scholarly journals Equity of health care financing in South Korea: 1990–2016

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tae-Jin Lee ◽  
Inuk Hwang ◽  
Hea-Lim Kim
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Vertical Equity ◽  
Health Coverage ◽  
Policy Reforms ◽  
Study Results ◽  
Out Of Pocket Payments ◽  
Kakwani Index

Abstract Background The National Health Insurance in Korea has been in operation for more than 30 years since having achieved universal health coverage in 1989 and has gone through several policy reforms. Despite its achievements, the Korean health insurance has some shortfalls, one of which concerns the fairness of paying for health care. Method Using the population representative Household Income and Expenditure Survey data in Korea, this study examined the yearly changes in the vertical equity of paying for health care between 1990 and 2016 by the source of financing using the Kakwani index, considering health insurance and other related policy reforms in Korea during this period. Results The study results suggest that direct tax was the most progressive mode of health care financing in all years, whereas indirect tax was proportional. The out-of-pocket payments were weakly regressive in all years. The Kakwani index for health insurance contributions was regressive but now is proportional to the ability to pay, whereas the Kakwani index for private health insurance premiums turned from progressive to weakly regressive. The Kakwani index for overall health care financing showed a weak regressivity during the study period. Discussion The overall health care financing in Korea has transformed from a slight regressivity to proportional over time between 1990 and 2016. It is expected that these changes were closely related to the improved equity of health insurance contributions from 1998 to 2008, which was the result of a merger of the health insurance societies and an amendment in the health insurance contribution structure. These results suggest that standardizing insurance managing organizations and financing rules potentially has positive implications for the equity of healthcare financing in a country where the major method of health care financing is social health insurance.

Umverteilungseffekte in der Finanzierung von Gesundheitsleistungen / Redistribution Effects of Health Care Financing

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Florian Buchner ◽  
Rebecca Deppisch ◽  
Jürgen Wasem
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Systems ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Health Care Expenditures ◽  
Social Health ◽  
Financing System ◽  
Out Of Pocket Payments ◽  
Care Systems

SummaryHealth care systems are financed through a mixture of different components: taxes, contributions to social health insurance, premiums to private health insurance, out of pocket payments by patients. These components can be combined differently leading to specific effects of interpersonal redistribution. This can be compared between different countries. In such a comparison the redistributional impact of the German health care systems is rather regressive - which is basically caused by the opportunity for people with high income to leave social health insurance. In comparison to a health insurance system with risk rated premiums, financing of the German social health insurance leads to interpersonal redistribution from higher to lower income, from the young to the elderly, from healthy to sick and from singles to families with children. The pay-as-you-go character of the system leads especially in combination with an aging population and technological change to burden for future generations. In comparison to a system in which each region finances its own health care expenditures, there are also considerable interregional redistributions. The financing system in Germany is not conceptually consistent. Reform proposals (unified health insurance for all; flat rate premiums) tackle these inconsistencies.

scholarly journals Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China

2018 ◽  
Vol 14 (4) ◽  
pp. 468-486 ◽  
Author(s):  
Si Ying Tan ◽  
Xun Wu ◽  
Wei Yang
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Rapid Expansion ◽  
Social Health ◽  
Service Utilisation ◽  
Provider Payment ◽  
Out Of Pocket Payments ◽  
The Impact

AbstractWhile moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket payments for outpatients. We argue that, unless effective measures are introduced to deal with perverse provider payment incentives, the move towards a unified system with more generous benefits may usher in a new wave of cost escalation for health care systems in China.

Health care financing and income inequality in Nigeria

2020 ◽  
Vol 47 (11) ◽  
pp. 1419-1431
Author(s):  
Chukwuedo Susan Oburota ◽  
Olanrewaju Olaniyan
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Income Inequality ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Household Survey ◽  
Study Data ◽  
Horizontal Inequity ◽  
Content Type ◽  
High Level

PurposeThe purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in health care financing sources are of immense policy concern particularly in developing countries such as Nigeria, where high-level income inequality exists, and the cost of medical care is generally financed out-of-pocket (OOP) due to limited access to health insurance.Design/methodology/approachThe Duclos et al. decomposition model provided the theoretical framework for the study. Data were obtained from two waves of the Nigeria General Household Survey (GHS) panel, 2012–13 and 2015–16. The analysis covered 3,999 households in 2012–13 and 4,051 households in 2015–16. Two measures of health care financing: OOP payment and health insurance contribution (HIC) were used. The ability to pay measure was household consumption expenditure.FindingsThe major inequity issue induced by the OOP payments was vertical inequity. HICs created the problems of vertical inequity, horizontal inequity and reranking among households. Overall both health care financing options were associated with the worsening of income inequality both at the national and sectorial levels in the country. The operations of the NHIS need to be improved to ensuring improved health care coverage for the poor.Originality/valueThis paper fulfills an identified need to determine the income redistributive effects (REs) of the social health insurance (SHI) contribution at the national, urban and rural locations overtime.

scholarly journals Determinants of out of pocket healthcare expenditures: The case of Mugla province in Turkey

2019 ◽  
Vol 9 (2) ◽  
pp. 76-83
Author(s):  
Bilge Senturk ◽  
Aysun Danisman Isik ◽  
Cisel Ekiz Gokmen
Keyword(s):  
Health Care ◽  
Health Care Financing ◽  
Health Expenditures ◽  
Least Square Method ◽  
Health Care Expenditures ◽  
Least Square ◽  
Health Coverage ◽  
Ordinary Least Square ◽  
Income Status ◽  
Out Of Pocket Payments

As the share of health care financing from public funds was increasing in Turkey, the utilization of the health care services has also increased, dramatically. Despite of universal health coverage, the result of this trend causes to increase the incidence of making out of pocket expenditures. The aim of this study is to evaluate the determinants of households’ health expenditures in Mugla province of Turkey. A total of 204 households living in the central district of Mugla were surveyed and questioned both for their total consumption and health expenditures, as well as their health status, demographic and socio-economic characteristics. Ordinary least square method was used for the multiple regression analysis to identify the factors that affect the out of pocket health care expenditures. In addition to other empirical studies in Turkey, the effects of relative poverty and types of income and occupation on oop expenditures were estimated. Results identify that consumption expenditure of the household, poverty, wage/income status, education, household size, having chronic disease and having elderly in the households have significant effects on the amount of out of pocket (oop) health expenditure of the households. Keywords: Health care financing; Out of pocket payments; Ordinary least square method; Turkey

scholarly journals Insured clients out-of-pocket payments for health care under the national health insurance scheme in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patricia Akweongo ◽  
Moses Aikins ◽  
Kaspar Wyss ◽  
Paola Salari ◽  
Fabrizio Tediosi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Facility ◽  
National Health Insurance ◽  
National Health Insurance Scheme ◽  
Health Facilities ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Out Of Pocket Payments ◽  
Universal Health

Abstract Background In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) designed to promote universal health coverage and equitable access to health care. The scheme has largely been successful, yet it is confronted with many challenges threatening its sustainability. Out-of-pocket payments (OOP) by insured clients is one of such challenges of the scheme. This study sought to examine the types of services OOP charges are made for by insured clients and how much insured clients pay out-of-pocket. Methods This was a descriptive cross-sectional health facility survey. A total of 2066 respondents were interviewed using structured questionnaires at the point of health care exit in the Ashanti, Northern and Central regions of Ghana. Health facilities of different levels were selected from 3 districts in each of the three regions. Data were collected between April and June 2018. Using Epidata and STATA Version 13.1 data analyses were done using multiple logistic regression and simple descriptive statistics and the results presented as proportions and means. Results Of all the survey respondents 49.7% reported paying out-of-pocket for out-patient care while 46.9% of the insured clients paid out-of-pocket. Forty-two percent of the insured poorest quintile also paid out-of-pocket. Insured clients paid for consultation (75%) and drugs (63.2%) while 34.9% purchased drugs outside the health facility they visited. The unavailability of drugs (67.9%) and drugs not covered by the NHIS (20.8%) at the health facility led to out-of-pocket payments. On average, patients paid GHS33.00 (USD6.6) out-of-pocket. Compared to the Ashanti region, patients living in the Northern region were 74% less at odds to pay out-of-pocket for health care. Conclusion and recommendation Insured clients of Ghana’s NHIS seeking health care in accredited health facilities make out-of-pocket payments for consultation and drugs that are covered by the scheme. The out-of-pocket payments are largely attributed to unavailability of drugs at the facilities while the consultation fees are charged to meet the administrative costs of services. These charges occur in disadvantaged regions and in all health facilities. The high reliance on out-of-pocket payments can impede Ghana’s progress towards achieving Universal Health Coverage and the Sustainable Development Goal 3, seeking to end poverty and reduce inequalities. In order to build trust and confidence in the NHIS there is the need to eliminate out-of-pocket payments for consultation and medicines by insured clients.

scholarly journals Good budget or good care: The dilemma of social health insurance in Vietnam

2021 ◽  
Vol 9 ◽  
pp. 205031212110425
Author(s):  
Quan-Hoang Vuong ◽  
Viet-Phuong La ◽  
Minh-Hoang Nguyen ◽  
Thanh-Huyen T Nguyen ◽  
Manh-Toan Ho
Keyword(s):  
Health Insurance ◽  
Geographical Distribution ◽  
Financial Burden ◽  
Social Health Insurance ◽  
Bayesian Regression ◽  
Health Coverage ◽  
Data Set ◽  
Out Of Pocket Payments ◽  
Public Commitment ◽  
Healthcare Insurance

Objective: 2014 marked a rising public commitment to universal health coverage in Vietnam to eliminate the financial burden for patients, but there are lots of hindrances. It is evident that patients met difficulties to validate their insurances, so health insurance does not significantly address out-of-pocket payments issues. Furthermore, the unequal geographical distribution of hospitals in Vietnam has created an inequality between non-residing patients and residing patients; the former usually pay more. This calls into question how the validity of healthcare insurance and patient’s residence could be related to patient’s financial status and their satisfaction with health insurance. Methods: Bayesian regression models are employed to analyze a data set of 1042 inpatients in hospitals of all levels in Northern Vietnam. Result: The results show that living in the same region as the hospital and having valid insurance is negatively correlated with the impoverishing risk. Regarding patients’ satisfaction with health insurance, it is negatively correlated with having a residence in the same region as the hospital but positively correlated with higher socioeconomic status and insurance validity. Finally, on average, the satisfaction of patients who have already recovered from the illness and those who quit early is lower than that of patients who needed follow-up in medical care or stop in the middle. Conclusion: This article suggests that policymakers consider addressing the unequal geographical distribution of hospitals and healthcare quality to help patients avoid going to hospitals outside their regions, which may generate a financial burden for patients and lower their satisfaction with health insurance.

Equity in health care financing in Portugal: findings from the Household Budget Survey 2010/2011

2015 ◽  
Vol 11 (3) ◽  
pp. 233-252 ◽  
Author(s):  
Carlota Quintal ◽  
José Lopes
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Expenditure ◽  
Health Care Financing ◽  
Total Health Expenditure ◽  
Equity In Health ◽  
Household Budget Survey ◽  
Out Of Pocket Payments ◽  
Household Budget ◽  
Equity In Health Care

AbstractEquity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive.

scholarly journals Equity of health-care financing: a progressivity analysis for Egypt

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Yara Ahmed ◽  
Racha Ramadan ◽  
Mohamed Fathi Sakr
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care System ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Financing System ◽  
Content Type ◽  
Health System Financing ◽  
The Impact ◽  
Care System

Purpose This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system. Design/methodology/approach Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall. Findings The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing. Originality/value The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

scholarly journals Gabon health care system: a 20 year analysis

2017 ◽  
Vol 4 (7) ◽  
pp. 2208 ◽  
Author(s):  
Brice Wilfried Obiang Obounou
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care System ◽  
Social Health Insurance ◽  
Insurance Fund ◽  
Health Coverage ◽  
African Countries ◽  
Middle Income ◽  
The Government ◽  
Care System

In response to a high prevalence of HIV/AIDS and malaria, the government of Gabon launched the National Insurance and Social Welfare Fund in 2008. It is a national health insurance fund voted by the parliament to extend health-care coverage to the country’s different socioeconomic groups, bringing everyone under one social health insurance roof. Analysis of the WHO, World Bank and available data from 1995 to 2014 to evaluate progress before and after the creation of the universal health coverage. Maternal health is fully covered and the cost of medical care is reimbursed by 80-90%. However, out-of-pocket spending (21.87%) as a percentage of total health care spending is still higher that other Sub-Saharan African countries classified in the upper-middle income countries. The government and policy makers should increase health care system financing and work in partnership with private clinics regarding over-servicing and over billing.

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