Ethical Reflections on the Equity of the Current Basic Health Insurance System Reform in China: A Case Study in Hunan Province

2018 ◽  
Vol 27 (3) ◽  
pp. 447-458 ◽  
Author(s):  
JUNXIANG LIU ◽  
JINGZI XU ◽  
TIANYU ZHANG ◽  
YONGHUI MA
Keyword(s):  
Health Insurance ◽  
Hunan Province ◽  
Vulnerable Groups ◽  
System Reform ◽  
Health Insurance System ◽  
Basic Health Insurance ◽  
Basic Health ◽  
Insurance System ◽  
Insurance Reform ◽  
Health Insurance Reform

Abstract:China’s current basic health insurance reform aims at promoting equity in the economic accessibility of health services for all citizens, to better ensure healthcare justice. Therefore, it is important to assess equity not only from a socioeconomic perspective but also from an ethical angle. This article investigates the basic health insurance system of Hunan Province in China by focusing on insurance types as well as their classification standards, mechanisms, and utilization according to local policy documents and data. This study demonstrates the reforming achievements and the inequity of institutional design according to two interrelated dimensions: equal opportunity of access to healthcare insurance and reducing inequality in insurance benefits. The article concludes that to achieve opportunity equity and outcome fairness, the reform should focus on designing the system to promote equity with respect to procedures and rules and to be more attentive to the interests of vulnerable groups and especially to rural residents.

scholarly journals Health Insurance in Myanmar: The Views and Perception of Healthcare Consumers and Health System Informants on the Establishment of a Nationwide Health Insurance System

Risks ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 81
Author(s):  
Marjolein van Rooijen ◽  
Chaw-Yin Myint ◽  
Milena Pavlova ◽  
Wim Groot
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Rural Areas ◽  
Social Protection ◽  
Vulnerable Groups ◽  
Health Insurance System ◽  
Structured Interviews ◽  
Insurance System ◽  
Supplementary Health Insurance ◽  
Insurance Model

(1) Background: Health insurance and social protection in Myanmar are negligible, which leaves many citizens at risk of financial hardship in case of a serious illness. The aim of this study is to explore the views of healthcare consumers and compare them to the views of key informants on the design and implementation of a nationwide health insurance system in Myanmar. (2) Method: Data were collected through nine focus group discussions with healthcare consumers and six semi-structured interviews with key health system informants. (3) Results: The consumers supported a mandatory basic health insurance and voluntary supplementary health insurance. Tax-based funding was suggested as an option that can help to enhance healthcare utilization among the poor and vulnerable groups. However, a fully tax-based funding was perceived to have limited chances of success given the low level of government resources available. Community-based insurance, where community members pool money in a healthcare fund, was seen as more appropriate for the rural areas. (4) Conclusion: This study suggests a healthcare financing mechanism based on a mixed insurance model for the creation of nationwide health insurance. Further inquiry into the feasibility of the vital aspects of the nationwide health insurance is needed.

scholarly journals Trade-off between Efficiency and Equity on the Rationing in Health Insurance System: the Burden on the Poor

2019 ◽  
Author(s):  
Manal Etemadi ◽  
HasanAbolghasem Gorji
Keyword(s):  
Health Insurance ◽  
Vulnerable Groups ◽  
Service Access ◽  
Health Insurance System ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Financing System ◽  
Insurance System ◽  
The Poor ◽  
Main Challenge

Background: Nearly all of the rationing mechanisms have negative impacts on the poor. If the fair service access is not set as the top priority in the rationing choices, the poor will experience service limitation and scarcity. This study aims at investigating the effects of rationing policies on the poor covered by Iran Health Insurance System. Methods: This article is based on a qualitative study conducted in 2017. In total, 32 experts of health system financing participated in the study. A purposeful sampling method was applied till reaching knowledge saturation. Data were collected using semi-structured interviews. Afterwards, data was analyzed by framework analysis based on Bennet and Gilson pro-poor health financing system framework using MAXQDA10 software.        Results: The main challenge of rationing through the insurance system in Iran is the rationing only for the poor. As a result of rationing decisions, the poor are mostly the first group affected by service limitation only because they exempted from paying the premium. The current implicit or explicit health services rationing policies in each dimension has jeopardized the access of the poor to the services. Conclusion: Every resource allocation and negotiation of service purchaser on the budgets should be aligned with the focus on vulnerable groups and their needs. The access of deprived groups should not be reduced for limited budgets or income prioritization. Every decision about the constraints on the usage of the services should be accompanied by the analysis of potential effects on the poor and preventive policies should be implemented so that the burden of service rationing could not be imposed on the poor

scholarly journals Health insurance reform in China after the 16th National Congress of the Communist Party of China

2020 ◽  
pp. 1-10
Author(s):  
Khentsze Lyu
Keyword(s):  
Health Insurance ◽  
Communist Party ◽  
Healthcare Sector ◽  
Communist Party Of China ◽  
Insurance System ◽  
Insurance Reform ◽  
Stage Of Development ◽  
Health Insurance Reform ◽  
National Congress ◽  
The Government

This article reviews the health insurance reforms in China for the period from 2002 to the present. It stated that 16th National Congress of the Communist Party of China introduced significant amendments to health insurance system, balancing the negative impact of capitalist mechanisms, on the one hand, and justice and equality – on the other. This stage of development in China’s healthcare insurance system is described as the “second generation” in healthcare system, characterized with the change of government’s role in allocation of resources in healthcare sector: proliferation of “wild capitalism” in medicine is replaced with the concept of granting freedom to the market mechanisms under the government supervision. The reforms of PRC government in the area of health have a clear social focus. The state takes over responsibility for health of the citizens, which was released to a free market in the “new course” of the 1980s – 1990s. At the same time, the former paternalistic scheme is replaced by the equal system of interaction between society and the government. In all cases, the insurance funds are formed out of personal deposits of the citizens and deposits of local and central authorities. Municipalities are responsible for majority of decisions in the area of development of insurance schemes. The government’s role consists in establishment of minimum deposits and maximum coverage. This is how the central authorities, local administration and citizens are involved in insurance schemes on equal terms.

scholarly journals Employer-Sponsored Health Insurance and the Promise of Health Insurance Reform

2009 ◽  
Vol 46 (2) ◽  
pp. 187-202 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
Alan C. Monheit
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Goodness Of Fit ◽  
Insurance Coverage ◽  
Health Care Financing ◽  
Health Insurance Coverage ◽  
System Reform ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
National Debate

The central role that employers play in financing health care is a distinctive feature of the U.S. health care system, and the provision of health insurance through the workplace has important implications well beyond its role as a source of health care financing. In this paper, we consider the “goodness of fit” of employer-sponsored health insurance (ESI) in the current economic and health insurance environments and in light of prospects for a vigorous national debate over the shape of health care reform. The main issue that we explore is whether ESI can have a viable role in health system reform efforts or whether such coverage will need to be significantly modified or even abandoned as reform seeks to address important issues in the efficient provision and equitable distribution of health insurance coverage.

scholarly journals Dental Expenditure by Household Income in Korea over the Period 2008–2017: A Review of the National Dental Insurance Reform

2021 ◽  
Vol 18 (8) ◽  
pp. 3859
Author(s):  
Hosung Shin ◽  
Han-A Cho ◽  
Bo-Ra Kim
Keyword(s):  
Health Insurance ◽  
Concentration Index ◽  
Dental Health ◽  
Age Groups ◽  
The Elderly ◽  
Dental Service ◽  
Delta Method ◽  
Dental Services ◽  
Insurance Reform ◽  
Health Insurance Reform

Since 2009, the National Health Insurance in Korea (NHI) has been implementing a series of policies to expand the scope of dental benefits. This study reviewed the changes in co-payments and dental use patterns before (2008 to 2012) and after (2013 to 2017) the NHI’s dental health insurance reform. The study used Korea Health Panel data of 7681 households (16,493 household members) from a 10-year period (2008–2017). Dental expenditures and equivalent income using square root of household size were analyzed. Dental services were categorized into 13 types and a concentration index and 95% confidence interval using the delta method was calculated to identify income-related inequalities by a dental service. Dental expenditures and the number of dental services used increased significantly, while the proportion of out-of-pocket spending by the elderly decreased. The expenditure ratio for implant services to total dental expenditures increased substantially in all age groups, but the ratio of expenditures for dentures and fixed bridges decreased relatively. The concentration index of implant services was basically in favor of the rich, but there was no longer a significant bias favoring the better-off after the reforms. The dental health insurance reform in Korea appears to contribute not only to lowering the ratio of out-of-pocket to total dental expenses per episode in the elderly but also to improving the inequality of dental expenses.

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