scholarly journals Social health insurance for the poor: lessons from a health insurance programme in Karnataka, India

2018 ◽  
Vol 3 (1) ◽  
pp. e000582 ◽  
Author(s):  
Neeraj Sood ◽  
Zachary Wagner
Keyword(s):  
Health Insurance ◽  
Financial Burden ◽  
Tertiary Care ◽  
Substantial Reduction ◽  
Unmet Need ◽  
Social Health Insurance ◽  
Well Being ◽  
Poverty Line ◽  
Social Health ◽  
The Poor

Life-saving technology used to treat catastrophic illnesses such as heart disease and cancer is often out of reach for the poor. As life expectancy increases in poor countries and the burden from chronic illnesses continues to rise, so will the unmet need for expensive tertiary care. Understanding how best to increase access to and reduce the financial burden of expensive tertiary care is a crucial task for the global health community in the coming decades. In 2010, Karnataka, a state in India, rolled out the Vajpayee Arogyashree scheme (VAS), a social health insurance scheme focused on increasing access to tertiary care for households below the poverty line. VAS was rolled out in a way that allowed for robust evaluation of its causal effects and several studies have examined various impacts of the scheme on poor households. In this analysis article, we summarise the key findings and assess how these findings can be used to inform other social health insurance schemes. First, the evidence suggests that VAS led to a substantial reduction in mortality driven by increased tertiary care utilisation as well as use of better quality facilities and earlier diagnosis. Second, VAS significantly reduced the financial burden of receiving tertiary care. Third, these benefits of social health insurance were achieved at a reasonable cost to society and taxpayers. Several unique features of VAS led to its success at improving health and financial well-being including effective outreach via health camps, targeting expensive conditions with high disease burden, easy enrolment process, cashless treatment, bundled payment for hospital services, participation of both public and private hospitals and prior authorisation to improve appropriateness of care.

Regional Outlook

2021 ◽  
pp. 811-815
Author(s):  
Tamara Popic ◽  
Guergana Stolarov-Demuth
Keyword(s):  
Health Insurance ◽  
Eastern Europe ◽  
Financial Burden ◽  
Unmet Need ◽  
Social Health Insurance ◽  
Social Health ◽  
Average Life Expectancy ◽  
Public And Private ◽  
Out Of Pocket Payments ◽  
Health Related

The Southern Eastern Europe regional outlook presents a comparative assessment of the historical development of the healthcare system, health politics, and selected health-related indicators for Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo, Montenegro, North Macedonia, Romania, and Serbia. Despite variations in their healthcare systems during communism, since 1989 the countries of the region have all undertaken efforts to introduce or consolidate social health insurance and combine it with a mix of public and private provision. In most of the countries at least half of healthcare financing originates from compulsory contributory health insurance, but in many of them, out-of-pocket payments constitute an extremely large share. Given this financial burden, satisfaction in the region is very low. Health outcomes are unsatisfactory, with low average life expectancy, very high infant mortality, and relatively high levels of health inequality. Unmet need is high, especially in Romania, mainly due to costs. Since at least 2004, healthcare has tended to be a moderately salient issue in Southern Eastern Europe. The key healthcare issues in the region have been incomplete or ineffective social health insurance coverage, privatization, insufficient financing, and high out-of-pocket payments, especially for pharmaceuticals and private services.

scholarly journals Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044322
Author(s):  
Wenqi Fu ◽  
Jufang Shi ◽  
Xin Zhang ◽  
Chengcheng Liu ◽  
Chengyao Sun ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Social Health Insurance ◽  
Poverty Line ◽  
Post Treatment ◽  
Social Health ◽  
Daily Consumption ◽  
Out Of Pocket Payments ◽  
Per Capita

ObjectivesTo determine the incidence and intensity of household impoverishment induced by cancer treatment in China.DesignAverage income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment.ParticipantsCancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded.Data sourcesA household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling.Findings5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666–4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024–0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China.ConclusionsThe financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.

scholarly journals Social health insurance schemes in Africa leave out the poor

2018 ◽  
Vol 10 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Ama Pokuaa Fenny ◽  
Robert Yates ◽  
Rachel Thompson
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Social Health ◽  
The Poor

scholarly journals Factors affecting the Utilization of Social Health Insurance by the General Population in Bhaktapur Municipality

2020 ◽  
Vol 3 (1) ◽  
pp. 42-48
Author(s):  
Punam Karanjit ◽  
Prajita Mali ◽  
Rakshya Khadka ◽  
Lisasha Poudel
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
General Population ◽  
Financial Burden ◽  
Household Head ◽  
Social Health Insurance ◽  
Health Insurance Scheme ◽  
Social Health ◽  
Insurance Scheme ◽  
Factors Affecting

Introduction:  For the reduction of financial burden and to achieve universal health care, Government of Nepal launched a security program called as Social Health Insurance Program. This study aimed to find the factors associated with the utilization of the social health insurance scheme. Methods: Descriptive cross-sectional study was conducted in the Bhaktapur Municipality ward no 2. 422 households were chosen using systematic random sampling. Questionnaires were used to measure the factors affecting the utilization. The collected data was entered in Epidata and analyzed in SPSS version 16. The data were presented in the frequency and percentage. Bivariate analysis was done to identify factors utilizing social health insurance. Factors having p value less than 0.05 was taken as significantly associated. Multivariate analysis was done to examine the association between the outcome variables. Results: Almost half of the general population (42.4 %) were utilizing social health insurance scheme and reason for not utilizing includes lack of confidence in the scheme and the services of the scheme, followed by high premium cost. Age (p=0.044), occupation (p= 0.049), wealth quintiles (p=<0.001) were found to be significantly associated with utilization of social health insurance. Logistic regression analysis showed that the odds of enrollment among very rich population group were lower than the medium (AOR 0.550, 95% CI 0.305-0.993) and rich population (AOR 0.557, 95% CI 0.316-0.981). Conclusions: Multiple factors were found to be associated with the utilization of the health insurance scheme which includes age of the household head, occupation of the household head, economic status, availability of the drugs and charge paid during their visit in the health care services, behavior showed by the health care provider, confidence in the scheme, satisfaction in the services that have been providing and source of the information.

scholarly journals Population Characteristics and Their Implications on the Benefit Basket of National Social Health Insurance Scheme in Sierra Leone: A Prospective View

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Abraham Isiaka Jimmy ◽  
Kwabena Anarfi Boateng ◽  
Peter Twum ◽  
Deborah Larbie ◽  
Abdul Bangura ◽  
...  
Keyword(s):  
Health Insurance ◽  
Sierra Leone ◽  
Tertiary Care ◽  
Social Health Insurance ◽  
Health Insurance Scheme ◽  
Population Characteristics ◽  
Social Health ◽  
Insurance Scheme ◽  
Care Services ◽  
Household Heads

Background. The government of Sierra Leone introduced social health insurance (SHI) scheme to provide universal health coverage to people. This study was carried out to assess the population characteristics and their implications on the benefit basket of the proposed national health insurance scheme. Methods. A cross-sectional study design was employed in six selected districts in Sierra Leone. Quantitative data were collected for this study through the use of semistructured questionnaires with a sample of 1,185 respondents. Data were analysed using descriptive and inferential statistics. Statistical analysis was run at 5% significant level using Stata 14.0 software. Results. The study found that most (83.54%) of the respondents affirmed that children below 18 years should be excluded from premium payments and as high as 71.65% also stated that pregnant women should be excluded as well. The majority, 63.69%, of the respondents want lactating mothers to be excluded from premium payments. Also, 79.87% of respondents wanted mentally challenged persons not to pay premium, while a significant proportion (84.26%) of respondents further affirmed that the aged (above 70 yrs) should also be excluded from premium payment. Most household heads (89.71%) preferred the accreditation of public health facilities. Regarding the level at which healthcare services should be covered by the scheme, 61.45% preferred the primary care services, 89% mentioned secondary care services, and 98.93% affirmed the provision of tertiary care under the scheme. As for the type of care that should be covered by the scheme, 98.66% and 99.73% affirmed outpatient and inpatient care, respectively. Conclusion. From the findings on population characteristics and their implications on the benefit basket for the proposed nation social health in Sierra Leone, most of the household heads want exemptions from paying premium for a section of the population. This provides a clear insight for policy makers into the formulation of the benefit basket.

The Politics of Promoting Social Protection in Uganda

2019 ◽  
pp. 202-224
Author(s):  
Badru Bukenya ◽  
Sam Hickey
Keyword(s):  
Health Insurance ◽  
Social Protection ◽  
Social Health Insurance ◽  
Cash Transfers ◽  
Process Tracing ◽  
Social Health ◽  
Holding Power ◽  
The Poor ◽  
External Actors ◽  
Political Settlement

The success of efforts to promote social protection in Uganda since the early 2000s has varied considerably, with cash transfers progressing much further than social health insurance. Using original primary research and a process-tracing methodology, we show that external actors were able to form a coherent policy coalition around cast transfers and promote them in ways that became aligned with the dominant ideas and incentives of powerful actors within Uganda’s political settlement. In contrast, proponents of health insurance struggled to mobilize a coalition capable of overcoming actors with greater holding power, particularly the President and private sector actors. Whereas ‘just giving money to the poor’ fits with Uganda’s increasingly personalized-populist political settlement, the hard work of building a credible health system, and formally requiring citizens to contribute to their own healthcare, requires a commitment and capacity to promoting a new social contract that seems to be lacking in Uganda.

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