scholarly journals The impact of National Health Insurance upon accessibility of health services and financial protection from catastrophic health expenditure: a case study of Savannakhet province, the Lao People’s Democratic Republic

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Somdeth Bodhisane ◽  
Sathirakorn Pongpanich
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Health Expenditure ◽  
Democratic Republic ◽  
Catastrophic Health Expenditure ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Financial Protection ◽  
The Government ◽  
The Impact

Abstract Introduction Many schemes have been implemented by the government of the Lao People’s Democratic Republic to provide equity in health service utilisation. Initially, health service utilisations were fully supported by the government and were subsequently followed by the Revolving Drug Fund. In the 2000s, four health financing schemes, namely the Social Security Organization, the State Authority for Social Security, the Health Equity Fund and Community-Based Health Insurance (CBHI), were introduced with various target groups. However, as these voluntary schemes have suffered from a very low enrolment rate, the government decided to pilot the National Health Insurance (NHI) scheme, which offers a flat, co-payment system for health service utilisation. This study aims to assess the effectiveness of the NHI in terms of its accessibility and in providing financial protection from catastrophic health expenditure. Methods The data collection process was implemented in hospitals of two districts of Savannakhet province. A structured questionnaire was used to retrieve all required information from 342 households; the information comprised of the socioeconomics of the household, accessibility to health services and financial payment for both outpatient and inpatient department services. Binary logistic regression models were used to discover the impact of NHI in terms of accessibility and financial protection. The impact of NHI was then compared with the outcomes of the preceding, voluntary CBHI scheme, which had been the subject of earlier studies. Results Under the NHI, it was found that married respondents, large households and the level of income significantly increased the probability of accessibility to health service utilisation. Most importantly, NHI significantly improved accessibility for the poorest income quantile. In terms of financial protection, households with an existing chronic condition had a significantly higher chance of suffering financial catastrophe when compared to households with healthy members. As probability of catastrophic expenditure was not affected by income level, it was indicated that NHI is able to provide equity in financial protection. Conclusion The models found that the NHI significantly enhances accessibility for poor income households, improving health service distribution and accessibility for the various income levels when compared to the CBHI coverage. Additionally, it was also found that NHI had enhanced financial protection since its introduction. However, the NHI policy requires a dramatically high level of government subsidy; therefore, there its long-term sustainability remains to be determined.

scholarly journals Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Huan Liu ◽  
Hong Zhu ◽  
Jiahui Wang ◽  
Xinye Qi ◽  
Miaomiao Zhao ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Low Income ◽  
Health Expenditure ◽  
Concentration Index ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Integration System ◽  
Integration Policies ◽  
The Impact

Abstract Background By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is − 0.071 and − 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

scholarly journals Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana

2019 ◽  
Vol 34 (9) ◽  
pp. 694-705 ◽  
Author(s):  
Lucia Fiestas Navarrete ◽  
Simone Ghislandi ◽  
David Stuckler ◽  
Fabrizio Tediosi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Financial Risk ◽  
Financial Protection ◽  
Medical Needs ◽  
Medical Spending ◽  
Out Of Pocket Payments ◽  
The Impact

Abstract A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012–13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (−5 p.p. vs −9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (−10 p.p. vs. −6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC.

scholarly journals Catastrophic Health Expenditure: An Experience from Health Insurance Program in Nepal

2019 ◽  
Vol 3 (5) ◽  
pp. 327-336 ◽  
Author(s):  
Deepak Raj Paudel
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Expenditure ◽  
Health Care Expenditure ◽  
Catastrophic Health Expenditure ◽  
Health Concern ◽  
Government Health ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Government

High expenditure due to health care is a noted public health concern in Nepal and such expenditure is expected to reduce through the access to health insurance. This study determines the factors affecting household’s catastrophic health care expenditure in Kailali district, where the government health insurance program was first piloted in Nepal. A cross-sectional survey was conducted from January to February 2018 among 1048 households (6480 individuals) after 21 months of the execution of the social health insurance program.  For the sample selection, wards were selected in the first stage followed by the selection of the households. Overall, 17.8% of the households reported catastrophic health expenditure using a threshold of more than 10% of out-of-pocket payment to total household expenditure. The study found that households without having health insurance, low economic status, and head with low level of education were more likely to face catastrophic spending. The findings suggest a policy guideline in the ongoing national health insurance debate in Nepal. The government health insurance program is currently at expansion stage, so, increase in insurance coverage, could financially help vulnerable households by reducing catastrophic health expenditure.

scholarly journals The impact of a health facility construction campaign on health service utilisation and outcomes: analysis of spatially linked survey and facility location data in Ethiopia

2020 ◽  
Vol 5 (8) ◽  
pp. e002430
Author(s):  
Kevin Croke ◽  
Andualem Telaye Mengistu ◽  
Stephen D. O'Connell ◽  
Kibrom Tafere
Keyword(s):  
Caesarean Section ◽  
Health Service ◽  
Neonatal Mortality ◽  
Facility Delivery ◽  
Health Facilities ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Percentage Points ◽  
Facility Construction ◽  
The Impact

BackgroundAccess to health facilities in many low-income and middle-income countries remains low, with a strong association between individuals’ distance to facilities and health outcomes. Yet plausibly causal estimates of the effects of facility construction programmes are rare. Starting in 2004, more than 2800 government health facilities were built in Ethiopia. This study estimates the impact of this programme on maternal health service utilisation and birth outcomes.MethodsWe analyse the impact of Ethiopia’s health centre construction programme on health service utilisation and outcomes, using a difference-in-difference design. We match facility opening years to child birth years in four rounds of Demographic and Health Surveys (DHS) using georeferenced data. We also use event study models to test for pre-trends in the outcomes of interest.ResultsOpening of new health facilities within 5 km increases facility delivery by 7.2 percentage points (95% CI 5.2 to 9.1) and antenatal care by 0.38 visits (95% CI 0.24 to 0.52). It is not significantly associated with changes in caesarean section births or neonatal mortality. Opening of district hospitals increases facility delivery by 18.2 percentage points (95% CI 12.7 to 23.7), and caesarean section births by 6.8 percentage points (95% CI 2.5 to 11.2), but is not associated with reduction of neonatal mortality.ConclusionsEthiopia’s facility construction program improved access to antenatal and delivery care. However, there was no detectable association between facility construction and neonatal mortality. Increased access to care must be combined with health system quality improvements and broader social development initiatives to sustainably improve health outcomes.

scholarly journals The impact of health insurance on poverty among rural older adults: an evidence from nine counties of western China

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shaoguo Zhai ◽  
Shuiping Yuan ◽  
Quanfang Dong
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
Health Expenditure ◽  
Financial Burden ◽  
Catastrophic Health Expenditure ◽  
Western China ◽  
Cooperative Medical Scheme ◽  
The Impact ◽  
The Relationship ◽  
Rural Older Adults

Abstract Background Older adults are more prone to various diseases. Health insurance becomes effective mechanism to relieve financial burden when the insured is sick. In China, most older adults live in the countryside, and New Rural Cooperative Medical Scheme is a kind of health insurance system in rural areas. The relationship between New Rural Cooperative Medical Scheme and financial burden due to health expenditure of older adults in China was investigated. This paper aims at the impact of New Rural Cooperative Medical Scheme on the poverty among rural older adults. Methods This study employs Probit model and Tobit model to assess the impact of New Rural Cooperative Medical Scheme on alleviating poverty among rural older adults based on a survey in nine representative counties in western China. Results The findings show that diseases have significantly negative impact on rural elderly poverty. New Rural Cooperative Medical Scheme has impact on alleviating of the health-payment poverty due to catastrophic health expenditure, but the impact is limited. The impact of health insurance on poverty alleviation is greater for men, older adults aged between 60 to 69 and households in in economically poorer area than their counterparts. Conclusions This study show the relationship between New Rural Cooperative Medical Scheme and catastrophic health expenditure of older adults in China. The results draw policy attention to introduce different reimbursement expense ratios for different groups to alleviate them from poverty based on more comprehensive insurance packages.

scholarly journals The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

2021 ◽  
Author(s):  
Stephen Sevalie ◽  
Daniel Youkee ◽  
Alex J van Duinen ◽  
Emma Bailey ◽  
Thaimu Bangura ◽  
...  
Keyword(s):  
Health Service ◽  
Sierra Leone ◽  
Health Systems ◽  
Hospital Admissions ◽  
Health Service Utilisation ◽  
Sub Saharan Africa ◽  
Service Utilisation ◽  
Hospital Data ◽  
Sub Saharan ◽  
The Impact

Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

scholarly journals Awareness on health insurance and health care costs among non-communicable disease patients attending a tertiary care centre

2019 ◽  
Vol 6 (3) ◽  
pp. 1301
Author(s):  
J. Jebamalar ◽  
P. K. Kailash Kumar
Keyword(s):  
Health Insurance ◽  
Health Expenditure ◽  
Communicable Disease ◽  
Tertiary Care ◽  
Catastrophic Health Expenditure ◽  
Communicable Diseases ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Non Communicable Diseases ◽  
The Government

Background: The silent epidemic of non-communicable diseases threatens to retard the progress towards curbing catastrophic health expenditure. The present study aimed to describe the level of awareness about and utilisation of health insurance and to measure the healthcare costs for non-communicable diseases.Methods: A total of 354 adult patients suffering from non-communicable diseases, who reside in Villupuram district and attend the NCD clinic in the Government medical college hospital, Villupuram were studied over a period of 6 months.Results: 77% of the subjects were aware of health insurance. The most frequent source of information was local government officials and the hospitals themselves. 74.01% had availed some form of health insurance. There was a moderately strong correlation between loss of wages and total health expenses. The incidence of catastrophic health expenditure due to NCD clinic visits was around 7%.Conclusions: The absence of outpatient costs in the covers of most health insurance schemes may be decreasing their effectiveness in controlling catastrophic health expenditure.

scholarly journals The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach

2020 ◽  
Vol 17 (5) ◽  
pp. 1782
Author(s):  
Jiaqi Chen ◽  
Song Xu ◽  
Jing Gao
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Service ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Coverage Rate ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Mixed Effect ◽  
Utilisation Efficiency

In 2009, China launched a new health care reform as it endeavoured to develop a tiered system of disease diagnosis and treatment to promote the integration of medical resources. This was important for improving service capacity and building medical alliances that would eventually lead to improved health service utilisation efficiency. However, while the 2009 reform aimed to provide universal health insurance coverage to all citizens, its overall effect on health service utilisation efficiency remains unclear. We aimed to examine the new health care reform’s mixed effect by applying a longitudinal study using China Health and Nutrition Survey (CHNS) data and the difference-in-difference (DID) method to estimate the health reform’s impact on health insurance coverage rate. Then, we studied whether the increase in health insurance coverage rate affected health service utilisation efficiency in China. Our results showed that the increase in insurance coverage rate has indeed made expensive medical services available to low-income individuals. However, it also increased the likelihood of use of hospitals rather than primary care facilities, since there is more insurance cover for outpatient visits, which has led to an increased demand for quality services. This effect has generated a negative impact on health care utilisation which directly pertains to systemic inefficiency. This study thus indicates that China’s latest health reform requires further policies to improve its overall efficiency.

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