Medical Insurance and Out-Of-Pocket Expenses on Medical Care

2021 ◽  
pp. 161-192
Author(s):  
Xinxin Ma
Keyword(s):  
Medical Care ◽  
Medical Insurance ◽  
Out Of Pocket Expenses

Organization of immunobiological therapy for severe bronchial asthma in the Sverdlovsk region

2021 ◽  
Author(s):  
Evgeny K. Beltyukov ◽  
Valery A. Shelyakin ◽  
Veronika V. Naumova ◽  
Alexander V. Vinogradov ◽  
Olga G. Smolenskaya
Keyword(s):  
Differential Diagnosis ◽  
Targeted Therapy ◽  
Medical Care ◽  
Clinical Guidelines ◽  
Medical Insurance ◽  
Continuation Therapy ◽  
Insurance Program ◽  
Routine Medical Care ◽  
Insurance Funds ◽  
Stay Hospital

Background: Biologicals use in severe asthma (SA) is associated with problem of targeted therapy (TT) availability. Ensuring availability of biologicals can be resolved within the territorial compulsory medical insurance program (TCMIP) in day-stay or round-the-clock hospital. Aims: development and implementation of program for introduction of immunobiological therapy (IBT) for SA in Sverdlovsk Region (SR). Materials and methods: Program for introduction of IBT for SA was developed in SR in 2018 to provide patients with expensive biologicals within the TCMIP. Program includes: SA prevalence study in SR; practitioners training in differential diagnosis of SA; organization of affordable therapy for patients with SA; register of SA patients сreation and maintenance; patients selection and management of patients with SA in accordance with federal clinical guidelines. Results: Atopic phenotype in SA was detected in 5%, eosinophilic - in 2.3% of all analyzed cases of asthma (n=216). Practitioners of SR were trained in differential diagnosis of SA. The orders of the Ministry of Health of SR were issued, regulating the procedure for referring patients with SA to IBT, a list of municipal medical organizations providing IBT in a day-stay or round-the-clock hospital; approved regional register form of SA patients requiring biologicals use; ungrouping of clinical and statistical groups of day-stay hospital was carried out depending on INN and dose of biologicals; patients with SA are selected for TT and included in the regional register. Initiating of TT in round-the-clock hospital and continuation therapy in day-stay hospital provides a significant savings in compulsory medical insurance funds. Conclusions: introduction of IBT for SA in SR is carried out within framework of developed program. Principle of decentralization brings highly specialized types of medical care closer to patients and makes it possible to provide routine medical care in allergology-immunology profile in context of restrictions caused by COVID-19 pandemic.

Comparison of medical care utilization patterns between beneficiaries of medical aid and medical insurance

1991 ◽  
Vol 8 (2) ◽  
pp. 185
Author(s):  
Bok Youn Kim ◽  
Seok Beom Kim ◽  
Chang Yoon Kim ◽  
Pock Soo Kang ◽  
Jong Hak Chung
Keyword(s):  
Medical Care ◽  
Medical Insurance ◽  
Care Utilization ◽  
Medical Aid ◽  
Medical Care Utilization ◽  
Utilization Patterns

scholarly journals Analysis of the Effect of Serious Illness Medical Insurance on Relieving the Economic Burden of Rural Residents in China: A Case Study in Jinzhai County

2020 ◽  
Author(s):  
Yang Li ◽  
Guangfeng Duan ◽  
Linping Xiong
Keyword(s):  
Economic Burden ◽  
Rural Areas ◽  
Descriptive Analysis ◽  
Medical Insurance ◽  
Rural Residents ◽  
Serious Illness ◽  
Medical Expenses ◽  
Out Of Pocket Expenses ◽  
Annual Average Number ◽  
Technology Level

Abstract Background: In 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. However, its reimbursement for high medical costs was insufficient. Therefore, China gradually established the Serious Illness Insurance System (SIMIS) based on NRCMS. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. This study aimed to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County.Methods: The study used the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province, from 2013 to 2016. We adopted descriptive and regression discontinuity (RD) methods to analyze the payment effect of SIMIS. The RD analysis targeted patients (n = 7,353) whose annual serious illness expenses were between CNY 10,000 (1,414 USD) and CNY 30,000 (4,242 USD), whereas the descriptive analysis was used for data of the patients compensated by SIMIS (n = 2720).Results: The results of RD showed that the actual medical insurance payment proportion increased by about 2.5% (lwald = 0.025, P <0.01), inside medical insurance self-payment proportion increased by about 2% (lwald = 0.020, P <0.10), and outside medical insurance self-payment proportion decreased by about 1.6% (lwald = -0.016, P <0.05). The descriptive results showed that patients with serious illnesses mostly chose to go to a hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out-of-pocket medical expenses were still high.Conclusion: The medical technology level of Jinzhai County could not meet the needs of patients with seriously illnesses, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of the rural residents was insufficient. The high out-of-pocket expenses increased the possibility that only people with good economic conditions could benefit from the reimbursement of SIMIS, resulting in inequity.

scholarly journals Regulation of inter-regional differences of the Russian Federation regions in the context of national projects «Healthcare» and «Demography»

2020 ◽  
Vol 16 (3) ◽  
pp. 59-69 ◽  
Author(s):  
Nail M. Gabdullin ◽  
Igor A. Kirshin ◽  
Aleksey V. Shulaev
Keyword(s):  
Public Health ◽  
Medical Care ◽  
Development Strategy ◽  
Russian Federation ◽  
Regional Differences ◽  
Medical Insurance ◽  
The State ◽  
Demographic Situation ◽  
The Subject ◽  
The Russian Federation

The subject of the study is the inter-regional differences in the state of public health and the demographic situation in the Russian Federation regions. The theoretical aspect of the subject is determined by the development of priorities of the Russian healthcare development strategy aimed at alignment of regional differences in the levels of healthcare development in the Russian Federation regions. The empirical aspect of the subject is to identify interregional differences in the state of public health and the demographic situation in the Russian Federation regions by using the EM cluster analysis method (Expectation Maximization). The method was implemented in the integrated development environment RStudio. The official statistics from Rosstat for the period 2014–2018 were used as the initial dataset. The purpose of the study is justifying the regulation of inter-regional differences of the Russian Federation regions. As a result of clustering, nine homogeneous clusters of the Russian Federation regions were identified. The main characteristics of the formed clusters are determined. Among the priorities of the RF healthcare development strategy are as follows: implementation of a unified tariff policy in the system of compulsory medical insurance; ensuring the balance of territorial compulsory medical insurance programs within the framework of the basic programme of compulsory medical insurance through financial security based on a single per capita standard; development of telemedicine, providing prompt remote consultation of leading experts in the provision of medical care, regardless of the territorial location of the patient and the doctor; ensuring the implementation of distance education courses and continuing education programs for medical workers; rationalization of the distribution of resources and capacities of medical organizations based on a three-tier system of medical care; development of regional public health centres. The results of this study can be used to develop federal and territorial programs for socioeconomic development, formulate a strategy for the development of healthcare at macro- and meso- levels, and optimize decisions of regional authorities regarding population policy.

scholarly journals Całkowicie prywatna opieka medyczna — próba zarysu

Ekonomia ◽  
2020 ◽  
Vol 26 (1) ◽  
pp. 155-195
Author(s):  
Stanisław Wójtowicz ◽  
Kamil Rozynek
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Service Providers ◽  
Free Market ◽  
Medical Insurance ◽  
Economic Incentives ◽  
The State ◽  
Medical Services ◽  
Market Mechanisms ◽  
Quality Of Medical Care

In this paper, we explore what the market for medical services and products could look like if the state completely withdrew from the area of medical care. In section 1, we demonstrate that medical services would be purchased mainly through direct payments and medical insurance. We analyse two models of medical insurance: guaranteed renewable insurance and health-status insurance. Other types of insurance that may emerge on the market are also discussed. In section 2, we exam-ine how the privatisation of the health-care system would affect the prices of medical services. We analyse fundamental problems of the state-run health care and discuss how they contribute to small-er supply and higher prices of medical services. We then describe how the introduction of market mechanisms would allow to solve many of these problems. We argue that internalisation of the costs of medical care in a free market order would create strong economic incentives for individuals to take better care of their health, and we contrast this with the state-run health care in which these costs are externalised. In section 3, we explore how medical services could be obtained by individuals without sufficient funds. In section 4, we discuss how the quality of medical care could be ensured without the help of the state. We argue that competition between service providers would be the main guarantor of quality. We also identify mechanisms that would lead to spontaneous emergence of a system of private medical licencing.

scholarly journals The problem of unreliability of information in the system of compulsory medical insurance in the context of the implementation of the constitutional right to free medical care

2021 ◽  
Vol 21 (2) ◽  
pp. 206-214
Author(s):  
Veronika A. Fadeeva ◽  
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Medical Insurance ◽  
Relevant Information ◽  
Medical Services ◽  
Legal Analysis ◽  
The Russian Federation ◽  
Constitutional Right ◽  
The Right ◽  
The Cost

Introduction. The addition of the section “Information on the cost of medical services rendered” to “Public Services”, the state information system, allowed the citizens of the Russian Federation to receive relevant information promptly. This possibility soon exacerbated the problem of unreliability of information about the medical services provided to the insured persons under compulsory medical insurance. The article defends a position based on the legal analysis of the legislation of the Russian Federation in the sphere of compulsory medical insurance. According to this position, the problem can be overcome by appropriate changes in the regulatory documents governing the control powers of the territorial funds of compulsory medical insurance, health insurance organizations. Theoretical analysis. The right to reliable information is enshrined in a number of regulatory legal acts of the Russian Federation, the analysis of which allows us to investigate the problem of unreliability of information in the system of compulsory medical insurance (“medical prescriptions”). Empirical analysis. Identification of unreliability of information about the provided medical services can be carried out both by the insured persons under compulsory medical insurance and through the control of the competent authorities. In this regard, the article analyzes the control powers of the territorial funds of compulsory medical insurance, medical insurance organizations. Results. The result of the author’s analysis of the problem of unreliability of information in the system of compulsory medical insurance (“medical attributions”) is a proposal to improve the procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care for compulsory medical insurance.

scholarly journals Applicability of Theory of Planned Behavior and Protection Motivation Theory in Predicting Intention to Purchase Health Insurance

2020 ◽  
Vol 6 (1) ◽  
pp. 41
Author(s):  
Nor Azmaniza Azizam ◽  
Mohd Redhuan Dzulkipli ◽  
Nor Intan Shamimi ◽  
Siti Noorsuriani Maon ◽  
Disera John ◽  
...  
Keyword(s):  
Health Insurance ◽  
Theory Of Planned Behavior ◽  
Medical Care ◽  
Planned Behavior ◽  
Private Insurance ◽  
Medical Insurance ◽  
Protection Motivation Theory ◽  
Protection Motivation ◽  
Motivation Theory ◽  
Intention To Purchase

In the era of increasing healthcare cost, private medical and health insurance ownership substantially reduces out of pocket expenses for medical care. The main objective of this paper is to apply theory of planned behavior and (TPB) model and protection motivation theory (PMT) in predicting intention to purchase health and medical insurance among graduating students. A cross-sectional survey was performed for data collection. A total of 443 questionnaires were completed and valid for data analysis purposes. Findings showed that there was statistically significant correlation between attitudes and subjective norm with the intention to purchase medical insurance. Severity, vulnerability and self-efficacy correlate negatively, while response efficacy demonstrates a positive correlation. Despite of the negative perception over private insurance, it significantly reduces out of pocket expenditures for medical care. Thus, there is a need of a further study examining the factors affecting the demand and individual’s decision purchasing private insurance in Malaysia

scholarly journals Development of voluntary medical insurance in the Russian Federation

2019 ◽  
Vol 100 (5) ◽  
pp. 796-801
Author(s):  
E V Arsentyev
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medical Care ◽  
Russian Federation ◽  
Medical Insurance ◽  
Insurance Policy ◽  
Labor Migrants ◽  
Voluntary Health Insurance ◽  
Legislative Framework ◽  
The Russian Federation

Aim. To analyze the dynamics of the development of voluntary medical insurance in the Russian Federation. To identify the factors hindering the development of this insurance sector in modern conditions. Methods. In the course of the study, analysis was conducted of the legislative framework for organizing medical care for the population of the Russian Federation in the system of voluntary medical insurance. The problem-chronological, systematic, and analytical research methods were used. Results. It has been established that, despite the development of voluntary medical insurance system over the past 25 years, the availability of this type of insurance for citizens of the Russian Federation still remains very low. The policy of voluntary medical insurance is mainly available only to working citizens, and only in those large enterprises where the employer is interested in preserving and protecting the health of its employees. For most citizens of the Russian Federation, the voluntary health insurance policy remains inaccessible due to the high cost of the policy, as well as due to relatively low incomes. At the same time, a voluntary health insurance policy is required by law for labor migrants to obtain a patent for employment in the Russian Federation. However due to the absence of legislative framework for voluntary health insurance, organization of medical care for labor migrants is not always standardized. Conclusion. For the further development of voluntary medical insurance, it is necessary to develop the measures for decreasing the cost and increasing the availability of a voluntary medical insurance policy for citizens of the Russian Federation; to optimize organization of health care for labor migrants it is necessary to primarily develop regulatory framework of emergency health care.

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