If the Pillars are Shaky, Does Faith in Medicare Crumble?

2003 ◽  
Vol 16 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Rein Lepnurm ◽  
Roy Dobson ◽  
Allen Backman
Keyword(s):  
British Columbia ◽  
Health Insurance ◽  
Health Services ◽  
Healthcare System ◽  
Urban Areas ◽  
Mail Survey ◽  
Access To Health Services ◽  
Full Coverage ◽  
Family Practitioners ◽  
Access To Health

The objectives of the study described in this article were to determine whether the faith of physicians in the Canadian system of health insurance depends on their assessment of quality and access to health services and whether their assessments of quality and access to health services affect their support of out-of-pocket and other methods of financing healthcare. To this end, a mail survey of 600 physicians in British Columbia and 240 physicians in Saskatchewan was conducted. The sample was stratified to ensure equal representation from urban and non-urban areas and between female and male specialists and family practitioners. Our conclusions indicate that physicians seem to be open minded in their views on financing. Their overriding concerns are to ensure the provision of sufficient resources to the healthcare system and to maintain full coverage of the population.

scholarly journals Do adult health outcomes in urban population reflect local health risk? A matched cohort analysis of migration effects in Ouagadougou, Burkina Faso

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029059
Author(s):  
Philippe Bocquier ◽  
Abdramane Bassiahi Soura ◽  
Souleymane Sanogo ◽  
Sara Randall
Keyword(s):  
Health Status ◽  
Health Services ◽  
Health Outcomes ◽  
Health Risks ◽  
Rural Areas ◽  
Urban Areas ◽  
Cohort Analysis ◽  
Local Health ◽  
Access To Health Services ◽  
Access To Health

BackgroundSelective migration may affect health indicators in both urban and rural areas. Sub-Saharan African urban areas show evidence of both negative and positive selection on health status at outmigration. Health outcomes as measured in urban populations may not reflect local health risks and access to health services.MethodsUsing the Ouagadougou Health and Demographic Surveillance System and a migrant follow-up survey, we measured differences in health between matched non-migrants and outmigrants. We applied Cox and competing risks models on migration and death.ResultsControlling for premigration health status, migrants who moved out of Ouagadougou have higher mortality (HR 3.24, 95% CI 1.23 to 8.58) than non-migrants and migrants moving to other Ouagadougou areas. However, these effects vanish in the matched sample controlling for all interactions between death determinants. These and other results show little evidence that migration led to higher mortality or worse health.ConclusionsHealth outcomes as measured in Ouagadougou population do reflect local health risks and access to health services despite high migration intensity. However, neither the hypothesis of effect of health on migration nor the hypothesis of negative effect of migration on health or survival was confirmed.

scholarly journals Vertical Equity in Access to Health Insurance Services: a Qualitative Analysis of Perceptions and Enrollment in the Jirapa Municipality, North-Western Ghana.

2020 ◽  
Author(s):  
Maximillian Kolbe Domapielle ◽  
Constance Awinpoka Akurugu ◽  
Emmanuel Kanchebe Derbile
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Rural Setting ◽  
Northern Ghana ◽  
Vertical Equity ◽  
Access To Health Services ◽  
Rural Residents ◽  
Middle Income ◽  
Strict Adherence ◽  
Access To Health

Abstract Background: Given concerns about the spiralling cost of health services in Low and Middle Income Countries (LMICs), this study draws on a framework for assessing poverty and access to health services to ascertain progress towards achieving vertical equity in the National Health Insurance Scheme (NHIS) in a rural setting in northern Ghana. Rural-urban disparities in financial access to NHIS services are seldom explored in equity-related studies although there is a knowledge gap of progress and challenges of implementing the scheme’s vertical equity objectives to inform social health protection planning and implementation. Methods: A qualitative approach was used to collect and analyse the data. Specifically, in-depth interviews and observation provided the needed data to critically analyse the relationship between location, livelihoods and ability to pay for health insurance services. Results: The article found that flat rate contributions for populations in the informal sector of the economy and lack of flexibility and adaptability of timing premium collections to the needs of rural residents make the cost of membership disproportionately higher for them, and this situation contradicts the vertical equity objectives of the NHIS. Conclusion: The study concludes that the current payment arrangements serve as important deterrence to poor rural residents enrolling in the scheme. Based on this, we advocate strict adherence and implementation of the scheme’s vertical equity measures through the adoption of the Ghana National Household Register (GNHR) as a tool for ensuring that contributions are based on income and also collection is well-timed.

scholarly journals Expanding the use of community health workers in urban settings: a potential strategy for progress towards universal health coverage

2019 ◽  
Author(s):  
Brian Wahl ◽  
Susanna Lehtimaki ◽  
Stefan Germann ◽  
Nina Schwalbe
Keyword(s):  
Health Services ◽  
Community Health ◽  
Low Income ◽  
Urban Areas ◽  
Access To Health Services ◽  
Middle Income ◽  
Urban Settings ◽  
Middle Income Countries ◽  
Access To Health ◽  
Low And Middle Income

Abstract Community health worker (CHW) programmes have been used for decades to improve access to health services in rural settings in low- and middle-income countries. With more than half of the world’s population currently living in urban areas and this population expected to grow, equitable access to health services in urban areas is critically important. To understand the extent to which CHW programmes have been successfully deployed in low-income urban settings, we conducted a review of the literature between 2000 and 2018 to identify studies evaluating and describing CHW programmes implemented fully or partially in urban or peri-urban settings. We identified 32 peer-reviewed articles that met our inclusion criteria. Benefits have been documented in several urban settings in low- and middle-income countries including those to address TB/HIV, child health, maternal health and non-communicable diseases through a variety of study designs.

scholarly journals Surviving on a mountain of rubbish: the state and access to health social security for female scavengers

2020 ◽  
Vol 5 (1) ◽  
pp. 119
Author(s):  
Fairus Dwi Putri ◽  
Khaerul Umam Noer
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Social Life ◽  
The State ◽  
Access To Health Services ◽  
Five Dimensions ◽  
Female Head ◽  
Access To Health ◽  
The Government ◽  
The Right

This paper focuses on the lives of women scavengers heads of households and how the state guarantees the fulfillment of the right to health. Women are relatively more vulnerable to various risks related to their life cycle and role in the family; thus, their access to health insurance is an obligation that must be met by the government. This paper has two objectives: to map social life and, at the same time, analyze the accessibility of the Healthy Indonesia National Health Insurance Card for female head of household scavengers in TPA Cipayung, Depok City. Using qualitative methods, and focusing on five dimensions of accessibility: availability, accessibility, accommodation, affordability, and acceptance, this study found that all health insurance arrangements are still very problematic. Even though these women scavengers are protected by JKN-KIS PBI, in reality, they are still challenging to get access to health services, ranging from the availability of doctors, the scarcity of drugs, to the discrimination of health services. This shows that they have not yet received full health insurance, which has a direct impact on the social and economic lives of the scavengers.

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

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. 

scholarly journals Equality Analysis of Main Health Indicators among Children under 5 Years in Uganda

1970 ◽  
Vol 29 (2) ◽  
Author(s):  
Adel Hussein Elduma
Keyword(s):  
Child Health ◽  
Health Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Indicators ◽  
Great Effort ◽  
Access To Health Services ◽  
Data Set ◽  
Access To Health ◽  
Children Under 5

BACKGROUND: Inequality in the access to health services is a major cause of health problemsamong children under five old. The aim of this analysis is to measure the inequality among children under-5 years in relation to main health indicators inUganda.METHOD: Main child health indicators data in Uganda were obtained from WHO inequity data set for the years 1995, 2000, 2001 and 2011. Indicators such as under-5 years mortality rate, underweight prevalence and full vaccination converge and child with infection access to health facilities were included in th analysis. For simple indicators, inequality difference wascalculated, and relative concentration index for complex order indicators was used. Four different inequality dimensions were used to work as stratifies for these indicators.RESULTS: Inequality regarding child health indicators was observed in different dimensions. It was clear that inequality among people living in rural areas were more than urban areas. Femaleshad high inequality than males. Poor and uneducated people are more likely to have inequality than rich and educated people.CONCLUSION: Great effort should be made to decrease inequality among children less than five years through access to health services for all groups in different areas. 

scholarly journals Vertical equity in access to health insurance services: An exploration of perceptions and enrolment in the Jirapa Municipality, north-western Ghana

2021 ◽  
Vol 2 (1) ◽  
pp. 1-12
Author(s):  
Maximillian Kolbe Domapielle ◽  
Constance Awinpoka Akurugu ◽  
Emmanuel Kanchebe Derbile
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Rural Setting ◽  
Northern Ghana ◽  
Vertical Equity ◽  
Access To Health Services ◽  
Rural Residents ◽  
Middle Income ◽  
Strict Adherence ◽  
Access To Health

Given concerns about the spiralling cost of health services in low and middle-income countries (LMICs), this study draws on a framework for assessing poverty and access to health services to ascertain progress towards achieving vertical equity in the National Health Insurance Scheme (NHIS) in a rural setting in northern Ghana. Rural-urban disparities in financial access to NHIS services are seldom explored in equity-related studies although there is a knowledge gap of progress and challenges of implementing the scheme’s vertical equity objectives to inform social health protection planning and implementation. A qualitative approach was used to collect and analyse the data. Specifically, in-depth interviews and observation were deployed to explore participants’ lived experiences, the relationship between location, livelihoods and ability to pay for health insurance services. The article found that flat rate contributions for populations in the informal sector of the economy and lack of flexibility and adaptability of timing premium collections to the needs of rural residents make the cost of membership disproportionately higher for them, and this situation contradicts the vertical equity objectives of the NHIS. The study concludes that the current payment regimes serve as important deterrence to poor rural residents enrolling in the scheme. Based on this, we advocate strict adherence and implementation of the scheme’s vertical equity measures through the adoption of the Ghana National Household Register (GNHR) as a tool for ensuring that contributions are based on income, and collection is well-timed

scholarly journals Gambaran Akses Pelayanan Kesehatan pada Balita di Indonesia

2019 ◽  
Vol 22 (1) ◽  
pp. 54-61
Author(s):  
Zainul Khaqiqi Nantabah ◽  
Zulfa Auliyati A ◽  
Agung Dwi Laksono
Keyword(s):  
Health Services ◽  
Health Center ◽  
Rural Areas ◽  
Golden Age ◽  
Urban Areas ◽  
Inpatient Care ◽  
Health Care Facilities ◽  
Access To Health Services ◽  
Access To Health ◽  
The Rich

ABSTRAK Anak balita merupakan periode masa yang disebut golden age. Akses pelayanan kesehatan untuk kelompok ini menjadi perhatian karena kesinambungan hidup pada kelompok tersebut menjadi salah satu tolok ukur pembangunan kesehatan. Penelitian ini merupakan analisis lanjut data Riskesdas 2013, yang disajikan secara deskriptif kuantitatif. Analisis dilakukan pada variabel-variabel cakupan kunjungan balita ke pelayanan kesehatan. Pelayanan kesehatan dimaksud adalah Rumah Sakit, Puskesmas/Pustu, Praktik Dokter/Klinik, dan Polindes/Praktik Bidan. Hasil penelitian menunjukkan bahwa balita yang tinggal di perkotaan dan pada kelompok kaya dan sangat kaya memiliki akses yang lebih baik di Rumah Sakit dan praktik dokter/klinik pada akses rawat jalan dan rawat inap. Sementara mereka yang tinggal di perdesaan dan pada kelompok miskin memiliki akses yang lebih baik ke Puskesmas/Pustu dan Polindes/praktik bidan baik di rawat jalan maupun rawat inap. Berdasarkan hasil penelitian dapat disimpulkan bahwa balita yang tinggal di perkotaan dan pada kelompok kaya memiliki akses yang lebih baik pada pelayanan kesehatan rujukan, sementara mereka yang tinggal di perdesaan dan pada kelompok miskin memiliki akses yang lebih baik di fasilitas pelayanan kesehatan dasar. Kata kunci: akses, pelayanan kesehatan, balita   ABSTRACT Toddler is a period of time called golden age. Access to health services for this group is a concern because the continuity of life in the group is one of the benchmarks for health development. This research is an advance analysis of the Riskesdas 2013, which is presented in quantitative descriptive manner. Analysis was carried out on the variables of coverage of toddler visits to health services. The intended health services are hospitals, health center/Pustu, doctor/clinic, and Polindes/midwife, both on outpatient visits and inpatients. The results showed that toddlers who lived in urban areas and in the rich and very rich groups had better access in hospitals and doctor/clinic practices on access to outpatient and inpatient care. While those who live in rural areas and the poor have better access to health center/Pustu and Polindes/ midwives both in outpatient and inpatient care. Based on the results of the study it can be concluded that toddlers who live in urban areas and in rich groups have better access to referral health services, while those who live in rural areas and in poor groups have better access to basic health care facilities. Keyword: access, health services, toddler

scholarly journals Women’s and Health Officer’s Knowledge on Access to Reproductive and Sexual Health Services Covered by the National Health Insurance: Surveys in 15 Districts-Cities in Indonesia

2019 ◽  
Vol 24 (3) ◽  
pp. 259
Author(s):  
Herna Lestari ◽  
Atnike Nova Sigiro
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Sexual Health ◽  
National Health Insurance ◽  
National Health ◽  
Sexual And Reproductive Health ◽  
Longitudinal Research ◽  
Access To Health Services ◽  
Access To Health ◽  
Reproductive And Sexual Health

<p>The availability of reproductive and sexual health services provided by the National Health Insurance (Jaminan Kesehatan National/JKN) in Indonesia could expand women’s access to reproductive and sexual health services. However, the knowledge of community and service provider will determine to what extent women will access the reproductive and sexual health services provided by JKN. This article assesses and analyzes the knowledge of women and health officers about the availability of reproductive and sexual health services provided in JKN. The article elaborates for main findings from the research that was conducted by women organizations that are members of the Women’s Health Care Network (Jaringan Perempuan Peduli Kesehatan or JP2K). JP2K conducted longitudinal research with a series of surveys in 2015, 2016, and 2017 in 15 regions of districts/cities in Indonesia on knowledge and access to reproductive and sexual health services provided by JKN. The surveys show limited knowledge of the respondents, both women and health officers, about forms and scope of reproductive and sexual health services that are covered by JKN. The research concludes that one of the important agendas for encouraging women’s access to health services covered by JKN is through intensifying the socialization of the scope of sexual and reproductive health to women and health facility officers.</p>

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