure management. Results The government of Benin faces important budgeting challenges when it comes to implementing the ARCH social insurance project: (i) the fiscal space is quite limited, there is a limited potential for new taxes and these may not benefit the ARCH funding, hence the need to prioritise fiscal resources without jeopardising other areas; (ii) the purchasing of health services should be more strategic so as to increase allocative efficiency and equity; (iii) the efficiency of the expenditure process needs to be improved, and more autonomy needs to be devoted to the operational level, so as to ensure that health facilities are reimbursed in a timely fashion in order to meet insured people’s health costs, in such a way as to avoid jeopardizing the financial equilibrium of these facilities. Conclusion The important budgeting challenges faced by Benin when it comes to implementing its UHC policy are also faced by many other African countries. It is important to avoid a situation in which the resources dedicated by the government to the social health insurance system are at the expense of a reduction in the financing of preventive and promotional primary healthcare services.

中文翻译：

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全民健康覆盖道路上的预算挑战：贝宁的案例。

背景 为了实现全民健康覆盖（UHC），贝宁政府正在试点名为“ARCH”的强制性健康社会保险项目。方法 我们分析了预算数据和 ARCH 文件，并于 2018 年 3 月至 2020 年 1 月期间在贝宁进行了四次观察任务。结果根据公共支出管理的三个经典目标提出。结果 贝宁政府在实施 ARCH 社会保险项目时面临着重要的预算挑战：(i) 财政空间相当有限，新税收的潜力有限，这些可能不会有利于 ARCH 资金，因此需要在不损害其他领域的情况下优先安排财政资源；(ii) 卫生服务购买应更具战略性，以提高配置效率和公平性；（三）支出流程的效率有待提高，操作层面需要给予更多自主权，确保医疗机构及时报销，满足参保人员的医疗费用，例如：避免危及这些设施的财务平衡的一种方法。结论 贝宁在实施全民健康覆盖政策时面临着重要的预算挑战，许多其他非洲国家也面临着这一挑战。重要的是要避免出现政府向社会医疗保险体系投入的资源以减少预防性和促进性初级卫生保健服务经费为代价的情况。