Out-of-Pocket Health Expenditures Among Insured and Uninsured Patients in Vietnam

2019 ◽  
Vol 31 (3) ◽  
pp. 210-218 ◽  
Author(s):  
Nguyen Duc Thanh ◽  
Bui Thi My Anh ◽  
Chu Huyen Xiem ◽  
Hoang Van Minh
Keyword(s):  
Outpatient Care ◽  
Inpatient Care ◽  
Health Care Services ◽  
Health Facilities ◽  
Least Square ◽  
Health Centers ◽  
Health Coverage ◽  
District Health ◽  
District Hospitals ◽  
Universal Health

Out-of-pocket expenditure/payment (OOP) is one of the indicators measuring the achievement of Universal Health Coverage. This article aimed to compare OOP among the insured and uninsured for their outpatient and inpatient health care services. The data of 6710 individuals using outpatient care and 924 individuals using inpatient care at 78 district hospitals and 246 commune health centers in 6 provinces from the World Bank survey, “The 2015 Vietnam District and Commune Health Facility,” were used for analysis. In the ordinary least square model, the estimated coefficient of the insurance status variable suggested that insurance reduced OOP by 31.1% for outpatient care and 31.5% for inpatient care of the insured as compared with the uninsured ( P <0.001). For outpatient care, insurance reduced OOP more for those enrollees using commune health centers than those using district health facilities, 42.3% and 20.2%, respectively. For inpatient care at district health facilities, insurance reduced OOP by 34.9% as compared with the uninsured ( P <0.001). The study suggested that more active solutions should be created to promote the universal health insurance in Vietnam.

scholarly journals Impact of Public Health Insurance on Out-of-Pocket Health Expenditures of the Near-Poor in Vietnam

2021 ◽  
Vol 14 ◽  
pp. 117863292110174
Author(s):  
Nguyen Duc Thanh ◽  
Bui Thi My Anh ◽  
Phung Thanh Hung ◽  
Pham Quynh Anh ◽  
Chu Huyen Xiem
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Universal Health Coverage ◽  
Outpatient Care ◽  
Health Facilities ◽  
World Health ◽  
Asia Pacific ◽  
Health Coverage ◽  
Out Of Pocket Payments ◽  
Universal Health

Out-of-pocket payment is one of the indicators measuring the achievement of Universal Health Coverage. According to the World Health Organization, for countries from the Asia Pacific Region, out-of-pocket payments should not exceed 30%-40% of total health expenditure. This study aimed to identify factors influencing out-of-pocket payment for the near-poor for outpatient healthcare services as well as across health facilities at different levels. The data of 1143 individuals using outpatient care were used for analysis. Healthcare payments were analyzed for those who sought outpatient care in the past 6 months. The Heckman selection model was used to control any bias resulting from self-selection of the insurance scheme. The finding revealed that health insurance reduces average out-of-pocket payments by about 21% ( P < .001). Using private health facilities incurred more out-of-pocket payments than public health facilities ( P < .001). The study suggested that health insurance for the near-poor should be modified to promote universal health coverage in Vietnam.

scholarly journals Results Based Financing in Zambia: Performance Evaluation and Exploration of Opportunities in Health System Adoption

2021 ◽  
Vol 3 (1) ◽  
pp. 40-49
Author(s):  
Mayeya Paul Mayeya ◽  
◽  
Fredrick Mulenga Chitangala
Keyword(s):  
Health System ◽  
Health Care Services ◽  
Health Management ◽  
Health Sector ◽  
Poor Performance ◽  
Health Facilities ◽  
Management Support ◽  
Health Coverage ◽  
District Health ◽  
Results Based Financing

Background–Results Based Financing has strategically fit into discussions of the Universal Health Coverage agenda at global level with the aim of meeting the Sustainable Development Goals. It has been viewed that Results Based Financing is a potent financing model and can be used as a strategic tool for remodeling the health systems in many developing countries as suggested by prior studies which argued that Results Based Financing implementation requires: (i) a strong management support and political will; (ii) maximum innovative efficiencies and willingness for change; and (iii) strengthened health management information and reporting systems. Therefore, this study aimed at understanding how Results Based Financing approaches can be scaled-up by exploring the Successes, Challenges and Opportunities of adopting it into the health system from its project form.Methods -A case study design was used for this research with a quantitativedata collection approach. Data was analyzed using SPSS version 22.Results-The Results Based Financingprogramme improved all the indicators targeted in Lunte District Health facilities. The successes of the project included improved quality of health care services and strengthened health system. A notable challenge for Results BasedFinancing implementers was poor performance of non-incentivized indicators compared with the incentivized. However, an opportunity was seen with the project in that other financing models were discussed to either mimic or simply use Results Based Financing tools, pool funds in one basket and apply the concept. Results Based Financing improved efficiency and effectiveness based on results that health facilities learnt how to manage funds, shown by 67% of respondents, and commitment to re-investment 60% of their bonuses back into the system.Conclusion-Results based financing can be regarded as a model for harmonizing other donor funds and drive forward the financial sustainability of being a successful financing strategy for the health sector

scholarly journals Managing pneumonia through facility-based integrated management of childhood management (IMCI) services: an analysis of the service availability and readiness among public health facilities in Bangladesh

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Ehsanur Rahamn ◽  
Shema Mhajabin ◽  
David Dockrell ◽  
Harish Nair ◽  
Shams El Arifeen ◽  
...  
Keyword(s):  
Public Health ◽  
Distribution System ◽  
Integrated Management ◽  
Child Death ◽  
Health Facilities ◽  
Family Welfare ◽  
Service Availability ◽  
District Health ◽  
Public Health Facilities ◽  
District Hospitals

Abstract Background With an estimated 24,000 deaths per year, pneumonia is the single largest cause of death among young children in Bangladesh, accounting for 18% of all under-5 deaths. The Government of Bangladesh adopted the WHO recommended Integrated Management of Childhood Illness (IMCI)-strategy in 1998 for outpatient management of pneumonia, which was scaled-up nationally by 2014. This paper reports the service availability and readiness related to IMCI-based pneumonia management in Bangladesh. We conducted a secondary analysis of the Bangladesh Health Facility Survey-2017, which was conducted with a nationally representative sample including all administrative divisions and types of health facilities. We limited our analysis to District Hospitals (DHs), Maternal and Child Welfare Centres (MCWCs), Upazila (sub-district) Health Complexes (UHCs), and Union Health and Family Welfare Centres (UH&FWCs), which are mandated to provide IMCI services. Readiness was reported based on 10 items identified by national experts as ‘essential’ for pneumonia management. Results More than 90% of DHs and UHCs, and three-fourths of UH&FWCs and MCWCs provide IMCI-based pneumonia management services. Less than two-third of the staff had ever received IMCI-based pneumonia training. Only one-third of the facilities had a functional ARI timer or a watch able to record seconds on the day of the visit. Pulse oximetry was available in 27% of the district hospitals, 18% of the UHCs and none of the UH&FWCs. Although more than 80% of the facilities had amoxicillin syrup or dispersible tablets, only 16% had injectable gentamicin. IMCI service registers were not available in nearly one-third of the facilities and monthly reporting forms were not available in around 10% of the facilities. Only 18% of facilities had a high-readiness (score 8–10), whereas 20% had a low-readiness (score 0–4). The readiness was significantly poorer among rural and lower level facilities (p < 0.001). Seventy-two percent of the UHCs had availability of one of any of the four oxygen sources (oxygen concentrators, filled oxygen cylinder with flowmeter, filled oxygen cylinder without flowmeter, and oxygen distribution system) followed by DHs (66%) and MCWCs (59%). Conclusion There are substantial gaps in the readiness related to IMCI-based pneumonia management in public health facilities in Bangladesh. Since pneumonia remains a major cause of child death nationally, Bangladesh should make a substantial effort in programme planning, implementation and monitoring to address these critical gaps to ensure better provision of essential care for children suffering from pneumonia.

scholarly journals Assessing health services accessibility in Colombia: Beyond universal health coverage

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Arrivillaga
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Right To Health ◽  
Primary Data ◽  
Pilot Test ◽  
Health Coverage ◽  
Human Right ◽  
Care Services ◽  
Universal Health

Abstract Background Colombia has an insurance-based, private and public health care system, with the intermediation of health insurance agencies that control the resources. At present, the Universal Health Coverage (UHC) is around 97%. However, there is wide scientific evidence that criticizes the structure and operation of the system due to the persistent differences between the UHC indicator and real accessibility to health services. This study aimed to analyze the concept of accessibility of health services in order to design and validate alternatives instruments for its assessment beyond UHC. Methods A mixed methods approach with concurrent design in three phases was conducted between 2014 and 2017: 1) systematic review of literature and documentary research; 2) design, content validation with experts and pilot test of instruments to assess health care accessibility and 3) definition of a route to assess accessibility. Results The reviewed literature revealed five conceptual logics to define accessibility: decent minimum of health care, health care market, factors and multicausality, needs and, social justice and human right to health. A Household Survey on Accessibility to Health Care Services and a Health Care Services Availability Questionnaire was designed and validated with experts and pilot test in representative samples of households and care centers in three cities in Colombia was conducted. Those instruments were designed under the conceptual logic of human right to health. Finally, an alternative route to assess accessibility in Colombia was proposed. Conclusions The route for assessing accessibility with primary data, territorial approach and without intermediation of health insurance agencies allow obtaining an overview of the real situation beyond the UHC indicator. The instruments included in this assessing process can be useful to monitor progress in guaranteeing the human right to health, declared in Colombia and other countries. Key messages The UHC indicator is not enough to assess real accessibility to health services. This study presents an alternative route and two validated instruments for its assessment with primary data and territory-based approach, applicable to countries with public-private health systems.

scholarly journals Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257348
Author(s):  
Vivian Naidoo ◽  
Fatima Suleman ◽  
Varsha Bangalee
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Universal Health Coverage ◽  
Health Care Services ◽  
Online Survey ◽  
Health Coverage ◽  
Care Services ◽  
Primary Health ◽  
Comprehensive Service ◽  
Universal Health

Background The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. Objectives To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. Methods Community pharmacists’ across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. Results Six hundred and sixty-four pharmacists’ responded to the online survey. Seventy-five percent of pharmacists’ reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. Conclusions This study provides baseline data for policy makers on pharmacists’ readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.

scholarly journals Factors Influencing Recovery among Children with Moderate Acute Malnutrition Treated at Kirehe District Health Centers

2020 ◽  
Vol 3 (1) ◽  
pp. 20-27
Author(s):  
Vianney Bihibindi Kabundi ◽  
Camille Kayihura ◽  
Onesmus Marete ◽  
Nicodeme Habarurema ◽  
Erigene Rutayisire
Keyword(s):  
Low Income ◽  
Family Income ◽  
Health Facilities ◽  
Health Centers ◽  
Acute Malnutrition ◽  
District Health ◽  
Middle Income ◽  
Factors Associated ◽  
Income Status ◽  
Moderate Acute Malnutrition

Acute malnutrition affects nearly 52 million of under five years children globally, 75% of them live in low to middle income countries. The treatment of acute malnutrition using supplement foods could help children recovering and could reduce the risk of sickness. The present study investigated the factors associated with recovery among children with moderate acute malnutrition (MAM) under a follow-up program at health facilities. A prospective study was conducted in 16 health centers of Kirehe District of Rwanda and included 200 children from 6 to 59 months. A semi-structured questionnaire was used for data collection. All children enrolled in the study spent three months in nutrition program at health centers. The results show that after 3 months in the program 77.5% recovered from MAM. Children aged above 36 to 59 months were recovered at 90% whereas children aged from 24-35 months were recovered at 73.5%. Micronutrients and deworming provided at health facility were contributed to the recovery as children who received them were recovered at 89.1% and for those who didn’t were recovery at 72.1%. The findings demonstrated that boys were 16 times more likely to recover from MAM in three months of intervention than girls (AOR=16.19, p<0.001, 95% CI: 5.39- 48.63). Children from moderate income families were 3 more likely to recover than those from very low income families (AOR=2.8, p=0.029, 95% CI: 1.11-7.51). Male gender, receiving micronutrients and deworming from health facilities and family income status were factors associated with MAM recovery status

scholarly journals Assessment of Facility based newborn care at various health care facilities in Rajkot district

2017 ◽  
Vol 4 (4) ◽  
pp. 1125
Author(s):  
Jasmin R. Oza ◽  
Ashutosh D. Jogia ◽  
Bhavesh R. Kanabar ◽  
Dhara V. Thakrar
Keyword(s):  
Health Care ◽  
Health Personnel ◽  
Newborn Care ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Health Centers ◽  
Care Providers ◽  
Digital Thermometer ◽  
Neonatal Deaths ◽  
District Hospitals

Background: India carries the single largest share (around 25-30%) of neonatal deaths in the world. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively with high coverage.Methods: A cross-sectional observational study was conducted at various health facilities of Rajkot district where facility based newborn care are created as per the guidelines under NRHM. It was conducted during August 2013 to October, 2013. The data entry was done in Microsoft Office Excel 2007 and analyzed in Epi info software from CDC Atlanta. Results: This study included total 32 health facilities including 10 Primary Health Centers (PHC) (24X7), 15 Community Health Centers (CHC), 5 Sub District Hospitals (SDH), one District Hospital (DH) and one Medical College (MC). There are a total of 36 facilities of different level available in government set up for newborn care starting from NBCC to SNCU. All (100%) of the health centers visited were equipped with NBCC for newborn care, while NBSU and SNCU for newborn care were created at only 2 (6.2%) centers respectively. Only 2 out of 10 PHC had all required equipments for NBCC. All the required equipments were available at 3 CHCs out of total 15 CHCs. All the SDH were having adequate equipment for NBCC except resuscitator & separate Digital Thermometer were not available at 2 SDH. At DH, except for Digital thermometer, all equipments were adequate. Only 1 SDH has been established for NBSU and it did not have adequate no. of radiant warmer and resuscitator. DH is lacking in all the required equipment for SNCU except for resuscitator (250 ml) and refrigerator. Out of total 101 health personnel, 68 (67.3%) have been trained for NSSK.  From total 68 trained health personnel, 12 (17.7%) got the score above the cut off for resuscitation skill. Out of the trained respondents, 29 (42.7%) acquired score above cut off for routine care.Conclusion: All the PHCs, CHCs, SDHs and DH were deficient in equipments. NBSU was created in only one SDH. SNBU was created at DH and MC, but equipments were not sufficient at both centers. Health care providers involved in facility based newborn care units had poor knowledge regarding routine newborn care and also not properly trained in resuscitation.

Universal Health Coverage for Undocumented Migrants. The Spanish Case

2018 ◽  
Vol 25 (2) ◽  
pp. 283-299
Author(s):  
María Dalli
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Access To Health Care ◽  
Health Care Services ◽  
Universal Coverage ◽  
Right To Health ◽  
Undocumented Migrants ◽  
Health Coverage ◽  
The Right ◽  
Universal Health

Implementation of the universal right to health, along with the UN’s goal to achieve universal health coverage (UHC), face common challenges to ensuring universal health care entitlement. One of these difficulties is health care restrictions for undocumented migrants. A recent example is the Spanish health care regulation that places universal coverage at risk by restricting access to it by this group. The work herein examines the right to health and UHC’s regulations with the aim of determining if access to health care services for undocumented migrants is indeed recognized and if this recognition could therefore be valid to limit those kinds of measures. The UHC proposal does not sufficiently deal with this problem. Regarding the right to health, even though there are some limitations within international human rights laws regarding protection for this group, it can be concluded that the right to health is also applicable to undocumented migrants.

scholarly journals Determinants of Health Coverage Awareness for Poor Beneficiaries of the Thai Universal Health Coverage Scheme

2018 ◽  
Vol 14 (9) ◽  
pp. 98
Author(s):  
Anchana NaRanong
Keyword(s):  
Universal Health Coverage ◽  
Low Income ◽  
Quantitative Research ◽  
Health Care Services ◽  
Determinants Of Health ◽  
Health Coverage ◽  
Quantitative Research Methods ◽  
Level Of Education ◽  
Short Period ◽  
Universal Health

The Thai universal health coverage scheme (UHCS), or “30 Baht Scheme”, has played an important role in increasing the accessibility of health care services for low income earners. The objective of this paper is to study poor beneficiaries’ awareness of the UHCS. Quantitative research methods were employed. Data were collected, and multiple regression performed, to explore the determinants of health coverage awareness. The regression shows that age, education level, and number of years as card holder are significant determinants of health coverage awareness. Those with a higher age or level of education scored higher than those who were younger or with a low level of education or no education. Those who held UHCS cards for long periods of time possessed higher health coverage awareness than those who had recently received their membership cards. Greater exposure to news and information, therefore, is needed for those of a younger age and those who have less education, if awareness is to be increased. The same applies to those who have only held UHCS cards for a short period.

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