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 What support do frontline workers want? A qualitative study of health and social care workers’ experiences and views of psychosocial support during the COVID-19 pandemic

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256454
Author(s):  
Jo Billings ◽  
Nada Abou Seif ◽  
Siobhan Hegarty ◽  
Tamara Ondruskova ◽  
Emilia Soulios ◽  
...  
Keyword(s):  
Mental Health ◽  
Support Services ◽  
Social Care ◽  
Psychosocial Support ◽  
Structured Interview ◽  
Snowball Sampling ◽  
Frontline Staff ◽  
Frontline Workers ◽  
Care Workers ◽  
Health And Social Care

Background The COVID-19 pandemic has placed a significant burden on the mental health and wellbeing of frontline health and social care workers. The need to support frontline staff has been recognised. However, there is to date little research specifically on how best to support the mental health needs of frontline workers, and none on their own experiences and views about what might be most helpful. Aims We set out to redress this research gap by qualitatively exploring UK frontline health and social care workers’ own experiences and views of psychosocial support during the pandemic. Method Frontline health and social care workers were recruited purposively through social media and by snowball sampling via healthcare colleagues. Workers who volunteered to take part in the study were interviewed remotely following a semi-structured interview guide. Transcripts of the interviews were analysed by the research team following the principles of Reflexive Thematic Analysis. Results We conducted 25 interviews with frontline workers from a variety of professional groups working in health and social care settings across the UK. Themes derived from our analysis showed that workers’ experiences and views about psychosocial support were complex. Peer support was many workers’ first line of support but could also be experienced as a burden. Workers were ambivalent about support shown by organisations, media and the public. Whilst workers valued psychological support services, there were many disparities in provision and barriers to access. Conclusions The results of this study show that frontline health and social care workers are likely to need a flexible system of support including peer, organisational and professional support. More research is needed to fully unpack the structural, systemic and individual barriers to accessing psychosocial support. Greater collaboration, consultation and co-production of support services and their evaluation is warranted.

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 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 What support do frontline workers want? A qualitative study of health and social care workers’ experiences and views of psychosocial support during the COVID-19 pandemic

2020 ◽  
Author(s):  
Jo Billings ◽  
Nada Abou Seif ◽  
Siobhan Hegarty ◽  
Tamara Ondruskova ◽  
Emilia Soulios ◽  
...  
Keyword(s):  
Mental Health ◽  
Support Services ◽  
Social Care ◽  
Psychosocial Support ◽  
Structured Interview ◽  
Snowball Sampling ◽  
Frontline Staff ◽  
Frontline Workers ◽  
Care Workers ◽  
Health And Social Care

AbstractBackgroundThe COVID-19 pandemic has placed a significant burden on the mental health and wellbeing of frontline health and social care workers. The need to support frontline staff has been recognised. However, there is to date little research specifically on how best to support the mental health needs of frontline workers, and none on their own experiences and views about what might be most helpful.AimsWe set out to redress this research gap by qualitatively exploring UK frontline health and social care workers’ own experiences and views of psychosocial support during the pandemic.MethodFrontline health and social care workers were recruited purposively through social media and by snowball sampling via healthcare colleagues. Workers who volunteered to take part in the study were interviewed remotely following a semi-structured interview guide. Transcripts of the interviews were analysed by the research team following the principles of Reflexive Thematic Analysis.ResultsWe conducted 25 interviews with frontline workers from a variety of professional groups working in health and social care settings across the UK. Themes derived from our analysis showed that workers’ experiences and views about psychosocial support were complex. Peer support was many workers’ first line of support but could also be experienced as a burden. Workers were ambivalent about support shown by organisations, media and the public. Whilst workers valued psychological support services, there were many disparities in provision and barriers to access.ConclusionsThe results of this study show that frontline health and social care workers are likely to need a flexible system of support including peer, organisational and professional support. More research is needed to fully unpack the structural, systemic and individual barriers to accessing psychosocial support. Greater collaboration, consultation and co-production of support services and their evaluation is warranted.

Utilization Of Healthcare Services To General Patient At Inpatient Unit of Anutapura General Hospital, Palu City

2020 ◽  
Vol 10 (1) ◽  
pp. 35-44
Author(s):  
Fausiah Fausiah
Keyword(s):  
Health Services ◽  
General Hospital ◽  
Health Beliefs ◽  
Secondary Data ◽  
Healthcare Services ◽  
Primary Data ◽  
Utilization Of Health Services ◽  
The People ◽  
Quantitative Descriptive ◽  
Utilization Of Healthcare

The number of inpatient visits in RSU Anutapura Palu, where in 2015 inpatient visits of 5,640, then in 2016 patient visits decreased to 5,451, in 2017 also decreased to 3,999 and in 2018 also decreased Drastic to 1,146 patient visits. This research aims to determine the utilization of health services in patients in general hospitalization in RSU Anutapura Palu. This type of research is quantitative descriptive. Research was conducted from May-June 2019. The population in the study is a visitor (number of hospitalizations) at the General Hospital (RSU) Anutapura Palu. In this case the people who use health services in the General Hospital (RSU) Anutapura Palu recorded as many as 1,146 visitors (patients) in the year 2018. Primary data collection is through questionnaires and secondary data through the study of patient record documents and other supporting documents. The utilization of health services in patients in general hospitalization in RSU Anutapura Palu is well from the aspects of health beliefs, abilities and needs. RSU Anutapura Palu is expected to be able to improve the promotion of health services so that people use the health services provided.  

scholarly journals Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sajad Vahedi ◽  
Amin Torabipour ◽  
Amirhossein Takian ◽  
Saeed Mohammadpur ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Health System ◽  
Age Groups ◽  
Unmet Need ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Outpatient Services ◽  
Self Medication ◽  
Cross Sectional ◽  
Organizational Policies ◽  
Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

scholarly journals Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017–18 Jordan demographic and health survey

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Petula Fernandes ◽  
Emmanuel Kolawole Odusina ◽  
Bright Opoku Ahinkorah ◽  
Komlan Kota ◽  
Sanni Yaya
Keyword(s):  
Health Insurance ◽  
Antenatal Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Healthcare Services ◽  
Skilled Birth Attendance ◽  
Reproductive Age ◽  
Maternal Healthcare ◽  
Services Utilization ◽  
Birth Attendance

Abstract Background Despite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan. Methods This study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression. Results Out of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33, p < 0.05, aOR = 1.25, p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72 p < 0.001). Conclusions Jordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.

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