Purchasing health services under the Egypt's new Universal Health Insurance law: What are the implications for universal health coverage?

AbstractThere has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.

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Urgensi Kebijakan Jaminan Kesehatan Semesta (Universal Health Coverage) bagi Penyelenggaraan Pelayanan Kesehatan Masyarakat di Masa Pandemi Covid-19

Administrative Law & Governance Journal ◽

10.14710/alj.v3i2.272-299 ◽

2020 ◽

Vol 3 (2) ◽

pp. 272-299

Author(s):

FC. Susila Adiyanta

Keyword(s):

Public Health ◽

Health Insurance ◽

National Health ◽

Universal Health Coverage ◽

National Health System ◽

Universal Health Insurance ◽

Health Coverage ◽

Health Administration ◽

Global Pandemic ◽

Universal Health

Tujuan penelitian ini untuk mengetahui urgensi dan relevansi kebijakan Pemerintah dalam memperbaiki ekosistem penyelenggaraan kesehatan masyarakat dengan penguatan JKN sebagai skema asuransi kesehatan sosial yang bersifat wajib sebagai akibat adanya kesejangan antara iuran dengan manfaat yang komprehensif di masa wabah pandemi global Covid-19. Hasil penelitian menunjukkan bahwa: 1) kebijakan skema Jaminan Kesehatan Semesta (Universal Health Coverage, UHC) dalam SJSN-KIS mempunyai urgensi sebagai pemenuhan penyelenggaraan jaminan kesehatan yang terjangkau oleh seluruh lapisan masyarakat secara adil dan merata sesuai amanat konstitusi; 2) Skema sistem Jaminan Kesehatan Semesta (Universal Health Coverage, UHC) Sistem UHC telah dimodifikasi oleh Pemerintah untuk diselaraskan dengan kondisi dan tujuan penyelenggaraaan kesehatan nasional yang profesional, efisien dan efektif, dan menjangkai seluruh lapisan masyarakat;3) Skema Jaminan Kesehatan Semesta (Universal Health Coverage, UHC) yang terintegrasi antara Sistem Jaminan Sosial Nasional (SJSN) dan Sistem Kesehatan Nasional (SKN) sangat relevan bagi penyelenggaraan kesehatan masyarakat berdasarkan kerjasama, solidaritas dan empati semua warga di masa pandemi global Covid-19. Kata kunci: Universal Health Coverage, penyelenggaraan kesehatan masyarakatAbstract The purpose of this study is to study the urgency and relevance of Government policies in improving the public health ecosystem by strengthening JKN as a health insurance needed to improve the compatibility between contributions and useful benefits in the future of the global pandemic outbreak Covid-19. The results of the study show that: 1) the policy on universal health insurance requirements (Universal Health Coverage, UHC) in the SJSN-KIS has urgency as fulfilling the implementation of health insurance that is affordable to the whole community and in accordance with the mandate of the constitution; 2) Scheme of the Universal Health Insurance System (Universal Health Coverage, UHC) The UHC system is supported by the Government to be aligned with the requirements and objectives of national health care that are professional, efficient and effective, and reaches all communities; 3) The Universal Health Coverage Scheme (Universal Health Coverage, UHC) which is integrated between the National Social Security System (SJSN) and the National Health System (SKN) is very relevant for the implementation of public health through cooperation, solidarity, and empathy for all citizens in the global pandemic -19. Keywords: universal health coverage, public health administration

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Towards Universal Health Coverage: An Analysis of the Health Insurance Coverage in Nigeria

International Journal of Health and Life Sciences ◽

10.5812/ijhls.108727 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Yusuff Olanrewaju Azeez ◽

Yusuf Olalekan Babatunde ◽

Damilola Babatunde ◽

Joseph Olasupo ◽

Elizabeth Alabi ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

National Health Insurance ◽

Informal Sector ◽

Universal Health Coverage ◽

National Health Insurance Scheme ◽

Health Insurance Scheme ◽

Health Coverage ◽

Insurance Scheme ◽

Universal Health

Context: Achieving universal health coverage requires a Health Insurance Scheme that minimizes out-of-pocket expenditure, guarantees the provision of essential health services, and covers majority of the population. This study examines the NHIS, it's success, failures, efforts so far towards achieving UHC and overall, examines if Nigeria is progressing towards the achievement of universal health coverage. Evidence Acquisition: We conducted a narrative review of published articles on National Health Insurance Scheme (NHIS) coverage in Nigeria. Pubmed and Google Scholar were searched with the following keywords: National Health Insurance Scheme (NHIS), Success, Failure, Universal Health Coverage (UHC). Results: NHIS has failed in its inclusiveness and covers only about 5% of the general population, mainly from the formal sector while most from the informal sector are excluded. Certain factors such as the inadequate legal framework for a successful scheme, optional enrollment policy, poor funding and lack of political will are responsible for the failure of the NHIS. Conclusions: Revising the NHIS to cover all segments of the society including remote areas and ensuring the insured have access to health services at all hospitals and health centers across the country is essential in attaining the third sustainable development goal in Nigeria. Also, there is need for intensify public awareness programs to enlighten the people and relevant groups on the positive values of the scheme. The attributes of the scheme should be well publicized in a way that both the formal and informal sector would understand clearly. This might involve the use of all local languages spoken in different parts of the country.

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Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage

Iranian Journal of Public Health ◽

10.18502/ijph.v48i3.895 ◽

2019 ◽

Author(s):

Shahin SOLTANI ◽

Amirhossein TAKIAN ◽

Ali AKBARI SARI ◽

Reza MAJDZADEH ◽

Mohammad KAMALI

Keyword(s):

Health Insurance ◽

Health Services ◽

Universal Health Coverage ◽

Healthcare Services ◽

Health Coverage ◽

Access To Health Services ◽

Financial Barriers ◽

Access To Health ◽

People With Disability ◽

Universal Health

Background: Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran. Methods: In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran. Results: We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD). Conclusion: Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD.

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Achieving Universal Health Coverage as a Goal of Vietnam’s Socio-Economic Development

Economics and Management ◽

10.35854/1998-1627-2021-4-269-280 ◽

2021 ◽

Vol 27 (4) ◽

pp. 269-280

Author(s):

Zh. V. Pisarenko ◽

Thi Mai Doan

Keyword(s):

Health Care ◽

Economic Development ◽

Health Insurance ◽

Health Services ◽

Universal Health Coverage ◽

Vulnerable Groups ◽

Health Coverage ◽

Financing System ◽

Socio Economic Development ◽

Universal Health

Aim. The presented study aims to analyze and identify the “bottlenecks” Vietnam may face on the way to achieving the goal of universal health coverage of the country’s population.Tasks. The authors analyze the situation regarding the implementation of sustainable development goals in terms of ensuring the availability of health services; assess the situation regarding the availability of health services in Vietnam; assess the potential of health insurance to achieve universal health coverage as a goal of Vietnam’s socio-economic development.Methods. This study uses statistical, empirical, and comparative analysis.Results. Achieving the goal of universal health coverage in the country requires more than just financing health care. It reflects the importance of ensuring equal access to quality health services and enforcing the right to health, especially for vulnerable groups. The authors analyze population coverage, the organization of the financing system, and the cost of medical care for households. Funding for health programs in Vietnam is increasing. However, due to the enduring poverty in the country, households spending a large share of their own funds on health services, and the number of challenges associated with the COVID-19 new coronavirus pandemic, there is still a risk of not achieving the goal of universal coverage in the near term.Conclusions. To achieve the set goal, Vietnam needs to introduce effective mechanisms of compulsory and voluntary health insurance (VHI). This additional financial protection is seen as a way to enable more people to use the necessary services without the risk of catastrophic health care costs, thus effectively approaching the goal of universal health coverage for the citizens of the Socialist Republic of Vietnam (SRV).

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“Living long in India”– India’s progress towards Universal Health Coverage

European Journal of Public Health ◽

10.1093/eurpub/ckz185.202 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

L Balraj ◽

H Brand

Keyword(s):

Health Insurance ◽

Health Services ◽

Universal Health Coverage ◽

Primary Healthcare ◽

Indian Population ◽

Healthcare Services ◽

Fiscal Year ◽

Health Coverage ◽

Indian States ◽

Universal Health

Abstract Issue There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these issues and achieve Universal Health Coverage (UHC), India launched the healthcare scheme ‘Ayushman Bharat’ (“long live India”) in 2018. Description The Ayushman Bharat (AB) scheme has two components which include 1) transforming the existing primary healthcare centers (PHC) under the control of State Governments and 2) the National Health Protection Scheme (NHPS) also known as “ModiCare” - a health insurance. The scheme aims to transform nearly 150.000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. NHPS covers the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. The coverage will be approximately €6.400 per year per beneficiary family; 60% of the costs are borne by the Centre and 40% by the States. Results Approximately €127 million have already been allocated by the Centre towards the AB scheme for the fiscal year 2018-19. Till date, around 29 million health insurance cards have been issued, approximately 1,8 million beneficiaries have been admitted and around 15.291 hospitals have been empaneled under NHPS. However, there is no data available validating the usage of the health services yet. Few Indian states are yet to implement the AB scheme. Lessons For the first time, attempts have been made to provide affordable healthcare services to the Indian population under a single common initiative. However, the AB scheme fails to cover outpatient health services, which are an important part of OOP expenses in India. Main message The effort to launch Ayushman Bharat in a big, democratic and diverse country like India has to be lauded, which not only aims to make healthcare services affordable but also aligns itself to the concept of UHC.

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Barriers and facilitators to health insurance enrolment among people working in the informal sector in Morogoro, Tanzania

AAS Open Research ◽

10.12688/aasopenres.13289.1 ◽

2021 ◽

Vol 4 ◽

pp. 45

Author(s):

Elisante Abraham ◽

Cindy Gray ◽

Adeniyi Fagbamigbe ◽

Fabrizio Tediosi ◽

Brianna Otesinky ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Informal Sector ◽

Universal Health Coverage ◽

Perceived Control ◽

Health Financing ◽

Subjective Norms ◽

Barriers And Facilitators ◽

Health Coverage ◽

Universal Health

Background: Health insurance is a crucial pathway towards the achievement of universal health coverage. In Tanzania, health-financing reforms are underway to speed up universal health coverage in the informal sector. Despite improved Community Health Fund (iCHF) rollout, iCHF enrolment remains a challenge in the informal sector. This study aimed to explore the perspectives of local women food vendors (LWFV) and Bodaboda (motorcycle taxi) drivers on factors that challenge and facilitate their enrolment in iCHF. Methods: A qualitative study was conducted in Morogoro Municipality through in-depth interviews with LWFV (n=24) and Bodaboda drivers (n=26), and two focus group discussions with LWFV (n=8) and Bodaboda drivers (n=8). Theory of planned behaviour (TPB) constructs (attitude, subjective norms, and perceived control) provided a framework for the study and informed a thematic analysis focusing on the barriers and facilitators of iCHF enrolment. Results: The views of LWFV and Bodaboda drivers on factors that influence iCHF enrolment converged. Three main barriers emerged: lack of knowledge about the iCHF (attitude); negative views from friends and families (subjective norms); and inability to overcome challenges, such as the quality and range of health services available to iCHF members and iCHF not being accepted at non-government facilities (perceived control). A number of facilitators were identified, including opinions that enrolling to iCHF made good financial sense (attitude), encouragement from already-enrolled friends and relatives (subjective norms) and the belief that enrolment payment is affordable (perceived control). Conclusions: Results suggest that positive attitudes supported by perceived control and encouragement from significant others could potentially motivate LWFV and Bodaboda drivers to enroll in iCHF. However, more targeted information about the scheme is needed for individuals in the informal sector. There is also a need to ensure that quality health services are available, including coverage for non-communicable diseases (NCDs), and that non-government facilities accept iCHF.

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A single-payer health care system in Croatia: problem or solution?

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1400 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Kujundžić Tiljak ◽

S Orešković ◽

H Tiljak

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Services ◽

Health Care System ◽

Universal Health Coverage ◽

Health Priorities ◽

Health Coverage ◽

Single Payer ◽

Universal Health ◽

Care System

Abstract Background Andrija Štampar implemented innovative healthcare solutions in Croatia at the beginning of the 20th century, advocating principles of comprehensiveness, continuity, and availability. These principles are globally challenged at ideological, social and policy levels, reflecting discussions in the USA and EU on whether a single-payer, mandatory health insurance (MHI) system and universal health coverage (UHC) are optimal solutions for the sustainable health system of the 21st century? Methods Analyzing the impact of the Croatian Health Insurance Fund (CHIF) as a single-payer on the performance of Croatia's health care system through the analysis of the financial and health outcomes for the 2000-2020 period to assess allocative efficiency, organizational effectiveness, and economic sustainability. Results The CHIF is the single purchaser of all publicly financed individual health services, delivered through both public and private providers. Although the broad scope of the MHI scheme, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced in the last twenty years. The financial sustainability of the system is decreasing mainly caused by the model focusing on the tertiary care and payment scheme based on monthly hospital limits. However, the incidence of catastrophic and impoverishing payments is lower in Croatia than in many other EU13 countries. Conclusions The solution might be in the development of integrated health services, implementation of health promotion, education, and awareness, diseases prevention, and focus on the outcomes. The funding should follow the population needs in accordance with public health priorities and not only the structural demand of the existing system. The alternative is to face additional financial burden and impoverishment of the population in need of healthcare services. Key messages Modern universal health coverage strives to integrate health care and focuses on the outcomes. Single-payer system is not an obstacle for integration or source of fragmentation.

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