scholarly journals Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Taufique Joarder ◽  
Tahrim Z. Chaudhury ◽  
Ishtiaq Mannan
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Service Management ◽  
Service Providers ◽  
Health Financing ◽  
Community Empowerment ◽  
Health Coverage ◽  
Demand Side ◽  
Implementation Barriers ◽  
Universal Health

Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

scholarly journals Pooling arrangements in health financing systems: a proposed classification

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Inke Mathauer ◽  
Priyanka Saksena ◽  
Joe Kutzin
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Grey Literature ◽  
Health Spending ◽  
Health Financing ◽  
Policy Instrument ◽  
Health Coverage ◽  
Voluntary Health Insurance ◽  
Financing Policies ◽  
Universal Health

Abstract Objectives The function of pooling and the ways that countries organize this is critical for countries’ progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Methods The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Findings We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Conclusion Pooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.

scholarly journals Kebijakan Pembiayaan Kesehatan terhadap Masyarakat Miskin dalam Pencapaian Universal Health Coverage di Kabupaten Banjar

2020 ◽  
Vol 15 (2) ◽  
pp. 219-229
Author(s):  
Annida
Keyword(s):  
Health Insurance ◽  
Data Collection ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Poor People ◽  
Health Coverage ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
The Poor ◽  
Universal Health

Achievement of Universal Health Coverage (UHC) is achieved through the participation of JKN - Health BPJS by all Indonesians. Not all poor people were the premium assistance beneficiary, while since 2020 regional health insurance was abolished. The study aims to determine the UHC achievements of the governments, particularly in health financing for the poor. This research uses an Analytic-qualitative approach with the cross-sectional method and was conducted in 2019. Data collection through in-depth interviews with purposive sampling at the Regional Public Health Office, Regional Planning and Development Office, and Social Service in Banjar Regency. The stages for Analysis consist of data reduction, presentation, and data collection. Banjar Regency government involves CSR at TKPKD forum to cover health financing for the poor and underprivileged outside the premium assistance beneficiary, but there were gaps in the unified database synchronization, which can be an obstacle in projecting the health financing and budgeting. The government needs to increase the premium assistance beneficiary quota. The mid-income people or people who can afford health insurance should join the independent universal healthcare participants, so that premium assistance beneficiary is designated only for the poor. Coordination across sectors and programs must be integrated into SLRT. Keywords: Financial Policy, Health Financing, Universal Health Coverage, JKN-BPJS. ABSTRAK Pencapaian Universal Health Coverage (UHC) diwujudkan melalui kepesertaan pada JKN-BPJS Kesehatan oleh seluruh rakyat Indonesia, tanpa terkecuali. Masyarakat miskin dan tidak mampu yang didaftarkan oleh pemerintah daerah berdasarkan Basis Data Terpadu (BDT), dibayarkan oleh pemerintah daerah sebagai peserta Penerima Bantuan Iuran (PBI). Namun tidak semua masyarakat miskin dan tidak mampu masuk dalam daftar PBI. Disamping itu, di tahun 2020 kebijakan jaminan kesehatan daerah (Jamkesda) telah dihapus, sehingga masyarakat miskin bukan PBI tidak dapat lagi memperoleh bantuan pembiayaan kesehatan dari pemerintah. Penelitian ini dilakukan di Kabupaten Banjar untuk mengetahui langkah yang diambil oleh pemerintah daerah dalam menuju pencapaian UHC, yang diutamakan pada kebijakan pembiayaan kesehatan terhadap masyarakat miskin dan tidak mampu. Penelitian ini bersifat analitik dengan desain cross sectional, dilaksanakan pada pertengahan tahun 2019. Metode penelitian secara kualitatif. Pengumpulan data secara indepth interview. Informan penelitian adalah pemerintah daerah yang ditentukan secara purposive sampling, dari Dinas Kesehatan Kabupaten Banjar, Bappeda Kabupaten Banjar, dan Dinas Sosial Kabupaten Banjar. Analisis data dilakukan secara deskriptif dengan tahapan reduksi data, penyajian data dan penarikan kesimpulan. Kabupaten Banjar melalui forum Tim Koordinasi Penanggulangan Kemiskinan Daerah (TKPKD)  telah mewacanakan keterlibatan Corporate System Responsibility (CSR) dalam pembiayaan kesehatan masyarakat miskin dan tidak mampu yang berada diluar BDT atau bukan PBI, meskipun diperkirakan belum dapat membiayai masyarakat miskin secara keseluruhan. Namun masih terjadi permasalahan dalam sinkronisasi BDT masyarakat yang tergolong miskin dan tidak mampu tersebut yang dapat menjadi hambatan bagi Dinas Kesehatan dalam memperhitungkan anggaran pembiayaan kesehatan tersebut. Perlu diwacanakan penambahan kuota alokasi anggaran PBI sebagai salah satu solusi untuk dilaksanakan oleh pemerintah daerah. Disisi lain, masyarakat yang telah mampu secara ekonomi harus didorong untuk menjadi peserta BPJS mandiri, sehingga pembiayaan mereka yang semula PBI dapat dialihkan pada masyarakat miskin, diluar peserta PBI. Koordinasi lintas sektor maupun lintas program terintegrasi dalam SLRT, antara lain Dinas Kesehatan, Dinas Sosial, Dinas Kependudukan dan Catatan Sipil, dan Bappeda sehingga masyarakat miskin dan tidak mampu mendapatkan hak yang sama dalam memperoleh kesehatan. Rekomendasi dan strategi yang dilakukan oleh Kabupaten Banjar ini dapat diimplementasikan pada kabupaten/kota dengan kondisi dan permasalahan yang sama. Kata Kunci: Kebijakan Finansial, Pembiayaan Kesehatan, JKN-BPJS

scholarly journals Barriers and facilitators to health insurance enrolment among people working in the informal sector in Morogoro, Tanzania

2021 ◽  
Vol 4 ◽  
pp. 45
Author(s):  
Elisante Abraham ◽  
Cindy Gray ◽  
Adeniyi Fagbamigbe ◽  
Fabrizio Tediosi ◽  
Brianna Otesinky ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Informal Sector ◽  
Universal Health Coverage ◽  
Perceived Control ◽  
Health Financing ◽  
Subjective Norms ◽  
Barriers And Facilitators ◽  
Health Coverage ◽  
Universal Health

Background: Health insurance is a crucial pathway towards the achievement of universal health coverage. In Tanzania, health-financing reforms are underway to speed up universal health coverage in the informal sector. Despite improved Community Health Fund (iCHF) rollout, iCHF enrolment remains a challenge in the informal sector. This study aimed to explore the perspectives of local women food vendors (LWFV) and Bodaboda (motorcycle taxi) drivers on factors that challenge and facilitate their enrolment in iCHF. Methods: A qualitative study was conducted in Morogoro Municipality through in-depth interviews with LWFV (n=24) and Bodaboda drivers (n=26), and two focus group discussions with LWFV (n=8) and Bodaboda drivers (n=8). Theory of planned behaviour (TPB) constructs (attitude, subjective norms, and perceived control) provided a framework for the study and informed a thematic analysis focusing on the barriers and facilitators of iCHF enrolment. Results: The views of LWFV and Bodaboda drivers on factors that influence iCHF enrolment converged. Three main barriers emerged: lack of knowledge about the iCHF (attitude); negative views from friends and families (subjective norms); and inability to overcome challenges, such as the quality and range of health services available to iCHF members and iCHF not being accepted at non-government facilities (perceived control). A number of facilitators were identified, including opinions that enrolling to iCHF made good financial sense (attitude), encouragement from already-enrolled friends and relatives (subjective norms) and the belief that enrolment payment is affordable (perceived control). Conclusions: Results suggest that positive attitudes supported by perceived control and encouragement from significant others could potentially motivate LWFV and Bodaboda drivers to enroll in iCHF. However, more targeted information about the scheme is needed for individuals in the informal sector. There is also a need to ensure that quality health services are available, including coverage for non-communicable diseases (NCDs), and that non-government facilities accept iCHF.

scholarly journals Employment based health financing does not support gender equity in universal health coverage

BMJ ◽  
2020 ◽  
pp. m3384 ◽  
Author(s):  
Lavanya Vijayasingham ◽  
Veloshnee Govender ◽  
Sophie Witter ◽  
Michelle Remme
Keyword(s):  
Gender Equity ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Health Coverage ◽  
Universal Health

scholarly journals An Analysis of The National Health Insurance Policy Implementation in 2014 (Presidential Regulation No. 12 And 111/2013 on Health Insurance) from The Regulator’s Position

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Muhammad Arief Hasan ◽  
Puput Oktamianti ◽  
Dumilah Ayuningtyas
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Regional Government ◽  
Health Coverage ◽  
Healthcare Facilities ◽  
Road Map ◽  
Universal Health

Abstract. JKN (National Health Insurance) is a government program that aims to provide health assurance for all Indonesian citizens for a healthy, productive, and prosperous life. In the two years after JKN was implemented, various problems occurred. This research used the qualitative approach with the Edward II implementation theory. Results of the research indicated that there were problems in communication, stemming from the lack of socialization and inharmonic regulations, there was also the problem of the lack of healthcare resources. From the disposition side, the policy makers often obstructs the implementation preparation, this is evident from the information on determining the premium size. From the organization structure, all the stakeholders have been well coordinated. We conclude that we are not ready to implement the JKN. We recommend that mass and effective socialization program to be performed using various methods of communication and involve the community. To reduce the disparity of healthcare services, we recommend that the regional government to establish various healthcare facilities to accelerate health development. There should also be regulations that allocates healthcare staff in every corner of the country to achieve Universal Health Coverage in 2019, as stated in the National Health Insurance Road Map. Keywords: policy analysis, national health insurance, universal health coverage

scholarly journals Narrowing the Gap of Inequity in the Indonesia’s National Social Health Insurance Scheme, 2014-2018

2021 ◽  
Author(s):  
Hasbullah Thabrany ◽  
Ryan R. Nugraha ◽  
Ery Setiawan ◽  
Farah Purwaningrum
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
Universal Health Coverage ◽  
Low Income ◽  
National Health Insurance Scheme ◽  
Income Group ◽  
Health Insurance Scheme ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Universal Health

Abstract Background. Indonesia is nearing its 7-year implementation of its national health insurance scheme, or the Jaminan Kesehatan Nasional (JKN), as a facilitator for achieving universal health coverage (UHC). Despite its long-running system, it is contentious as to whether JKN has been narrowing the gap of inequity in its delivery. This paper aims to explore on whether the national health insurance scheme in Indonesia have been promoting equity of access towards health services.Methods. This study analyzes findings from JKN statistic data of 2014-2018 published by Government of Indonesia. Using a retrospective design, this study identified membership and utilization of health services within JKN, based on different membership enrollment groups as proxy for income.Results. JKN has been expanding its enrollment significantly within 5 years, during year 2014 to 2018. Moreover, the study concludes that there was increased access for outpatient in all membership groups. Inpatient care was increased in low-income group, but not in high-income group. Result also showed inpatient access was correlated with adequate supply side intervention, particularly hospital beds.Conclusion. JKN has been successful in narrowing the inequity gap, particularly by serving the low-income group better in terms of access. Going forward, equity needs to be incorporated into JKN achievement indicator, particularly to accelerate Indonesia’s effort to realize universal health coverage.

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