Implementation bottlenecks of the National Health Insurance program in Nepal: Paving the path towards Universal Health Coverage: A qualitative study

Author(s):  
Gaj Bahadur Gurung ◽  
Alessio Panza
2020 ◽  
Vol 4 (2) ◽  
pp. 219
Author(s):  
Adityo Pratikno Ramadhan ◽  
Budiyono Budiyono ◽  
Djonet Santoso

This research aimed to investigate the percentage of university students at the University of Bengkulu, Indonesia, who participated in the national health insurance program, and why the students did or did not participate in the national health insurance program. This research was performed with the inductive approach and sampled 366 university undergraduate students from eight faculties at the University of Bengkulu, Indonesia. The data collection was conducted by survey technique using a questionnaire. The results show that only 58.2% of university students who participated in the national health insurance program and their parents played an important role in determining whether they participated in the program. Pseudo universal health coverage would probably happen in Indonesia since some students participated in the national health insurance program. However, their premium payments were overdue, so that their insurance coverage became inactive. The unique finding of this research is that 1.96 percent of students mentioned that they did not participate in the national health insurance program because they perceived this program categorized as usury, which is forbidden in Islam. Penelitian ini bertujuan untuk mengetahui persentase mahasiswa Universitas Bengkulu yang mengikuti program jaminan kesehatan nasional, dan mengapa mahasiswa mengikuti atau tidak mengikuti program jaminan kesehatan nasional. Penelitian ini dilakukan dengan pendekatan induktif dan mengambil sampel 366 mahasiswa sarjana dari delapan fakultas di Universitas Bengkulu, Indonesia. Pengumpulan data dilakukan dengan teknik survei menggunakan kuesioner. Hasil penelitian menunjukkan bahwa hanya 58,2% mahasiswa yang mengikuti program jaminan kesehatan nasional dan orang tuanya yang berperan penting dalam menentukan keikutsertaan mereka dalam program tersebut. Pertanggungan kesehatan universal semu mungkin akan terjadi di Indonesia karena beberapa pelajar berpartisipasi dalam program jaminan kesehatan nasional. Namun, pembayaran premi mereka terlambat, sehingga pertanggungan asuransinya menjadi tidak aktif. Temuan unik dari penelitian ini adalah 1,96 persen mahasiswa menyatakan tidak mengikuti program jaminan kesehatan nasional karena menganggap program ini termasuk riba yang dilarang dalam Islam.


Author(s):  
Muhammad Arief Hasan ◽  
Puput Oktamianti ◽  
Dumilah Ayuningtyas

Abstract. JKN (National Health Insurance) is a government program that aims to provide health assurance for all Indonesian citizens for a healthy, productive, and prosperous life. In the two years after JKN was implemented, various problems occurred. This research used the qualitative approach with the Edward II implementation theory. Results of the research indicated that there were problems in communication, stemming from the lack of socialization and inharmonic regulations, there was also the problem of the lack of healthcare resources. From the disposition side, the policy makers often obstructs the implementation preparation, this is evident from the information on determining the premium size. From the organization structure, all the stakeholders have been well coordinated. We conclude that we are not ready to implement the JKN. We recommend that mass and effective socialization program to be performed using various methods of communication and involve the community. To reduce the disparity of healthcare services, we recommend that the regional government to establish various healthcare facilities to accelerate health development. There should also be regulations that allocates healthcare staff in every corner of the country to achieve Universal Health Coverage in 2019, as stated in the National Health Insurance Road Map. Keywords: policy analysis, national health insurance, universal health coverage


Author(s):  
Anom Dwi Prakoso ◽  
◽  
Endang Sutisna Sulaeman ◽  
Arief Suryono ◽  
◽  
...  

ABSTRACT Background: Government of Republic of Indonesia provides the national health insurance program since January 1st 2014. The payment scheme requires hospitals to provide the service first and then make a claim to BPJS on the service by using the tariff package called Indonesia Case Based Groups (INA CBGs). The purpose of this study was to examine factors associated with participation in the national health insurance program using path analysis model. Subjects and Method: This was a case control study. The study was conducted at 5 sub-districts in Kudus, Central Java, from September to October 2019. A sample of 200 informal workers was selected by purposive sampling. The dependent variable was participation in national health insurance. The independent variables were education, income, knowledge, perceived susceptibility, perceived seriousness, perceived benefit, family support, self-efficacy, and social environment. The data were collected by questionnaire and analyzed by path analysis run on stata 13. Results: Participation in the national health insurance program was directly and positively affected by high perceived susceptibility (b= 2.14; 95% CI= -0.09 to 4.38; p= 0.060), high perceived seriousness (b= 4.71; 95% CI= 2.15 to 7.28; p<0.001), high perceived benefit (b= 2.45; 95% CI= 0.07 to 4.83; p= 0.044), strong family support (b= 6.31; 95% CI= 3.20 to 9.41; p<0.001), strong self-efficacy (b= 3.55; 95% CI= 1.02 to 6.07; p= 0.006), and supportive social environment (b= 3.39; 95% CI= 1.24 to 5.55; p= 0.002). Participation in the national health insurance program was indirectly affected by education, income, and knowledge. Conclusion: Participation in the national health insurance program is directly and positively affected by high perceived susceptibility, high perceived seriousness, high perceived benefit, strong family support, strong self-efficacy, and supportive social environment. Participation in the national health insurance program is indirectly affected by education, income, and knowledge. Keywords: national health insurance, Health Belief Model, Social Cognitive Theory Correspondence: Anom Dwi Prakoso. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Centra Java, Indonesia. Email: [email protected]. Mobile: +62895363054393. DOI: https://doi.org/10.26911/the7thicph.04.37


Author(s):  
Kipo-Sunyehzi ◽  
Amogre Ayanore ◽  
Dzidzonu ◽  
Ayalsuma Yakubu

: Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.


2004 ◽  
Vol 59 (8) ◽  
pp. 1647-1659 ◽  
Author(s):  
Likwang Chen ◽  
Wen-Shan Yang ◽  
Shyh-Dye Lee ◽  
Hua-Chih Chang ◽  
Chen-Lin Yeh

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