scholarly journals Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

2020 ◽  
Vol 5 (3) ◽  
pp. e002087 ◽  
Author(s):  
Wenjuan Tao ◽  
Zhi Zeng ◽  
Haixia Dang ◽  
Peiyi Li ◽  
Linh Chuong ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Healthcare Reform ◽  
Insurance Coverage ◽  
Secondary Data ◽  
Health Insurance Coverage ◽  
Chinese Government ◽  
Health Coverage ◽  
Average Life Expectancy ◽  
Live Births ◽  
Universal Health

Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and ‘Healthy China 2030’, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.

scholarly journals Towards universal health coverage: lessons from 10 years of healthcare reform in China

2020 ◽  
Vol 5 (3) ◽  
pp. e002086 ◽  
Author(s):  
Wenjuan Tao ◽  
Zhi Zeng ◽  
Haixia Dang ◽  
Bingqing Lu ◽  
Linh Chuong ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Healthcare Reform ◽  
Service System ◽  
National Policy ◽  
Health Financing ◽  
Universal Coverage ◽  
Political Support ◽  
Chinese Government ◽  
Health Coverage ◽  
Universal Health

Universal health coverage (UHC) is driving the global health agenda. Many countries have embarked on national policy reforms towards this goal, including China. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. The year of 2019 marks the 10th anniversary of China’s most recent healthcare reform. Sharing China’s experience is especially timely for other countries pursuing reforms to achieve UHC. This study describes the social, economic and health context in China, and then reviews the overall progress of healthcare reform (1949 to present), with a focus on the most recent (2009) round of healthcare reform. The study comprehensively analyses key reform initiatives and major achievements according to four aspects: health insurance system, drug supply and security system, medical service system and public health service system. Lessons learnt from China may have important implications for other nations, including continued political support, increased health financing and a strong primary healthcare system as basis.

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 Can Mohalla Clinics be a Catalyst for Ayushman Bharat Pradhan Mantri Jan Arogya Yojna to achieve Universal Health Coverage in India?

2021 ◽  
Vol 4 (10) ◽  
pp. RV5-RV10
Author(s):  
Debraj Mukhopadhyay ◽  
Vibhor Dudhraj ◽  
Niharika Malhotra ◽  
Kritika Jain ◽  
Sananda Mishra
Keyword(s):  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Tertiary Care ◽  
Health Sector ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Indian Government ◽  
Indian Health ◽  
Depth Analysis ◽  
Universal Health

BACKGROUND: Expenditure on health sector in India is one of the lowest public health expenditures in the world at just over 1% of GDP, with substantial disparities in population, infrastructure, availability and provision of services that define the Indian health care system. In a reform of Indian health systems approved by the Indian Government in March 2018, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched on 23rd September, 2018 to provide financial health insurance coverage of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalizations to more than 10.74 million poor families that form the bottom 40% of population in India. OBJECTIVES: The objective of this paper is to discuss and analyze the benefits and weaknesses of the AB-PMJAY model and investigating the position that these clinics can play in (I) improving the provision of urban health facilities (II) resolving health inequities (III) and enhancing primary health care.MATERIALS AND METHOD: The authors explored different databases. Government portals, research publications on AB-PMJAY and Mohalla clinics (MC) to do in-depth analysis of various parameters.RESULTS: Although there are significant obstacles to the programme, by building impetus for program reform, AB-PMJAY offers an opportunity for the nation to resolve long-standing and ingrained shortcomings in governance, quality control and stewardship, and to accelerate India's development towards the stated UHC supply goal. The main achievement of these facilities in the last 18 months has been to introduce wellness to civic and political dialogue. CONCLUSION: Mohalla Clinics can prove as a major catalyst for Ayushman Bharat Pradhan Mantri Jan Arogya Yojna for health reforms and progress towards universal health coverage in India.

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.

scholarly journals Advancing universal health coverage in China and Vietnam: lessons for other countries

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenhui Mao ◽  
Yuchen Tang ◽  
Tra Tran ◽  
Michelle Pender ◽  
Phuong Nguyen Khanh ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Secondary Data ◽  
World Health ◽  
Health Coverage ◽  
Political Commitment ◽  
Population Coverage ◽  
Service Coverage ◽  
Universal Health

Abstract Background China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam. Methods This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage. Results China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups. Conclusion Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.

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.  

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