scholarly journals Benefit of China’s Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform

2021 ◽  
Vol 18 (11) ◽  
pp. 5672
Author(s):  
Wanyue Dong ◽  
Anthony B. Zwi ◽  
Ruhai Bai ◽  
Chi Shen ◽  
Jianmin Gao
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Social Health ◽  
Inpatient Service ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
Basic Medical Insurance ◽  
Basic Medical

With the deepening of health insurance reform in China, the integration of social health insurance schemes was put on the agenda. This paper aims to illustrate the achievements and the gaps in integration by demonstrating the trends in benefits available from the three social health insurance schemes, as well as the influencing factors. Data were drawn from the three waves of the China Health and Nutrition Survey (2009, 2011, 2015) undertaken since health reforms commenced. χ2, Kruskal–Wallis test, and the Two-Part model were employed in the analysis. The overall reimbursement rate of the Urban Employee Basic Medical Insurance (UEBMI) is higher than that of Urban Resident Basic Medical Insurance (URBMI) or the New Rural Cooperative Medical Scheme (NRCMS) (p < 0.001), but the gap has narrowed since health reform began in 2009. Both the outpatient and inpatient reimbursement amounts have increased through the URBMI and NRCMS. Illness severity, higher institutional level, and inpatient service were associated with significant increases in the amount of reimbursement received across the three survey waves. The health reform improved benefits covered by the URBMI and NRCMS, but gaps with the UEBMI still exist. The government should consider more the release of health benefits and how to lead toward healthcare equity.

scholarly journals Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand

2021 ◽  
Vol 6 (2) ◽  
pp. e004117
Author(s):  
Aniqa Islam Marshall ◽  
Kanang Kantamaturapoj ◽  
Kamonwan Kiewnin ◽  
Somtanuek Chotchoungchatchai ◽  
Walaiporn Patcharanarumol ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Civil Servant ◽  
Social Health ◽  
Health Coverage ◽  
Medical Benefit ◽  
The Social ◽  
Universal Health ◽  
Universal Coverage Scheme

Participatory and responsive governance in universal health coverage (UHC) systems synergistically ensure the needs of citizens are protected and met. In Thailand, UHC constitutes of three public insurance schemes: Civil Servant Medical Benefit Scheme, Social Health Insurance and Universal Coverage Scheme. Each scheme is governed through individual laws. This study aimed to identify, analyse and compare the legislative provisions related to participatory and responsive governance within the three public health insurance schemes and draw lessons that can be useful for other low-income and middle-income countries in their legislative process for UHC. The legislative provisions in each policy document were analysed using a conceptual framework derived from key literature. The results found that overall the UHC legislative provisions promote citizen representation and involvement in UHC governance, implementation and management, support citizens’ ability to voice concerns and improve UHC, protect citizens’ access to information as well as ensure access to and provision of quality care. Participatory governance is legislated in 33 sections, of which 23 are in the Universal Coverage Scheme, 4 in the Social Health Insurance and none in the Civil Servant Medical Benefit Scheme. Responsive governance is legislated in 24 sections, of which 18 are in the Universal Coverage Scheme, 2 in the Social Health Insurance and 4 in the Civil Servant Medical Benefit Scheme. Therefore, while several legislative provisions on both participatory and responsive governance exist in the Thai UHC, not all schemes equally bolster citizen participation and government responsiveness. In addition, as legislations are merely enabling factors, adequate implementation capacity and commitment to the legislative provisions are equally important.

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system

The Lancet ◽  
2015 ◽  
Vol 386 (10002) ◽  
pp. 1484-1492 ◽  
Author(s):  
Qingyue Meng ◽  
Hai Fang ◽  
Xiaoyun Liu ◽  
Beibei Yuan ◽  
Jin Xu
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Social Health Insurance ◽  
Social Health ◽  
The Social

scholarly journals Governance and Purchasing Function under Social Health Insurance in Nepal: Looking Back and Moving Forward

2017 ◽  
Vol 15 (1) ◽  
pp. 85-87
Author(s):  
Vishnu Prasad Sapkota ◽  
Umesh Prasad Bhusal
Keyword(s):  
Health Insurance ◽  
Social Protection ◽  
Service Providers ◽  
Social Health Insurance ◽  
Social Health ◽  
Health Coverage ◽  
Health Security ◽  
The Social ◽  
Development Committee ◽  
Health Services Needs

Nepal is pursuing Social Health Insurance as a way of mobilizing revenues to achieve Universal Health Coverage. The Social Health Insurance governance encourages service providers to maintain quality and efficiency in services provision by practicing strategic purchasing. Social Health Security Programme is a social protection program which aspires to achieve the goals of Social Health Insurance. Social Health Security Development Committee needs to consider following experiences to function as a strategic purchaser. The Social Health Security Development Committee need to be an independent body instead of falling under Ministry of Health. Similarly, purchasing of health services needs to be made strategic, i.e., Social Health Security Development Committee should use its financial power to guide the provider behavior that will eventually contribute to achieving the goals of quality and efficiency in service provision. The other social health security funds should be merged with Social Health Security Development Committee and develop a single national fund. Finally, the state has to regulate and monitor the performance of the SHI agency.

scholarly journals Slovenian Complementary Health Insurance Reform – Dichotomy between the Internal Market and the Social Dimension

2015 ◽  
Vol 6 (4) ◽  
pp. 205-216
Author(s):  
Bruno Nikolić
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Financing ◽  
Legal Regulation ◽  
Internal Market ◽  
Social Dimension ◽  
Financing System ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
The Social

Abstract Complementary health insurance is divided between the internal market (market principles) and social dimension, wherein the state has an extremely difficult task, as it must create the conditions necessary for the fair and efficient functioning of the health care financing system. Slovenia has failed to successfully accomplish this task, which consists of both ensuring the social dimension and also facilitating the operation of market principles. The aim of this article is not on the functioning of market principles, which are covered by the field of economics, but is instead on analyzing the dichotomy between the internal market (the rules that govern the functioning of the internal market) and the social dimension (the rules that enable the exercise of the social function), and, in this light, analyzes the legal regulation of the Slovenian complementary health insurance. Analysis of the legal regulation highlights the shortcomings in ensuring the social dimension, shortcomings which are, with the help of the measures proposed in the concluding section of the article, remedied by the author.

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