Equity in health care access to: assessing the urban health insurance reform in China

Since 1998, the central government has focused its attention on social security. Among other things, it has created a ministry for social security, pressed for the extension of health and unemployment insurance to larger numbers of the urban working population, and increased spending. Does this mean that the party-state is rebuilding the eroded urban social security system and re-asserting its role in ensuring collective provision? Do recent initiatives repair or damage the interests of urban workers? This article examines these questions through a study of urban health insurance reform. It argues the state has taken over from work units the responsibility for health insurance, that collectivism has been partially preserved through redistributory “risk-pooling” systems, and that the party-state is moving away from its traditional state enterprise-centred working-class base and widening participation to include workers in the private and rural industrial sectors. However, continued prioritization of economic growth means that the party-state's role is limited, while collectivist provision is restricted to the non-agricultural working population. In practice, government officials and workers in successful state enterprises are still the most likely to be insured.

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Correlates of health care access problems among reproductive age women in Ethiopia: In-depth analysis of 2016 Ethiopia demographic Health Survey

10.21203/rs.2.14127/v1 ◽

2019 ◽

Author(s):

koku Tamirat ◽

Zemenu Tadesse Tessema ◽

Fentahun Bikale Kebede

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Access ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Reproductive Age ◽

Rural Residence ◽

Factors Associated ◽

Care Access ◽

Reproductive Age Women

Abstract Background Health care access is timely use of personal health services to achieve best health outcomes. Difficulties to access health care among reproductive age women may led to different negative health outcomes to death and disability. Therefore, this study aimed to assess factors associated with problems of accessing health care among reproductive age women in Ethiopia.Method This study was based on 2016 Ethiopia Demography and Health Survey. Individual women record (IR) file was used to extract the dataset and 15, 683 women were included in the final analysis. A composite variable of problem of accessing health care were created from four questions used to rate problem of accessing health care among reproductive age women. Generalized estimating equation (GEE) model was fitted to identify factors associated with problem of accessing health care. Crude and Adjusted odds ratio with a 95%CI computed to assess the strength of association between independent and outcome variables.Result In this study the magnitude of problem in accessing health care among reproductive age women was 69.9% of with 95%CI (69.3 to 70.7). Rural residence (AOR= 2.13, 95%CI: 1.79 to 2.53), women age 35-49 years (AOR= 1.24, 95%CI: 1.09 to 1.40), married/live together (AOR= 0.72, 95%CI: 0.64 to 0.81), had health insurance coverage (AOR=0.83, 95%CI: 0.70 to 0.95), wealth index [middle (AOR=0.75,95%CI: 0.66 to 0.85) and rich (AOR=0.47,95%CI:0.42 to 0.53)], primary education(AOR= 0.80, 95%CI: 0.73 to 0.88), secondary education (AOR= 0.57, 95%CI:0.50 to 0.64) and diploma and higher education (AOR= 0.43, 95%CI: 0.37 to 0.50) were factors associated with problem of health care access among reproductive age women.Conclusion Despite better coverage of health system, problems of health care access among reproductive age women were considerably high. Health insurance coverage, middle and rich wealth, primary and above educational level were negatively associated with problems health care access. In contrast, older age and rural residence were positively associated with problems of health care access among reproductive age women. This suggests that further interventions are necessary to increase universal reproductive health care access for the achievement of sustainable development goals.

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The shared experiences of insured members and the uninsured in health care access and utilization under Ghana’s national health insurance scheme: Evidence from the Hohoe Municipality

PLoS ONE ◽

10.1371/journal.pone.0244155 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244155

Author(s):

Suraiya Umar ◽

Adam Fusheini ◽

Martin Amogre Ayanore

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Access ◽

Health Care Services ◽

National Health Insurance Scheme ◽

Insurance Scheme ◽

Financial Barriers ◽

Care Access ◽

Care Services ◽

Barriers To Health

Background The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 to remove financial barriers and to promote equitable access to health care services. Post implementation has been characterized by increases in access and utilization of services among the insured. The uninsured have been less likely to utilize services due to unaffordability of health care costs. In this study, we explored the experiences of the insured members of the NHIS, the uninsured and health professionals in accessing and utilizing health care services under the NHIS in the Hohoe Municipality of Ghana. Methods Qualitative in-depth interviews were held with twenty-five NHIS insured, twenty-five uninsured, and five health care professionals, who were randomly sampled from the Hohoe Municipality to collect data for this study. Data was analyzed using thematic analysis. Results Participants identified both enablers or motivating factors and barriers to health care services of the insured and uninsured. The major factors motivating members to access and use health care services were illness severity and symptom persistence. On the other hand, barriers identified included perceived poor service quality and lack of health insurance among the insured and uninsured respectively. Other barriers participants identified included financial constraints, poor attitudes of service providers, and prolonged waiting time. However, the level of care received were reportedly about the same among the insured and uninsured with access to quality health care much dependent on ability to pay, which favors the rich and thereby creating inequity in accessing the needed quality care services. Conclusion The implication of the financial barriers to health care access identified is that the poor and uninsured still suffer from health care access challenges, which questions the efficiency and core goal of the NHIS in removing financial barrier to health care access. This has the potential of undermining Ghana’s ability to meet the Sustainable Development Goal 3.8 of universal health coverage by the year 2030.

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