scholarly journals Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives

2021 ◽  
Vol 6 (8) ◽  
pp. e005964
Author(s):  
Doris Osei Afriyie ◽  
Brady Hooley ◽  
Grace Mhalu ◽  
Fabrizio Tediosi ◽  
Sally M Mtenga
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Financing ◽  
Health Insurance Coverage ◽  
Normalisation Process Theory ◽  
Successful Implementation ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Financing Policies

The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs), and others are underway to implement a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanzania. We interviewed 36 stakeholders including implementers of health financing reforms, policymakers and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro. Normalisation process theory and governance elements guided the structure of the in-depth interviews and analysis. Governance factors that emerged from participants as facilitators included a shared strategic vision for a single mandatory health insurance, community engagement and collaboration with diverse stakeholders in the implementation of health financing policies and enhanced monitoring of iCHF enrolment due to digitisation of registration process. Governance factors that emerged as barriers to the implementation were a lack of transparency, limited involvement of the private sector in service delivery, weak accountability for revenues generated from community level and limited resources due to iCHF design. If stakeholders do not address the governance factors that hinder the implementation of health financing reforms, then current efforts to expand health insurance coverage are unlikely to succeed on their own.

The Emergence of the New Era of Reform

2017 ◽  
pp. 36-59
Author(s):  
Gunnar Almgren
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Successful Implementation ◽  
Health Security ◽  
New Era ◽  
Low Income Children ◽  
Working Families

The chapter begins with a review of the efforts to reform health care in ways that would assure health care for all Americans, beginning with Progressive Era reforms in the early 1900’s through the William Clinton administration’s ill-fated Health Security Act in the early 1990’s. After delving into the less ambitious reforms of late 1900’s aimed at cost-containment and incremental expansions of health insurance coverage for low-income children, the chapter examines the devolution of the employment-based insurance for working families was pivotal to the economic and political context of the Affordable Care Act (ACA) of 2009 –the first federal legislation in U.S. history to advance universal health insurance for all American citizens as its central goal. The chapter concludes with a prognosis for the successful implementation of the ACA, as well as its long term prospects.

Health insurance coverage for vulnerable children: two HIV orphans with Burkitt lymphoma and their quest for health insurance coverage in Kenya

2020 ◽  
Vol 13 (8) ◽  
pp. e230508
Author(s):  
Sandra Langat ◽  
Festus Njuguna ◽  
Gertjan Kaspers ◽  
Saskia Mostert
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Burkitt Lymphoma ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Sub Saharan Africa ◽  
Health Coverage ◽  
Global Public Health ◽  
Sub Saharan ◽  
Uninsured Children

The United Nations and WHO have summoned governments from low-income and middle-income countries to institute universal health coverage and thereby improve their population’s healthcare access and outcomes. Until now, few countries responded favourably to this international plea. The HIV/AIDS epidemic, a major global public health challenge, resulted in over 11 million orphans in sub-Saharan Africa. Extended families have taken responsibility for more than 90% of these children. HIV orphans are likely to be poorer and less healthy. Burkitt lymphoma is the most common childhood cancer in sub-Saharan Africa. If orphans need lifesaving chemotherapy, appointing legal guardians becomes necessary to access health insurance. However, rules and regulations involved may be unclear and costly. This hinders its access for poor families who need it most. Uninsured children risk hospital detention over unpaid medical bills and have lower survival. Our case report depicts the quest for health insurance coverage of two HIV orphans with Burkitt lymphoma in Kenya.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

A COMPARATIVE STUDY ON AWARENESS AND HEALTH INSURANCE COVERAGE IN RURALAND URBAN MEERUT

2021 ◽  
pp. 65-67
Author(s):  
Harivansh Chopra ◽  
Tanveer Bano ◽  
Niharika Verma ◽  
Gargi Pandey
Keyword(s):  
Health Insurance ◽  
Urban Area ◽  
Rural Area ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Rural And Urban ◽  
Economics Of Health ◽  
Poverty Status ◽  
Rural And Urban Area

Universal Health Coverage aims to provide essential health services to all while providing protection from catastrophic expenditure on health. To mitigate the economics of health expenditure, health insurance is one of the important tool. Hence, this study was conducted to nd out the awareness and practice of health insurance coverage in rural and urban Meerut.90 households were studied in both rural and urban area. Awareness was higher in urban area but coverage was higher in rural area. Awareness and coverage were found to be signicantly associated with poverty status in rural area of Meerut.

scholarly journals Union Effects on Health Insurance Provision and Coverage in the United States

ILR Review ◽  
2002 ◽  
Vol 55 (4) ◽  
pp. 610-627 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
John Dinardo ◽  
Robert G. Valletta
Keyword(s):  
United States ◽  
Health Insurance ◽  
Survey Data ◽  
Insurance Coverage ◽  
Health Benefits ◽  
Union Density ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Coverage ◽  
Private Sector Union

During the past two decades, union density has declined in the United States and employer provision of health benefits has changed substantially in extent and form. Using individual survey data spanning the years 1983–97 combined with employer survey data for 1993, the authors update and extend previous analyses of private-sector union effects on employer-provided health benefits. They find that the union effect on health insurance coverage rates has fallen somewhat but remains large, due to an increase over time in the union effect on employee “take-up” of offered insurance, and that declining unionization explains 20–35% of the decline in employee health coverage. The increasing union take-up effect is linked to union effects on employees' direct costs for health insurance and the availability of retiree coverage.

France

2021 ◽  
pp. 558-589
Author(s):  
Matthias Brunn ◽  
Patrick Hassenteufel
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Public Management ◽  
New Public Management ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
National Health Insurance System ◽  
Health Politics ◽  
New Public ◽  
Unusual Combination

This chapter offers an in-depth look at health politics and the national health insurance system in France. It traces the development of the French healthcare system through its series of political regimes, characterized by its unusual combination of statism and corporatism. Since the 1990s, a technocratic consensus emerged that has led to new public management reforms, tighter parliamentary control of social security budgets, and efforts to improve coverage by subsidizing supplementary voluntary health insurance coverage for low-income persons and increasing tax-financing. Other healthcare issues have been regional health inequalities, reimbursement of medical professionals, and individuals’ responsibility for their health.

scholarly journals Prevalence and factors associated with health insurance coverage in resource-poor urban settings in Nairobi, Kenya: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031543 ◽  
Author(s):  
Peter O Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri F Mohamed ◽  
Hermann Pythagore Pierre Donfouet ◽  
Martin K Mutua
Keyword(s):  
Health Insurance ◽  
Primary Outcome ◽  
Insurance Coverage ◽  
Scale Up ◽  
Household Head ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Insurance Cover

ObjectiveTo determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.DesignThe data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars’ study conducted between June and July 2018.SettingThe Lown scholars’ survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.ParticipantsA total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.Primary outcome measureThe primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.ResultsThe prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).ConclusionsHealth insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya’s ‘Big Four Agenda’ for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.

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