scholarly journals Catastrophic Health Expenditures and Mental Health in Older Chinese People: The Role of Social Health Insurance

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 121-121
Author(s):  
Wei Yang ◽  
Bo Hu
Keyword(s):  
Mental Health ◽  
Health Insurance ◽  
Fixed Effects ◽  
Mental Health Problems ◽  
Social Health Insurance ◽  
Health Financing ◽  
Catastrophic Health Expenditure ◽  
Social Health ◽  
Protective Effects ◽  
Healthcare Needs

Abstract Catastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the impacts of CHE on people’s mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether and to what extent social health insurance (SHI) can lessen the impacts of CHE on mental health among older people aged over 60 in China. The data come from three waves of the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, and 2015, N = 13,166). We built fixed-effects quantile regression models to analyse the data. We found that incurring CHE has significantly detrimental effects on older people’s mental health, whereas the SHI demonstrates a protective effect. The observed protective effects of SHI are the strongest among those with relatively mild mental health problems, i.e., people whose CES-D scores are below the 50th percentile. Our findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for those with higher healthcare needs.

scholarly journals Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Obinna Onwujekwe ◽  
Nkoli Ezumah ◽  
Chinyere Mbachu ◽  
Felix Obi ◽  
Hyacinth Ichoku ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Health Financing ◽  
Catastrophic Health Expenditure ◽  
Social Health ◽  
Health Coverage ◽  
Health Maintenance ◽  
Use Of Resources ◽  
Regulatory Frameworks ◽  
Legal Frameworks

Abstract Background Various attempts to examine health financing mechanisms in Nigeria highlight the fact that there is no single mechanism that fits all contexts and people. This paper sets out findings of an in-depth assessment of different health financing mechanisms in Nigeria. Methods The study was undertaken in the Federal Capital territory of Nigeria and two States (Niger and Kaduna). Data were collected through review of government documents, and in-depth interviews of purposively selected respondents. Data analysis was guided by a conceptual framework which draws from various approaches for assessing health financing mechanisms. Data was examined for current practices, what needs to change and how the change can happen. Results Health financing mechanisms in Nigeria do not operate optimally. Allocation and use of resources are neither evidence-based nor results-driven. Resources are not allocated equitably or in a manner that minimizes wastage and improves efficiency. None of the mechanisms effectively protects individuals/households from catastrophic health expenditure. Issues with social health insurance cut across legal frameworks and use of Health Maintenance Organisations (HMOs) as purchasers. The concomitant effect is that attainment of Universal Health Coverage is greatly compromised. In order to improve efficiency of health financing mechanisms, government needs to allocate more funds for purchasing health services; this spending must be based on evidence (strategic), and appropriately tracked. The legislation that established National Health Insurance Scheme should be amended such that social health insurance becomes mandatory for all citizens. Implementation of the latter should be complemented by revision of benefit package, strict oversight and regulation of HMOs. Conclusion In order to improve health financing in the country, legal and regulatory frameworks need to be revised. Efficient utilization of resources could be improved through strategic purchasing arrangements and strict oversight.

scholarly journals Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chinyere Mbachu ◽  
Chinyere Okeke ◽  
Chinonso Obayi ◽  
Agnes Gatome-Munyua ◽  
Nkechi Olalere ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Health Financing ◽  
The State ◽  
Social Health ◽  
Defined Benefit ◽  
Data Systems ◽  
Government Documents ◽  
Provider Payment ◽  
Document Review

Abstract Background Tracking general trends in strategic purchasing of health financing mechanisms will highlight where country demands may exist for technical support and where progress in being made that offer opportunities for regional learning. Health services in Abia State, Nigeria are funded from general tax-revenues (GTR), and a new state social health insurance scheme (SSHIS) is proposed to overcome the failings of the GTR and expand coverage of services. This study examined purchasing functions within the GTR and the proposed SSHIS to determine if the failings in GTR have been overcome, identify factors that shape health purchasing at sub-national levels, and provide lessons for other states in Nigeria pursuing a similar intervention. Methods Data was collected through document review and key informant interviews. Government documents were retrieved electronically from the websites of different organizations. Hard copies of paper-only files were retrieved from relevant government agencies and departments. Interviews were conducted with seven key personnel of the State Ministry of Health and State Health Insurance Agency. Thematic analysis of data was based on a strategic health purchasing progress tracking framework which delves into the governance arrangements and information architecture needed for purchasing to work well; and the core purchasing decisions of what to buy; who to buy from; and how to buy. Results There are differences in the purchasing arrangements of the two schemes. Purchaser-provider split does not exist for the GTR, unlike in the proposed SSHIS. There are no data systems for monitoring provider performance in the GTR-funded system, unlike in the SSHIS. Whereas GTR is based on a historical budgeting system, the SSHIS proposes to use a defined benefit package, which ensures value-for-money, as the basis for resource allocation. The GTR lacks private sector engagement, provider accreditation and contracting arrangements while the SSHIS will accredit and engage private providers through selective contracting. Likewise, provider payment is not linked to performance or adherence to established standards in the GTR, whereas provider payment will be linked to performance in the SSHIS. Conclusions The State Social Health Insurance has been designed to overcome many of the limitations of the budgetary allocation to health. This study provides insights into the enabling and constraining factors that can be used to develop interventions intended to strengthen the strategic health purchasing in the study area, and lessons for the other Nigeria states with similar characteristics and approaches.

scholarly journals Healthcare Financing in Nigeria: The Analysis of the Inequity Perspective

2019 ◽  
Vol 7 (3) ◽  
Author(s):  
Akanni Olayinka Lawanson ◽  
Sekinat Olaide Opeloyeru
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Household Survey ◽  
Quality Of Healthcare ◽  
Social Health ◽  
Healthcare Financing ◽  
Healthcare Needs ◽  
Improve Health Status ◽  
General Household Survey

The volume and quality of healthcare needs vary from one individual to another but promoting access to the use of healthcare is germane to reduce/eliminate inequity in healthcare. This paper examines the extent of equity in healthcare financing in Nigeria, and determine the relative progressivity of each source of healthcare financing in the country using waves 2 and 3 of the General Household Survey. Kakwani and Modified Kakwani (MDK) indexes were used to estimate progressivity of out of pocket payment (OOP) and social health insurance. Overall result indicates a vertical inequity favouring the non-poor (pro-rich), OOP as a source of financing was regressive and social health insurance was moderately progressive. Given that a more progressive healthcare financing approach tends to promote welfare and improve health status of the population, Nigeria will be better off promoting health insurance as a means of eliminating inequity in healthcare financing.

scholarly journals Framing universal health coverage in Kenya: an interpretive analysis of the 2004 Bill on National Social Health Insurance

2020 ◽  
Author(s):  
Adam D Koon ◽  
Benjamin Hawkins ◽  
Susannah H Mayhew
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Health Financing ◽  
Social Health ◽  
Health Coverage ◽  
Structured Interviews ◽  
Financing Policy ◽  
Economic Liberalism ◽  
Interpretive Analysis ◽  
Document Review

Abstract In 2004, President Mwai Kibaki of Kenya refused to sign a popular Bill on National Social Health Insurance into law. Drawing on innovations in framing theory, this research provides a social explanation for this decision. In addition to document review, this study involved interpretive analysis of transcripts from 50 semi-structured interviews with leading actors involved in the health financing policy process in Kenya, 2014–15. The frame-critical analysis focused on how actors engaged in (1) sensemaking, (2) naming, which includes selecting and categorizing and (3) storytelling. We demonstrated that actors' abilities to make sense of the Bill were largely influenced by their own understandings of the finer features of the Bill and the array of interest groups privy to the debate. This was reinforced by a process of naming, which selects and categorizes aspects of the Bill, including the public persona of its primary sponsor, its affordability, sustainability, technical dimensions and linkages to notions of economic liberalism. Actors used these understandings and names to tell stories of ideational warfare, which involved narrative accounts of policy resistance and betrayal. This analysis illustrates the difficulty in enacting sweeping reform measures and thus provides a basis for understanding incrementalism in Kenyan health policy.

Which Therapeutic Progress Shall be Paid by Social Health Insurance?

2007 ◽  
Author(s):  
Jürgen Wasem ◽  
Hans-Dieter Nolting ◽  
Yvonne Grabbe ◽  
Stefan Loos
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Social Health

Trade Unions and the Welfare of Rural-Urban Migrant Workers in China

ILR Review ◽  
2021 ◽  
pp. 001979392110044
Author(s):  
Alison Booth ◽  
Richard Freeman ◽  
Xin Meng ◽  
Jilu Zhang
Keyword(s):  
Mental Health ◽  
Trade Union ◽  
Migrant Workers ◽  
Trade Unions ◽  
Fixed Effects ◽  
Mental Health Problems ◽  
Panel Survey ◽  
Monthly Income ◽  
Work Related ◽  
Urban Migrant

Using a panel survey, the authors investigate how the welfare of rural-urban migrant workers in China is affected by trade union presence at the workplace. Controlling for individual fixed effects, they find the following. Relative to workers from workplaces without union presence or with inactive unions, both union-covered non-members and union members in workplaces with active unions earn higher monthly income, are more likely to have a written contract, be covered by social insurances, receive fringe benefits, express work-related grievances through official channels, feel more satisfied with their lives, and are less likely to have mental health problems.

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.

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