Slovenia

2021 ◽  
pp. 788-808
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Primary Care Physicians ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Party Competition ◽  
Social Health ◽  
Large Hospital ◽  
Health Politics ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Slovenia based on compulsory social health insurance. It traces the development of the Slovenian healthcare system from the first health insurance schemes to the more established insurance system with universal coverage and focus on social medicine under communism. Since its independence in 1992, Slovenian politics has been marked by a pragmatic model of party competition with an important role in healthcare policymaking played by neo-corporatist structures. The major post-communist reform was the introduction of complementary private health insurance in 1993, which covers the majority of the population. Several unsuccessful reform proposals sought the abolition of complementary private insurance, the fairness of which remains the most controversial question regarding the system. Other healthcare issues outlined in the chapter include large hospital debt and uneven distribution of primary care physicians.

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.

Serbia

2021 ◽  
pp. 918-928
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Waiting Lists ◽  
The Self ◽  
Social Health ◽  
Healthcare Provision ◽  
Health Politics ◽  
Insurance System ◽  
Insurance Model ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Serbia based on compulsory social health insurance. It traces the development of the Serbian healthcare system after the breakup of Socialist Federal Republic of Yugoslavia, characterized by a move from the self-managed insurance model to a more standard Bismarckian health insurance system combined with passive privatization. Despite efforts to restructure healthcare provision through a reform in 2005, the system’s two-tier structure remains firmly entrenched, protected by professional interests. The chapter highlights other healthcare issues including long waiting lists and corruption.

Poland

2021 ◽  
pp. 745-766
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Public Hospitals ◽  
Social Health ◽  
Health Politics ◽  
Insurance System ◽  
Out Of Pocket Payments ◽  
Healthcare Politics ◽  
Veto Points ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Poland, financed through social health insurance. It traces the development of the Polish healthcare system under communism, characterized by a complete shift from an insurance system to a state-run Soviet Semashko model of healthcare with some elements of private provision. Since 1989, Polish health policy went through systemic changes which included a shift to a decentralized social health insurance system in the late 1990s and re-centralization in 2001. Polish healthcare politics has been turbulent, marked by political instability matched by a dense network of veto points, including the President and the judiciary, that had an impact on the direction of health reforms. As the chapter highlights, some of the main issues have been high out-of-pocket payments, corruption, and privatization and commercialization of public hospitals.

Croatia

2021 ◽  
pp. 908-917
Author(s):  
Tamara Popic
Keyword(s):  
Health Policy ◽  
Health Insurance ◽  
Health System ◽  
Policy Development ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Insurance Fund ◽  
Health Politics ◽  
Insurance Model ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Croatia based on compulsory social health insurance combined with elements of private insurance. Since its independence in 1993, Croatia’s health policy has been marked by a move from the Yugoslav self-managed insurance model to a more standard Bismarckian health insurance system. These reforms were combined with controlled efforts to privatize healthcare financing and delivery including, among others, the 2001 introduction of complementary private insurance. While Croatia’s health policy development suggests path dependency, the chapter highlights several issues facing the country’s health system such as hospital debts and the deficit of the national health insurance fund.

Montenegro

2021 ◽  
pp. 929-938
Author(s):  
Natalija Perišić
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Healthcare Delivery ◽  
Social Health Insurance ◽  
Social Health ◽  
Healthcare Provision ◽  
Health Politics ◽  
Private Healthcare ◽  
Incomplete Coverage

This chapter examines health politics and the health system in Montenegro based on compulsory social health insurance. It traces the post-communist development of the Montenegrin healthcare system that started with incremental privatization and continued toward a more decisive move toward liberalization through the 2004 reforms, which included, among other elements, a stronger role of private healthcare delivery and the introduction of different types of voluntary insurance. As the chapter notes, the main issues facing the health system in Montenegro are incomplete coverage, limited access to healthcare, and lack of regulation of private healthcare provision.

Supplementary Health Insurance and Regulation of Healthcare Systems

2019 ◽  
Author(s):  
Brigitte Dormont
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Social Insurance ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Social Health ◽  
Managed Competition ◽  
Benefit Package ◽  
Care Services ◽  
Supplementary Health Insurance

Most developed nations provide generous coverage of care services, using either a tax financed healthcare system or social health insurance. Such systems pursue efficiency and equity in care provision. Efficiency means that expenditures are minimized for a given level of care services. Equity means that individuals with equal needs have equal access to the benefit package. In order to limit expenditures, social health insurance systems explicitly limit their benefit package. Moreover, most such systems have introduced cost sharing so that beneficiaries bear some cost when using care services. These limits on coverage create room for private insurance that complements or supplements social health insurance. Everywhere, social health insurance coexists along with voluntarily purchased supplementary private insurance. While the latter generally covers a small portion of health expenditures, it can interfere with the functioning of social health insurance. Supplementary health insurance can be detrimental to efficiency through several mechanisms. It limits competition in managed competition settings. It favors excessive care consumption through coverage of cost sharing and of services that are complementary to those included in social insurance benefits. It can also hinder achievement of the equity goals inherent to social insurance. Supplementary insurance creates inequality in access to services included in the social benefits package. Individuals with high incomes are more likely to buy supplementary insurance, and the additional care consumption resulting from better coverage creates additional costs that are borne by social health insurance. In addition, there are other anti-redistributive mechanisms from high to low risks. Social health insurance should be designed, not as an isolated institution, but with an awareness of the existence—and the possible expansion—of supplementary health insurance.

Universal health coverage and user charges

2013 ◽  
Vol 8 (4) ◽  
pp. 529-535 ◽  
Author(s):  
Peter C. Smith
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Social Health Insurance ◽  
Social Health ◽  
World Health ◽  
World Health Report ◽  
Health Coverage ◽  
User Charges ◽  
Universal Health

AbstractThere has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.

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