scholarly journals The prominent role of informal medicine vendors despite health insurance: a weekly diaries study in rural Nigeria

2020 ◽  
Vol 35 (3) ◽  
pp. 354-363
Author(s):  
Heleen E Nelissen ◽  
Daniëlla Brals ◽  
Hafsat A Ameen ◽  
Marijn van der List ◽  
Berber Kramer ◽  
...  
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Expenditures ◽  
Insurance Status ◽  
Health Coverage ◽  
Rural Nigeria ◽  
Informal Providers ◽  
Insurance Programme ◽  
Universal Health

Abstract In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.

Population Coverage to Reach Universal Health Coverage in Selected Nations: A Synthesis of Global Strategies

2020 ◽  
Author(s):  
Minoo ALIPOURI SAKHA ◽  
Najmeh BAHMANZIARI ◽  
Amirhossein TAKIAN
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Coverage ◽  
Political Commitment ◽  
Population Coverage ◽  
Definite Indicator ◽  
Expanding Population ◽  
Universal Health

Background: This study aimed to provide tailored transferrable lessons for expanding population coverage through a descriptive lens by reviewing the population coverage policies, reforms and strategies in selected nations. Methods: In this comparative short communication, 14 countries with different status of population coverage and political economy that had successful experiences with coverage expansion were selected and categorized in four groups to study their approaches to reach Universal Health Coverage (UHC). Results: Although each country needs to tailor its policies and reforms based on its own contextual factors, the legal right of citizens to social security and health protection are enshrined in most countries' Constitution. Some countries adapted political and economic reforms to evolve their Social Health Insurance schemes. National laws to push governments to adapt UHC as a national strategy for ensuring that every resident is enrolled in health insurance schemes are key policies to reach UHC. Conclusion: A series of reforms are required to provide total population coverage through various approaches. To create an effective insurance coverage, physical merger of all insurance funds is not necessarily required. Further, the share of GDP for health is not a definite indicator to reach UHC. Finally, strong political commitment and citizens’ participation are the key issues in reaching UHC, while considering the poorest, remote and neglected population really matters.  

scholarly journals Gambaran Out of Pocket pada Awal Era JKN di Indonesia

2018 ◽  
pp. 141-146
Author(s):  
Ingan Tarigan ◽  
Taty Suryati
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Financial Protection ◽  
Health Coverage ◽  
Medical Expenses ◽  
The Poor ◽  
The Government ◽  
Universal Health

Abstrak Pogram Jaminan Kesehatan Nasional (JKN) salah satunya bertujuan memberikan perlindungan finansial khususnya biaya katastropik terhadap semua peserta. Penerima manfaat JKN berhak mendapatkan berbagai layanan sebagai bagian dari paket manfaat dasar tanpa mengeluarkan biaya pelayanan, dan diharapkan Out of Pocket (OOP) akan lebih rendah dibandingkan dengan mereka yang tidak memiliki asuransi kesehatan. Tujuan penulisan akan membandingkan total pengeluaran untuk kesehatan dari peserta jaminan kesehatan dengan yang tidak memiliki jaminan kesehatan pada awal era JKN. Dalam analisis ini, pengukuran pengeluaran perawatan kesehatan hanya mencakup biaya pengobatan langsung, seperti biaya konsultasi, pemakaian kamar di rumah sakit dan obat-obatan. Analisis dengan menggunakan data Susenas 2014 terdiri dari 274.673 individu dan 71.051 rumah tangga di 33 provinsi di Indonesia. Hasil penelitian menunjukkan bahwa pada awal era JKN ada sedikit perbedaan OOP pada penduduk miskin dibandingkan dengan penduduk dimana proteksi finansial terhadap penduduk miskin untuk pengeluaran kesehatan masih rendah.Kepemilikan jaminan kesehatan memberikan proteksi finansial akibat pengeluaran biaya kesehatan, khususnya pengeluaran biaya katastropik dibandingkan dengan yang tidak memiliki jaminan kesehatan. Kepesertaan penduduk miskin ditargetkan tahun 2019 sudah terpenuhi sehingga target pemerintah tentang Universal Health Coverage (UHC) perlindungan finansial pada penduduk miskin dan hampir miskin semakin tinggi atau OOP semakin mendekati nol. Kata kunci: OOP, Pembiayaan, Asuransi Kesehatan Abstract One of the main objectives of the JKN program is to provide financial protection, especially catastrophic costs to all members. JKN beneficiaries are entitled to various services as part of the basic benefit package without incurring service costs, and it is expected that Out of Pocket (OOP) will be lower than those who do not have health insurance. The purpose of writing will be to compare the total health expenditures of health insurance participants or beneficiaries and those without health insurance. In this analysis, the measurement of health care expenditures only includes direct medical expenses, such as consultation fees, hospital room usage and medication. Using Susenas data 2014 consists of 274,673 individuals and 71,051 households in 33 provinces in Indonesia. At the beginning of the JKN implementation, there was little difference of out of pocket in the poorest population compared to the richest population. This shows that financial protection to the poor for health expenditures are still low. The ownership of health insurance tends to provide financial protection due to health expenditures, especially catastrophic expenses compared to those without health insurance. In the Year of 2019 where the government targeted to Universal Health Coverage (UHC) expected protection financial on the poor and near poor is getting higher or out of pocket or getting closer up to zero. Keywords: OOP, Financial Protection, Health Insurance

scholarly journals Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Leila Doshmangir ◽  
Mohammad Bazyar ◽  
Arash Rashidian ◽  
Vladimir Sergeevich Gordeev
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Equity ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Impact ◽  
Universal Health

Abstract Background Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. Methods This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Results Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. Conclusion To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.

scholarly journals PEMANFAATAN JAMINAN KESEHATAN DALAM PELAYANAN KESEHATAN IBU DI TUJUH KABUPATEN/KOTA DI INDONESIA

2019 ◽  
Vol 18 (2) ◽  
pp. 111-121
Author(s):  
Heny Lestary ◽  
Sugiharti Sugiharti ◽  
Suparmi Suparmi
Keyword(s):  
Health Insurance ◽  
Maternal Health ◽  
Antenatal Care ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Reproductive Age ◽  
Health Coverage ◽  
Delivery Services ◽  
Universal Health

ABSTRACT  Since 2014, Indonesia has been implementing universal health coverage to increase health insurance coverage. However, health insurance utilization by the community for maternal health is still low. This research aimed to determine factors related to the use of health insurance for antenatal care and delivery services among pregnant and childbirth women. The research conducted in 7 districts/cities, namely Kota Bandar Lampung, Kota Palembang, Kabupaten Lebak, Kabupaten Karawang, Kota Semarang, Kota Surabaya, dan Kota Makasar. A total of 517 respondents has been interviewed. The results showed that most respondents aged 21-34 years (68.5%), unemployed (74.7%) and graduated from high school or higher (58.4%). Around 11% of the respondent had health insurance. 73.0% of respondents who had health insurance used it for antenatal care and 88.3% used it for delivery. Multivariate analysis shows that the level of income is related to the use of health insurance for antenatal care and delivery, whereas mothers who have income level higher than Rp 2,000,000 had lower odds to utilize health insurance for antenatal care (OR=0,56; 95%CI:0,35 - 0,91) and delivery (OR=0,52; 95%CI:0,27 - 1,02). Therefore, there is a need for broader socialization of health insurance utilization for antenatal and delivery, especially for couples at reproductive age. Keywords: Health insurance, health services, maternal health   ABSTRAK Pada tahun 2014, Indonesia mulai melaksanakan Universal Health Coverage untuk meningkatkan cakupan jaminan kesehatan. Namun, pemanfaatan jaminan kesehatan oleh masyarakat untuk kesehatan ibu masih rendah. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan pemanfaatan jaminan kesehatan untuk pemeriksaan kehamilan dan pelayanan persalinan pada ibu hamil dan bersalin. Penelitian dilaksanakan di 7 (tujuh) kabupaten/kota, yaitu Kota Bandar Lampung, Kota Palembang, Kabupaten Lebak, Kabupaten Karawang, Kota Semarang, Kota Surabaya, dan Kota Makasar. Sebesar 517 responden yang berhasil diwawancarai. Hasil analisis menunjukkan bahwa sebagian besar responden berumur 21 – 34 tahun (68,5%), tidak bekerja (74,7%) dan berpendidikan tamat SMA+ (58,4%). Sekitar 11,0% responden tidak memiliki jaminan kesehatan. Dari responden yang memiliki jaminan kesehatan, hanya 73,0% di antaranya yang memanfaatkan untuk pemeriksaan kehamilan dan 88,3% memanfaatkan untuk persalinan. Analisis multivariat menunjukkan bahwa tingkat pendapatan berhubungan dengan pemanfaatan jaminan kesehatan untuk pemeriksaan kehamilan, dan persalinan, dimana ibu yang memiliki tingkat pendapatan ≥Rp 2.000.000,- memiliki kemungkinan lebih rendah untuk memanfaatkan jaminan kesehatan untuk pemeriksaan kehamilan (OR=0,56; 95%CI:0,35 - 0,91) maupun persalinan (OR=0,52; 95%CI:0,27 - 1,02). Oleh sebab itu, perlu sosialisasi lebih luas agar memanfaatkan jaminan kesehatan untuk pemeriksaan kehamilan dan persalinan, terutama pada Pasangan Usia Subur (PUS). Kata kunci: Jaminan kesehatan, pelayanan kesehatan, kesehatan ibu

scholarly journals Health Insurance for Universal Health Coverage in India: A Critical Analysis based on Coverage, Distribution and Predictors from National Family Health Survey – 4 Data

2019 ◽  
Author(s):  
Vikash R Keshri ◽  
Saswata Ghosh
Keyword(s):  
Health Insurance ◽  
Health Survey ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Family Health ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
National Family Health Survey ◽  
National Family ◽  
Universal Health

Abstract Background: The movement for Universal Health Coverage (UHC) is gaining momentum. Health insurance is emerging as one of the favoured means to finance healthcare. The union government of India also started a health insurance scheme in 2018 in the spirit to leap towards UHC. Therefore, this study was carried out with the following objectives. To understand the coverage, distribution, and predictors of health insurance coverage in India. To examine the role of Pradhan Mantri Jan Arogya Yojana (PM-JAY) towards the goal of UHC in India. Methods: We analyzed unit-level data from the fourth round of National Family Health Survey (NFHS-4) to understand the coverage, distribution and predictors of health insurance. We categorized the health insurance schemes into four major categories based on standard categorization . The descriptive and bivariate analysis was conducted to understand the coverage and distribution and logit regression analysis was carried out to understand the predictors. Results: The overall health insurance coverage in India was around 25% out of which 22% is mandatory health insurance. Less than 2% of households reported having any voluntary health insurance. Household wealth and education of the head of households were found to be directly proportional to health insurance coverage. Overall, there was very wide inter-state and inter-class variation in health insurance coverage, which reflect a major void in the existing programmes. Conclusions: To achieve UHC in India, a definite policy direction is needed to protect those groups of citizens, who either not covered or are only partially covered from health insurance scheme. Either the PM-JAY scheme should be expanded for the larger population or an alternative health financing model is to be explored to expand the population coverage. Key-words: Health Insurance, Universal Health Coverage, India, Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana, National Family Health Survey.

scholarly journals Perkembangan Asuransi Kesehatan Swasta di Indonesia 2012 – 2016

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Kurnia Sari, SKM, MSE
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Life Insurance ◽  
Private Health Insurance ◽  
Private Insurance ◽  
Health Expenditures ◽  
Insurance Company ◽  
Health Coverage ◽  
Private Insurance Company ◽  
Universal Health

Abstrak Total belanja asuransi swasta di tahun 2015 sekitar 3,9% dari pengeluaran kesehatan Indonesia. Walaupun tidak cukup besar, informasi tentang asuransi kesehatan swasta di Indonesia masih terbatas. Kajian ini ditujukan untuk memberikan gambaran perkembangan perusahaan asuransi kesehatan swasta di Indonesia. Jumlah perusahaan asuransi swasta dalam beberapa ta­hun terakhir tidak banyak tumbuh, sementara jumlah kepesertaannya cenderung fluktuatif dalam 5 tahun terakhir, bahkan turun untuk kelompok asuransi kerugian. Uang pertanggungan cenderung naik sampai tahun 2014, lalu stagnan pada periode berikutnya. Jumlah premi yang diterima perusahaan dan klaim yang harus dibayarkan cenderung naik, dengan rasio klaim yang cukup tinggi pada asuransi kerugian dan dalam batas wajar untuk asuransi jiwa. Tidak dapat dipungkiri bahwa program pemerintah untuk mencapai universal health coverage merupakan sebuah ancaman bagi pihak asuransi swasta.AbstractTotal private insurance spending in 2015 is about 3.9% of Indonesia’s health expenditures. Although it is not considerably high, the information about private health insurance in Indonesia is still limited. This review is aimed to provide an overview of the private health insurance company growths in Indonesia. The number of private insurance company does not grow significantly, while the number of membership tends to fluctuate in the last 5 years, even it is tend to decrease for non life insurance category. Sums assured tend to rise until 2014, then stagnant for the next period. The amount of premium received by the company and claims to be paid (claim ratio) is considerably increase. It could not be denied that government program for achieving the universal health coverage is a threat to private insurance.

scholarly journals Media Exposure and the Social Determinants of Health Insurance Coverage in Ethiopia 2011 - 2016

2021 ◽  
Author(s):  
Eniola Olatunji ◽  
Sanam Maredia ◽  
Allen Nguyen ◽  
Natalie Freeman ◽  
David J Washburn
Keyword(s):  
Health Insurance ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Media Exposure ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Social ◽  
Universal Health

Background: In a push for universal health coverage, Ethiopia introduced two insurance schemes in 2010. Yet coverage rates remain very low. To encourage greater adoption, policymakers require a better understanding of who chooses to enroll and which promotional efforts are most effective in encouraging enrollment. Objective: Using nationally representative Demographic and Health Surveys, this research assessed the social determinants of health insurance coverage, including media exposure, in Ethiopia from 2011-2016. Methods: This research analyzed health insurance coverage and other sociodemographic and media exposure variables using multivariable logistic regression model. Results: Health insurance coverage increased 3.30 times from 1.48% in 2011 to 4.89% in 2016. In both years, coverage was associated with higher education, older age, higher wealth levels, and exposure to newspaper and television. Compared to those with no exposure to newspaper, those with newspaper exposure at least once a week were 1.80 times (2011) and 1.86 times (2016) more likely to be insured. Similar results were obtained for television exposure. Conclusion: Initiatives that target the poor and less educated will be necessary if Ethiopia is to achieve universal health coverage. This research suggests that, to date, newspaper and television mediums have been effective promotion mechanisms for growing enrollment.

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