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.

Bulgaria

2021 ◽  
pp. 816-856
Author(s):  
Guergana Stolarov-Demuth
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
Free Market ◽  
Social Health Insurance ◽  
Social Health ◽  
Reform Process ◽  
Control Mechanisms ◽  
Public And Private ◽  
Health Politics ◽  
Insurance System

This chapter provides an extended look at health politics and the compulsory health insurance system in Bulgaria. It traces the historical development of the Bulgarian healthcare system characterized by the introduction of social health insurance, which after the establishment of communist rule in Bulgaria after World War II was replaced with a state-run healthcare system. Starting in 1989, Bulgaria underwent a transition to democracy and free market economy. This triggered structural healthcare reforms, including the re-introduction of social health insurance with both public and private provision. However, as privatization was permitted without effective price control mechanisms and conditions for entry into the public insurance system, out-of-pocket payments became extensive, especially for pharmaceuticals. The main reform challenges have been to close the coverage gaps and secure sufficient financing by stipulating selective contracting with hospitals, strengthening the control on pharmaceuticals, and tightening the collection of insurance contributions. While political debates were initially structured along traditional left–right political party lines, since 2001 new center-right parties have shaped Bulgarian health politics. Nevertheless, the reform process still suffered from lack of continuity, and private interest groups have successfully blocked cost-containment policies.

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.

THE ROLE OF SELF-HELP IN PATIENTS SOLIDAR RESPONSIBILITY TO OWN HEALTH

Vestnik ◽  
2021 ◽  
pp. 328-331
Author(s):  
С.К. Молдабаев ◽  
С.А. Мамырбекова ◽  
Д.Н. Маханбеткулова
Keyword(s):  
Health Insurance ◽  
The State ◽  
Shared Responsibility ◽  
Self Management ◽  
Health Insurance System ◽  
Insurance System ◽  
Self Help ◽  
Compulsory Health Insurance ◽  
The Republic

Согласно Концепции Государственной программы улучшения здоровья населения на 2020-2025 годы в рамках дальнейшего внедрения системы ОСМС в РК одним из основных задач госудаства является повышение солидарной ответственности граждан за свое здоровье. Существующая солидарная ответственность должна побуждать пациентов развивать навыки самопомощи/самоменеджмента с целью лучшего управления собственным здоровьем. Цель исследования. Анализ роли самоменеджмента пациентов в системе солидарной ответственности за свое здоровье. Материал и методы. Данный обзор основывается на материалах ВОЗ и статей зарубежных и отечественных исследователей. Выводы. На сегодняшний день, в системе здравоохранения Казахстана одним из основных моментов является солидарная ответственность государства, пациента и работодателя. Ведь каждый гражданин должен принимать важные решения, которые оказывают существенное влияние на состояние его здоровья. Поэтому стратегии по повышению грамотности пациентов, их вовлеченность в процесс принятия решений и развитие самоменеджмента должны быть одними из фундаментальных стержней существующей системы ОСМС и политики здравоохранения. According to the Concept of the State Program for improving the health of the population for 2020-2025, as part of the further implementation of the compulsory health insurance system in the Republic of Kazakhstan, one of the main tasks of the state is to increase the joint responsibility of citizens for their health. The existing shared responsibility should encourage patients to develop self-help / self-management skills in order to better manage their own health. Purpose of the study. Analysis of the role of patients' self-management in the system of joint responsibility for their health. Material and methods. This review is based on WHO materials and articles of foreign and domestic researchers. Findings. Today, in the health care system of Kazakhstan, one of the main points is the joint responsibility of the state, the patient and the employer. After all, every citizen must make important decisions that have a significant impact on his health. Therefore, strategies to improve patient literacy, their involvement in the decision-making process and the development of self-management should be one of the fundamental pillars of the existing compulsory health insurance system and health policy.

Improving migrants’ access to the public health insurance system in China: A conceptual classification framework

2017 ◽  
Vol 26 (2) ◽  
pp. 274-284 ◽  
Author(s):  
Zuyu Huang ◽  
Zehan Pan
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Public Health Insurance ◽  
Chinese Government ◽  
Barriers To Entry ◽  
Health Insurance System ◽  
The Public ◽  
Insurance System ◽  
Classification Framework ◽  
Public Health Insurance System

Although the Chinese government has established a public health insurance system covering both rural and urban areas, the rural–urban migrants seem to have been neglected. To have a clear sense of the current status of migrants in the public health insurance system and to find ways to increase their enrollment to medical insurance, this paper attempts to construct a conceptual classification framework of China’s health insurance system. This was done by reviewing the development of China’s health insurance system and identifying barriers to entry for migrants. The finding suggests that migrants’ limited access to health insurance owes more to their reluctance than to system exclusions. The job and residential stability of migrants are critical factors to building the classification framework to account for supply and demand factors in the formulation of China’s health insurance policy.

scholarly journals IMPROVEMENT OF MANAGEMENT PROCESS TO PROVIDE DENTAL SERVICES IN THE COMPULSORY HEALTH INSURANCE SYSTEM

2018 ◽  
Vol 22 (6) ◽  
pp. 301-304
Author(s):  
M. V Zuev ◽  
Valentina Gavrilovna Butova ◽  
T. I Vlasova
Keyword(s):  
Health Insurance ◽  
Statistical Analysis ◽  
Institutional Changes ◽  
Fiscal Deficit ◽  
Management Process ◽  
Effective Management ◽  
Health Insurance System ◽  
Dental Services ◽  
Insurance System ◽  
Compulsory Health Insurance

The conducted comprehensive medical, economic and statistical analysis indicates the need to develop more effective management decisions aimed at monitoring, coordination and improvement of the provision of dental services and the activities of medical organizations in the implementation of the program of state guarantees. The fiscal deficit in the compulsory health insurance system in 2017, 1.36% of all expenditures allocated for the implementation of the CHI in the field of dentistry. This fact directly indicates that the stated guarantees of free medical care are implemented in insufficient volume and quality. Current scenarios of institutional changes in the CHI system are initiated at macro, meso and micro levels. And at each of them the priority is to create an appropriate regulatory framework.

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.

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