Albania

2021 ◽  
pp. 857-878
Author(s):  
Mirza Balaj
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Medical Practice ◽  
Rural Areas ◽  
Public System ◽  
Health Politics ◽  
The Public ◽  
Democratic System ◽  
Compulsory Health Insurance ◽  
Gradual Expansion

This chapter offers an in-depth look at health politics and the compulsory health insurance system in Albania. It traces the development of the Albanian healthcare system, characterized by the introduction of a universal and state-run health system during communism, which since the 1970s suffered underfinancing and outdated technology. Since the early 1990s, when Albania experienced a tumultuous transition from a communist to a democratic system, Albanian health politics focused on the legalization of private medical practice, the establishment and gradual expansion of compulsory health insurance, and, recently, the introduction of free primary care—reforms which were facilitated by the support of international organizations. Notably, the contracting of private services in the public system was not allowed until 2011. The main healthcare issues have been insufficient financing and extremely high out-of-pocket costs, people refraining from paying insurance contributions, and shortages of medical staff especially in rural areas.

North Macedonia

2021 ◽  
pp. 939-947
Author(s):  
Simonida Kacarska ◽  
Neda Milevska Kostova
Keyword(s):  
Health Insurance ◽  
Free Market ◽  
Reform Process ◽  
Health Insurance System ◽  
Local Public Health ◽  
Health Politics ◽  
The Public ◽  
Insurance System ◽  
The North ◽  
Compulsory Health Insurance

This chapter offers an in-depth look at health politics and the compulsory health insurance system in North Macedonia. It traces the development of the North Macedonian healthcare system, characterized by the establishment of decentralized free-for-all-at-point-of-delivery health system during communism, which served as a basis for the current system. Since the early 1990s, when North Macedonia declared independence and started a transition towards democracy and a free market economy, North Macedonian health politics focused on permitting private provision, establishing a compulsory health insurance system, and integrating private services in the public insurance. Despite support from international organizations, the reform process was hampered by economic difficulties, inter-ethnic conflict, and the conflict with Greece regarding North Macedonia. As highlighted in the chapter, the main healthcare challenges have been to ensure the insurance system’s fiscal solvency, the conversion of primary care provision from local public health centers into private practices, and, since 2012, the integration of higher level private hospital services into the public system in order to reduce out-of-pocket payments and ensure equal geographical access.

scholarly journals Primary health care pharmacists and vision for community pharmacy and pharmacists in Chile

2020 ◽  
Vol 18 (3) ◽  
pp. 2142
Author(s):  
Francisco Martinez-Mardones ◽  
Antonio Ahumada-Canale ◽  
Loreto Gonzalez-Machuca ◽  
Jose C. Plaza-Plaza
Keyword(s):  
Primary Care ◽  
Public Perception ◽  
Private Insurance ◽  
Pharmaceutical Services ◽  
Community Pharmacies ◽  
Care Model ◽  
Public And Private ◽  
Public System ◽  
Non Profit ◽  
The Public

The Chilean healthcare system is composed of public and private sectors, with most of the higher-income population being covered privately. Primary healthcare in the public system is provided in more than 2,500 public primary care centers of different sizes with assigned populations within territories. Private insurance companies have their own healthcare networks or buy services from individual health providers. Patients from the public system receive most medications free of charge in primary care pharmacies embedded in each care center. Private patients must purchase their medicines from community pharmacies. Some government policies subsidize part of the cost of medications, but original medicines remain as the most expensive of Latin America. Three chain pharmacies have more than 90% of the market share, and these pharmacies have negative public perception because of price collusion court sentences. A non-profit, municipal pharmacy model was developed but has limited implementation. Most privately owned independent and chain community pharmacies do not provide pharmaceutical services as there is no remuneration or cover by insurers. The limited number of publicly owned Municipal pharmacies could implement pharmaceutical services in community settings as they are non-profit establishments and have full-time pharmacists but are not resourced for these services. A limited number of pharmaceutical services are almost exclusively provided in public primary care, including medication reviews, pharmaceutical education, home visits and pharmacovigilance services, but several barriers to their implementation remain. A risk-based multimorbidity care model was implemented in 2020 for public primary care with additional employment of part-time pharmacists to provide services. We believe that this model will help pharmacists to optimize their time by prioritizing the much-needed clinical tasks. We propose within this multimorbidity care model that the more time-consuming services are provided to higher risk patients. Pharmacy prescribing i.e. amending or approving changes in medications in primary care for chronic conditions could also be useful for the health system, but pharmacists would require additional training. The landscape for pharmaceutical services for primary care in Chile is promising, but the integration with community pharmacies will not be possible until they are funded by public and private insurance, and the public perception of these establishments is improved.

scholarly journals EVALUATION OF THE COST-EFFECTIVENESS OF THE PUBLIC SECTOR SERVICES: VARIABILITY OF THE METHODOLOGICAL TOOLS

2019 ◽  
Vol 8 (4) ◽  
pp. 34-48
Author(s):  
Oksana Yurievna Dyagel
Keyword(s):  
Health Insurance ◽  
Cost Effectiveness ◽  
Public Sector ◽  
Economic Effects ◽  
The Public ◽  
Medical Institutions ◽  
Compulsory Health Insurance ◽  
Definition Of ◽  
The Cost ◽  
Analytical Tools

The purpose of the article was to reveal the analytical tools for evaluating the effectiveness of the allocated financing funds for the provision of the services provided in the public sector of the economy, the application of which does not have a uniform methodology today. The possibility to solve this issue is shown with regard to the compulsory health insurance system. To achieve the goal, the study reveals the definition of such categories as “effect” and “efficiency” of the medical institutions activities, “efficiency of spending” of the Territorial Fund for Compulsory Health Insurance. There is revealed the analytical significance of the existing methodological approaches to assessing the effectiveness of health care costs; their comparative analysis is carried out. Based on the results, the alternative is proposed, based on the system of the cost-effectiveness indices to achieve the health, social and economic effects of medical institutions; the analytical advantages of the alternative proposed are justified.

THE PEDIATRICIAN AND THE PUBLIC

PEDIATRICS ◽  
1951 ◽  
Vol 7 (3) ◽  
pp. 430-445
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Rural Areas ◽  
Growth And Development ◽  
The United States ◽  
Senior Author ◽  
Health Conditions ◽  
Deputy Minister ◽  
The Public ◽  
Source Of Information

THE first communication is a statement by the American Board of Pediatrics on the importance of better training in the care of the well child during its period of growth and development. The second communication is by Dr. Frederick D. Mott, Acting Deputy Minister of the Department of Public Health in the Province of Saskatchewan. Dr. Mott is an authority on medical care in rural areas and is senior author of Rural Health and Medical Care (McGraw-Hill, 1948), an outstanding source of information on health conditions and medical services in the rural areas of the United States. This communication requires reference to an earlier statement in the Journal of Pediatrics (31:228, August, 1947) by the Canadian Medical Association in which that association approved the principle of health insurance and maintained the opinion that health insurance programs should be developed by the various provinces in accordance with their local needs. Dr. Mott's paper describes what has been done in Saskatchewan.

Belgium

2021 ◽  
pp. 590-609
Author(s):  
Julia Lynch ◽  
Christiaan Vermorken
Keyword(s):  
Health Insurance ◽  
Patient Choice ◽  
European Court Of Justice ◽  
Mutual Aid ◽  
Health Insurance System ◽  
Health Politics ◽  
Insurance System ◽  
European Court ◽  
French Speaking ◽  
Compulsory Health Insurance

This chapter offers an in-depth look at health politics and the mutualism-based compulsory health insurance system in Belgium. It traces the development of the Belgian healthcare system, characterized by its very generous coverage and few restrictions on patient choice. Since 1980, the process of federalization of the Belgian state—which has been propelled by the divide between the Flemish-speaking North and the French-speaking South—has increasingly challenged the national basis of the Belgian health insurance system. Other healthcare issues have been cost containment and the privileged position of the mutual aid societies in health insurance provision which was subject to a European Court of Justice challenge.

scholarly journals Editorial: Access, affordability and equity

2004 ◽  
Vol 10 (1) ◽  
pp. 7
Author(s):  
Hal Swerissen
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Practice Patterns ◽  
Metropolitan Areas ◽  
Access To Services ◽  
Major Focus ◽  
Health Politics ◽  
Consumer Expectations ◽  
Access And Affordability ◽  
Out Of Pocket Costs

Access and affordability of primary care is currently a major focus of health politics. Bulk-billing rates for GPs have now fallen to around 65%, from a high of about 80% in 1997. A range of factors, including the supply of GPs, changing consumer expectations, shifts in practice patterns, increasing costs and declining relative incomes have probably contributed to the fall in bulk billing. As bulk-billing rates fall, out-of-pocket costs for patients go up and affordability and access to services is reduced, at least for people on lower incomes. Access and affordability are particular problems for people in rural areas where bulk-billing rates are generally 10% to 20% below those in metropolitan areas.

scholarly journals The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ramadhani Kigume ◽  
Stephen Maluka
Keyword(s):  
Health Insurance ◽  
Community Health ◽  
Rural Areas ◽  
Health Coverage ◽  
Access To Health Services ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Urban Districts ◽  
Health Fund ◽  
The Government

Abstract Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.

Sign in / Sign up

Export Citation Format

Share Document