scholarly journals Health Insurance Ownership and Quality of Computed Tomography Requests: Experience from a Peripheral Referral Hospital in Cameroon

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Joshua Tambe ◽  
Yannick Onana ◽  
Sylviane Dongmo ◽  
Georges Nguefack-Tsague ◽  
Pierre Ongolo-Zogo
Keyword(s):  
Computed Tomography ◽  
Health Insurance ◽  
Univariate Analysis ◽  
Healthcare Services ◽  
Referral Hospital ◽  
Health Coverage ◽  
Appropriateness Criteria ◽  
Acr Appropriateness Criteria ◽  
Baseline Information ◽  
Utilization Of Healthcare

Background. Health insurance ownership facilitates access and minimizes financial hardship after utilization of healthcare services such as computed tomography (CT). Understanding the rational utilization of CT by people with health insurance can help optimize the scheme and provide baseline information for a national universal health coverage program. Objective. To assess the relationship between health insurance ownership and the appropriateness of requests for CT in a peripheral referral hospital in Cameroon. Methods. A survey of CT users was conducted during which information on health insurance ownership was collected and the request forms for CT assessed for appropriateness using the American College of Radiologists (ACR) Appropriateness Criteria®. Results. We consecutively enrolled 372 participants of which 167 (45%) were females. The median age (range) was 52 (18–92) years. Thirty-eight out of 370 participants reported having health insurance (10.3%; 95% confidence interval (CI): 7.2%–13.4%). Twenty-nine out of 352 CT scan requests (8.2%; 95% CI: 5.3–11.0) were judged to be “inappropriate.” The proportion of inappropriate scan requests was higher amongst people with health insurance compared to those without health insurance (18.4% vs. 7.0%; χ2 = 5.8; p = 0.02 ). In the logistic regression analysis, health insurance ownership was associated to the appropriateness of CT requests in the univariate analysis only (OR = 0.33; 95% CI: 0.13–0.84; p = 0.020 ). Conclusions. Inappropriate requests for CT were low but nevertheless associated to health insurance ownership. The continuous sensitization and training of physicians would help minimize potential wasteful utilization of resources.

scholarly journals Occurrence of Medical Cases and Utilisation among Enrollees of Private Health Insurance Programme in Kaduna, Nigeria

2020 ◽  
pp. 30-37
Author(s):  
Oni, Oluwatobi Dapo ◽  
Zakari, Mustapha Mohammed ◽  
Okemmiri, Innocentia Chidinma
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Health Coverage ◽  
Primary Case ◽  
Health Maintenance ◽  
Insurance Programme ◽  
Chi Square Analysis ◽  
Health Insurance Programme

Aims: This study examines the occurrence of various medical cases presented by enrollees that have subscribed to access healthcare from a network of healthcare providers (HCPs) managed by a Health Maintenance Organisation (HMO) under its Private Health Insurance Programme (PHIP). Study Design:  A descriptive cross-sectional design was employed. Methodology: Secondary data from collected or submitted medical encounters in form of bills of registered enrollees (principals and their dependants) who have visited and received treatment from their chosen healthcare providers in Kaduna State between the month of January and December 2019 were purposively compiled and analysed. Cases were classified using the National Health Insurance Scheme (NHIS) Operational Guideline. Frequency tables, charts, percentages and Chi-Square analysis were used with the aid of Statistical Package for Social Sciences (SPSS) 22 at P=.05 level of significance. Results: A total of 11,156 medical cases were recorded after attrition, 9,525 (85.38%) primary cases and 1,632 (14.62%) secondary cases. Malaria (41.23%) and Respiratory Tract Infection (11.98%) led the primary case table while Hypertension (3.83%) Urology related cases (2.49%) and Diabetes (0.79%) were among the leading secondary cases. Female enrollees had slightly more cases and therefore higher tendencies to seek medical treatment than their male counterpart even though there was no significant relation between gender and type of case. Conclusion: The study concludes that the awareness and utilization of healthcare services are gradually growing among enrollees under the Private Health Insurance Programme (PHIP). In ensuring that there is an improvement in the health sector of Nigeria and achieving universal health coverage, focus should be on the primary healthcare services with high consideration for research, proper data management and periodic sharing of trends, observations and outcome of researches with the growing health community.

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 Awareness and Willingness to Participate in Community Health Insurance Scheme Among Household Heads in Rivers State Nigeria

2021 ◽  
pp. 35-44
Author(s):  
Benjamin O Osaro ◽  
Ishmael D Jaja ◽  
Tondor C Uzosike
Keyword(s):  
Health Insurance ◽  
Healthcare Services ◽  
Health Insurance Scheme ◽  
Willingness To Participate ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Quality Healthcare ◽  
Household Heads ◽  
Rivers State

Background: Community-Based Health Insurance scheme (CBHI) can guarantee access to quality healthcare services and increase universal health coverage. Enrolments for this scheme in Nigeria is however low. This study sought to assess the awareness and willingness of households in Rivers State to participate in CBHI. Methodology: This is a cross-sectional descriptive study done in Rivers State, Nigeria. A total of 332 heads of households recruited through multistage sampling and gave written informed consent were interviewed using a pretested interviewer-administered questionnaire. Participants gave information on their socio-demography, awareness and willingness to participate in CBHI and reasons for unwilling to participate. Data were analyzed using IBM SPSS Statistics 22 and results were presented in frequency tables. Chi-square test was done at P< 0.05.

South African health plan will prompt more controversy

2019 ◽  
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Health Coverage ◽  
Access To Health Services ◽  
Content Type ◽  
Private Healthcare ◽  
Health Rights

Subject National Health Insurance (NHI). Significance The long-awaited National Health Insurance (NHI) Bill has been released and is poised to begin its passage through parliament. The Bill contains the biggest health reforms in post-apartheid South Africa and is the first piece of enabling legislation for realising the government’s ambitions for achieving universal health coverage, called NHI. The Bill signals a sharply diminished role for medical schemes, which 8.9 million people use to pre-fund access to private healthcare services. Impacts Given the apartheid-era legacy of inequitable access to health services, opposition to NHI will be cast as being anti-black and anti-poor. With little scope to raise revenue with further tax hikes without undermining compliance, NHI funding will be a perennial problem. Anxiety about the rates government will be willing to offer private healthcare providers could trigger an exodus of doctors and nurses. The NHI Bill rolls back current health rights for migrants, raising the prospects of a future legal challenge.

scholarly journals Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Stephen Kwasi Opoku Duku ◽  
Francis Asenso-Boadi ◽  
Edward Nketiah-Amponsah ◽  
Daniel Kojo Arhinful
Keyword(s):  
Health Insurance ◽  
Adverse Selection ◽  
Healthcare Services ◽  
Utilization Of Healthcare

scholarly journals Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Anurag Saxena ◽  
Mayur Trivedi ◽  
Zubin Cyrus Shroff ◽  
Manas Sharma
Keyword(s):  
Health Insurance ◽  
Healthcare Services ◽  
Structured Interview ◽  
Frontline Staff ◽  
Frontline Workers ◽  
Early Implementation ◽  
Out Of Pocket Expenses ◽  
Treatment Package ◽  
Efficient Hospital ◽  
Utilization Of Healthcare

Abstract Background Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation. Methods Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. Results Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background. Conclusions There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

scholarly journals Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage

2019 ◽  
Author(s):  
Shahin SOLTANI ◽  
Amirhossein TAKIAN ◽  
Ali AKBARI SARI ◽  
Reza MAJDZADEH ◽  
Mohammad KAMALI
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Health Coverage ◽  
Access To Health Services ◽  
Financial Barriers ◽  
Access To Health ◽  
People With Disability ◽  
Universal Health

Background: Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran. Methods: In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran. Results: We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD). Conclusion: Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD. 

scholarly journals “Living long in India”– India’s progress towards Universal Health Coverage

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Balraj ◽  
H Brand
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Indian Population ◽  
Healthcare Services ◽  
Fiscal Year ◽  
Health Coverage ◽  
Indian States ◽  
Universal Health

Abstract Issue There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these issues and achieve Universal Health Coverage (UHC), India launched the healthcare scheme ‘Ayushman Bharat’ (“long live India”) in 2018. Description The Ayushman Bharat (AB) scheme has two components which include 1) transforming the existing primary healthcare centers (PHC) under the control of State Governments and 2) the National Health Protection Scheme (NHPS) also known as “ModiCare” - a health insurance. The scheme aims to transform nearly 150.000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. NHPS covers the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. The coverage will be approximately €6.400 per year per beneficiary family; 60% of the costs are borne by the Centre and 40% by the States. Results Approximately €127 million have already been allocated by the Centre towards the AB scheme for the fiscal year 2018-19. Till date, around 29 million health insurance cards have been issued, approximately 1,8 million beneficiaries have been admitted and around 15.291 hospitals have been empaneled under NHPS. However, there is no data available validating the usage of the health services yet. Few Indian states are yet to implement the AB scheme. Lessons For the first time, attempts have been made to provide affordable healthcare services to the Indian population under a single common initiative. However, the AB scheme fails to cover outpatient health services, which are an important part of OOP expenses in India. Main message The effort to launch Ayushman Bharat in a big, democratic and diverse country like India has to be lauded, which not only aims to make healthcare services affordable but also aligns itself to the concept of UHC.

scholarly journals Utilization of Healthcare Services & Healthcare Expenditure Patterns in the Rural Households of Nepal

2021 ◽  
Vol 16 (1) ◽  
pp. 86-94
Author(s):  
Sachin Pokharel ◽  
Shiva Raj Acharya ◽  
Sandip Pahari ◽  
Deog Hwan Moon ◽  
Yong Chul Shin
Keyword(s):  
Health Care ◽  
Health Services ◽  
Access To Health Care ◽  
Healthcare Expenditure ◽  
Rural Households ◽  
Healthcare Services ◽  
Health Coverage ◽  
Income Source ◽  
Community Based Research ◽  
Utilization Of Healthcare

Background: Healthcare financing as a lever to move closer to universal health coverage. Financing health care has been identified as a barrier to access to health care and increases the likelihood of impoverishment of households. There is still limited study and information on healthcare service utilization in the rural community of Nepal. Our study aims to assess utilization of healthcare services & patterns of healthcare expenditure in the rural households of Nepal. Methods: A community-based research study was conducted among 341 rural households of Tanahun District, Nepal. A Chi-square test was used for assessing the associated factors with healthcare utilization. Results: The utilization of in-patient and out-patient health services was 89.9 % and 10.1 % respectively. The majority of households (88%) had in USD less than $410 annual household healthcare expenditure. The mean annual healthcare expenditure was found to be $279. Nearly three-fourths (71.4%) of households had annual expenditure on medicine more than $40 with mostly on allopathic medicine (93.4%). The majority of participants (70%) mentioned that the healthcare expenditure was a burden to their household. Conclusion: Despite the higher knowledge of health insurance, the involvement was found to be very low & poor. Educational status, knowledge about insurance, privileged ethnicity, religion, income source were the major factors associated with the utilization of healthcare services. Awareness & promotion programs focusing on rural communities should be implemented with affordable health services.

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