scholarly journals Barriers to universal health coverage in Republic of Moldova: a policy analysis of formal and informal out-of-pocket payments

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Taryn Vian ◽  
Frank G. Feeley ◽  
Silviu Domente ◽  
Ala Negruta ◽  
Andrei Matei ◽  
...  
Keyword(s):  
Policy Analysis ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Republic Of Moldova ◽  
Out Of Pocket Payments ◽  
Universal Health

scholarly journals Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?

2021 ◽  
Vol 18 (4) ◽  
pp. 1382
Author(s):  
Marzena Tambor ◽  
Jacek Klich ◽  
Alicja Domagała
Keyword(s):  
Universal Health Coverage ◽  
European Countries ◽  
Eastern European ◽  
Health Coverage ◽  
Benefit Package ◽  
Significant Downward Trend ◽  
Out Of Pocket Payments ◽  
Eastern European Countries ◽  
Universal Health

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000–2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care.

scholarly journals Financial risk protection of Thailand’s Universal Health Coverage: results from series of national household surveys between 1996 and 2015

2020 ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
Universal Health

Abstract Background: Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not however provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods: We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payments for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results: Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8% to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion: The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefit package concertedly support the achievement of UHC goals of access and financial risk protection.

scholarly journals Implementation of provider payment system reforms in the age of universal health coverage: a realist review of evidence from Asian developing countries

2019 ◽  
Vol 24 (4) ◽  
pp. 279-287
Author(s):  
Si Ying Tan ◽  
GJ Melendez-Torres ◽  
Tikki Pang
Keyword(s):  
Developing Countries ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Realist Synthesis ◽  
Health Coverage ◽  
Payment Reform ◽  
Provider Payment ◽  
Out Of Pocket Payments ◽  
Universal Health ◽  
Asian Developing Countries

Objective Launched to assist in achieving universal health coverage, provider payment reform (PPR) is one of the most important policy tools deployed to transform incentives within a health system that is plagued with allocative inefficiency and high out-of-pocket payments to one that is able to deliver basic services and be cost-efficient. However, the black box of such reform – that is, the contexts in which reform operates, the mechanisms by which it changes health systems and behaviour within health systems, and the outcome patterns that arise from – remains unexplored. This review aims to examine the implementation mechanisms underlying PPR in Asian developing countries. Methods A realist synthesis approach was employed to tease out the configurative elements of PPR in developing countries. A multimethod and retrospective search was conducted to locate the evidence. A programme theory and data extraction framework were developed. Data were analysed using thematic synthesis to inform an overarching realist synthesis, expressed as a set of synthesized context-mechanism-outcome configurations. Results This review found that the policy design of PPR, policy capacity, willingness of policy adoption at the local government level and provider autonomy are critical contextual factors that could trigger different policy mechanisms leading to either intended theoretical outcomes or perverse incentives. Conclusions Our findings, demonstrating the PPR implementation contexts and mechanisms that have worked in Asian countries, have implications in terms of policy learning for most developing countries that are contemplating rolling out similar reforms in the future.

scholarly journals Infertility policy analysis: a comparative study of selected lower middle- middle- and high-income countries

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Bahar Morshed-Behbahani ◽  
Minoor Lamyian ◽  
Hassan Joulaei ◽  
Batool Hossein Rashidi ◽  
Ali Montazeri
Keyword(s):  
Supportive Care ◽  
Policy Analysis ◽  
Universal Health Coverage ◽  
High Income ◽  
Financial Protection ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
Universal Health

Abstract Background Infertility has recently become a salient but neglected global issue. Policies to address the sexual and reproductive health and rights (SRHR) are vital, especially in lower middle and middle-income countries (LMICs). Hence, the aim of this study was to compare the national infertility policies in the selected countries (LMICs comparing with high-income) to determine gaps or to confirm desirable policies in the given health systems. Methods This study has executed a comparative policy analysis of infertility services using the universal health coverage framework (financial protection, population coverage, and service features) in three scopes (prevention, treatment, and supportive care). Seven countries that had infertility programs in their health sectors were selected. Results The results showed that financial protection was good in high and middle-income countries, but in a lower middle income, and in one high-income country was poor. The findings also showed that health systems in the same countries had no infertility services for men. Preventive and supportive care services were neglected in LMICs by governments. Conclusion The findings indicate that income is not the only factor that fulfills universal health coverage for infertility care services. Perhaps to achieve equity in infertility care services, it should be seen as a universal human right to accomplish the right to have a child and to have a life with physical and mental health for all men and women.

scholarly journals UNIVERSAL HEALTH COVERAGE: AN ANALYSIS OF ALTERNATIVE POLICY FOR HEALTH CARE SPENDING IN BANGLADESH

2021 ◽  
Vol 21 (2) ◽  
pp. 46-68
Author(s):  
Ali MOHOSHIN ◽  
Shamima AKTER
Keyword(s):  
Health Care ◽  
Policy Analysis ◽  
Universal Health Coverage ◽  
Poverty Line ◽  
Health Protection ◽  
Health Care Spending ◽  
Health Coverage ◽  
Alternative Policy ◽  
The People ◽  
Universal Health

Health care spending is one of the crucial elements for ensuring universal health coverage in Bangladesh. The main purpose of the policy analysis report is to find out policy option of health care spending for ensuring universal health coverage in Bangladesh by 2030. The underlying objectives of the study are to examine the effectiveness of existing national health policy to ensure universal health coverage for the people of Bangladesh, to evaluate the current health care spending and to develop alternative policy for ensuring universal health coverage 2030. The policy analysis report has been prepared based on identifying the policy problems from the existing content, document research and organizational records and in doing so the multi-goal policy analysis approach and the criteria of measurement set against the goals and objectives of the policy. Data and information of this policy analysis have been accumulated and presented from various secondary sources. The major findings of the policy analysis can be noted that the policy alternative as policy intervention as such introducing multiple health protection schemes and create health protection fund especially for the people living below poverty line for ensuring universal health coverage in Bangladesh and thereby the household out of pocket expenditure will decrease significantly. Therefore, it is suggested and can be implemented in the whole countryfor the sake of ensuring universal health coverage and make accessible of quality health services to the people of Bangladesh. It is also recommended that Bangladesh needs to introduce the health protection schemes at least for the people living below poverty line and the people working in the formal sector.

scholarly journals Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253109
Author(s):  
Moses Aikins ◽  
Philip Teg-Nefaah Tabong ◽  
Paola Salari ◽  
Fabrizio Tediosi ◽  
Francis M. Asenso-Boadi ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Civil Society Organizations ◽  
Financial Sustainability ◽  
Health Coverage ◽  
Political Interference ◽  
Out Of Pocket Payments ◽  
Universal Health

Introduction The National Health Insurance Scheme (NHIS) was introduced in 2003 to reduce “out-of-pocket” payments for health care in Ghana. Over a decade of its implementation, issues about the financial sustainability of this pro-poor policy remains a crippling fact despite its critical role to go towards Universal Health Coverage. We therefore conducted this study to elicit stakeholders’ views on ways to improve the financial sustainability of the operations of NHIS. Methods Twenty (20) stakeholders were identified from Ministry of Health, Ghana Health Services, health workers groups, private medical practitioners, civil society organizations and developmental partners. They were interviewed using an interview guide developed from a NHIS policy review and analysis. All interviews were recorded and transcribed verbatim. The data were analysed thematically with the aid of NVivo 12 software. Results Stakeholders admitted that the NHIS is currently unable to meet its financial obligations. The stakeholders suggested first the adoption of capitation as a provider payment mechanism to minimize the risk of providers’ fraud and protection from political interference. Secondly, they indicated that rapid releases of specific statutory deductions and taxes for NHIS providers could reduce delays in claims’ reimbursement which is one of the main challenges faced by healthcare providers. Aligning the NHIS with the Community-based Health Planning and Services and including preventive and promotive health is necessary to position the Scheme for Universal Health Coverage. Conclusion The Scheme will potentially achieve UHC if protected from political interference to improve the governance and transparency that affects the finances of the scheme and the expansion of services to include preventive and promotive services and cancers.

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.

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