scholarly journals Japan: achieving UHC by regulating payment

2019 ◽  
Vol 15 (S1) ◽  
Author(s):  
Naoki Ikegami
Keyword(s):  
Social Health Insurance ◽  
Payment System ◽  
Social Health ◽  
Health Coverage ◽  
Population Coverage ◽  
Balance Billing ◽  
Catastrophic Coverage ◽  
Fee Schedule ◽  
To Receive ◽  
Universal Health

AbstractThe triple goals of Universal Health Coverage (UHC) are to cover the whole population, to reduce patients’ costs, and to expand coverage to all effective services, equitably available to all. This paper analyses the experience of Japan in achieving these goals, focusing on the central role played by the payment system. The payment system, or fee schedule, sets the price of services and pharmaceuticals, as well as the conditions that providers must comply with in order to receive payment. The fee schedule was first introduced following the enactment of social health insurance (SHI) in 1922. Initially, the SHI program covered only manual workers, who comprised a mere 3% of the population. However, the fee schedule of the largest SHI plan was subsequently adopted by all other SHI plans. From 1958, there has been only one fee schedule. Population coverage was achieved in 1961 by mandating all residing in Japan to enroll in SHI, thereby making everyone entitled to all the services and pharmaceuticals listed in the fee schedule. Next, co-insurance was capped to an affordable level by the introduction of catastrophic coverage in 1973. Lastly, extra billing and balance billing were explicitly restricted in 1984. The key to achieving and sustaining UHC goals in Japan lies in being able to contain costs and reallocate resources by revising the fee schedule.

scholarly journals Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand

2021 ◽  
Vol 6 (2) ◽  
pp. e004117
Author(s):  
Aniqa Islam Marshall ◽  
Kanang Kantamaturapoj ◽  
Kamonwan Kiewnin ◽  
Somtanuek Chotchoungchatchai ◽  
Walaiporn Patcharanarumol ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Civil Servant ◽  
Social Health ◽  
Health Coverage ◽  
Medical Benefit ◽  
The Social ◽  
Universal Health ◽  
Universal Coverage Scheme

Participatory and responsive governance in universal health coverage (UHC) systems synergistically ensure the needs of citizens are protected and met. In Thailand, UHC constitutes of three public insurance schemes: Civil Servant Medical Benefit Scheme, Social Health Insurance and Universal Coverage Scheme. Each scheme is governed through individual laws. This study aimed to identify, analyse and compare the legislative provisions related to participatory and responsive governance within the three public health insurance schemes and draw lessons that can be useful for other low-income and middle-income countries in their legislative process for UHC. The legislative provisions in each policy document were analysed using a conceptual framework derived from key literature. The results found that overall the UHC legislative provisions promote citizen representation and involvement in UHC governance, implementation and management, support citizens’ ability to voice concerns and improve UHC, protect citizens’ access to information as well as ensure access to and provision of quality care. Participatory governance is legislated in 33 sections, of which 23 are in the Universal Coverage Scheme, 4 in the Social Health Insurance and none in the Civil Servant Medical Benefit Scheme. Responsive governance is legislated in 24 sections, of which 18 are in the Universal Coverage Scheme, 2 in the Social Health Insurance and 4 in the Civil Servant Medical Benefit Scheme. Therefore, while several legislative provisions on both participatory and responsive governance exist in the Thai UHC, not all schemes equally bolster citizen participation and government responsiveness. In addition, as legislations are merely enabling factors, adequate implementation capacity and commitment to the legislative provisions are equally important.

Population Coverage to Reach Universal Health Coverage in Selected Nations: A Synthesis of Global Strategies

2020 ◽  
Author(s):  
Minoo ALIPOURI SAKHA ◽  
Najmeh BAHMANZIARI ◽  
Amirhossein TAKIAN
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Coverage ◽  
Political Commitment ◽  
Population Coverage ◽  
Definite Indicator ◽  
Expanding Population ◽  
Universal Health

Background: This study aimed to provide tailored transferrable lessons for expanding population coverage through a descriptive lens by reviewing the population coverage policies, reforms and strategies in selected nations. Methods: In this comparative short communication, 14 countries with different status of population coverage and political economy that had successful experiences with coverage expansion were selected and categorized in four groups to study their approaches to reach Universal Health Coverage (UHC). Results: Although each country needs to tailor its policies and reforms based on its own contextual factors, the legal right of citizens to social security and health protection are enshrined in most countries' Constitution. Some countries adapted political and economic reforms to evolve their Social Health Insurance schemes. National laws to push governments to adapt UHC as a national strategy for ensuring that every resident is enrolled in health insurance schemes are key policies to reach UHC. Conclusion: A series of reforms are required to provide total population coverage through various approaches. To create an effective insurance coverage, physical merger of all insurance funds is not necessarily required. Further, the share of GDP for health is not a definite indicator to reach UHC. Finally, strong political commitment and citizens’ participation are the key issues in reaching UHC, while considering the poorest, remote and neglected population really matters.  

Universal health coverage and user charges

2013 ◽  
Vol 8 (4) ◽  
pp. 529-535 ◽  
Author(s):  
Peter C. Smith
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Social Health Insurance ◽  
Social Health ◽  
World Health ◽  
World Health Report ◽  
Health Coverage ◽  
User Charges ◽  
Universal Health

AbstractThere has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.

Viral marketing content for Universal Health Coverage campaign in Indonesia

2019 ◽  
Vol 14 (1) ◽  
pp. 21-36
Author(s):  
Nuzulul Kusuma Putri ◽  
Ernawaty Ernawaty
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Social Health Insurance ◽  
Media Framing ◽  
Viral Marketing ◽  
Social Health ◽  
Health Coverage ◽  
Content Type ◽  
The Media ◽  
Universal Health

Purpose Today, viral marketing is popular as a highly effective marketing strategy with a low cost for mass targeting. This is suitable for the Universal Health Coverage campaign which seeks to attract the whole nation’s population to voluntarily register with social health insurance. It uses the target market itself as a weapon and the marketing content as a bullet. This study aims to determine the exact viral marketing content for the Universal Health Coverage campaign in Indonesia. Design/methodology/approach Viral marketing content is formulated based on the feelings of the target market toward social health insurance. Qualitative content analysis was conducted to identify the media framing and the audience’s response. Two of the biggest online news websites were analysed to determine the media framing. The audience’s response was identified through a Facebook group discussion. Findings This study shows that negative media framing makes people question the benefit of participating in social health insurance. Considering the local wisdom of Indonesia, helping poor people through social health insurance would be the best viral marketing content. Research limitations/implications Because of the limited number of sources focused on the audience’s responses that have been analysed, the variations in the audience response could not be captured completely. Researchers should also analyse other audience channels (social media and messenger application) besides Facebook. Practical implications The paper includes implications for the future marketing agenda of insurance providers in relation to engaging the community. Originality/value This study operationally introduced how to use the media channel selected and audience framing in designing an effective viral marketing content in health-care marketing.

scholarly journals The evolution of social health insurance in Vietnam and its role towards achieving universal health coverage

2020 ◽  
Vol 1 ◽  
pp. 100011
Author(s):  
Quynh Ngoc Le ◽  
Leigh Blizzard ◽  
Lei Si ◽  
Long Thanh Giang ◽  
Amanda L. Neil
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Social Health Insurance ◽  
Social Health ◽  
Health Coverage ◽  
Universal Health

scholarly journals Strategic purchasing for universal health coverage: examining the purchaser–provider relationship within a social health insurance scheme in Nigeria

2018 ◽  
Vol 3 (5) ◽  
pp. e000917 ◽  
Author(s):  
Enyi Etiaba ◽  
Obinna Onwujekwe ◽  
Ayako Honda ◽  
Ogochukwu Ibe ◽  
Benjamin Uzochukwu ◽  
...  
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Healthcare Providers ◽  
Social Health Insurance ◽  
Health Insurance Scheme ◽  
Social Health ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Strategic Purchasing ◽  
Universal Health

BackgroundIn an attempt to achieve universal health coverage, Nigeria introduced a number of health insurance schemes. One of them, the Formal Sector Social Health Insurance Programme (FSSHIP), was launched in 2005 to provide health cover to federal government and formal private sector employees. It operates with two levels of purchasers, the National Health Insurance Scheme (NHIS) and health maintenance organisations (HMOs). This study critically assesses purchasing arrangements between NHIS, HMOs and healthcare providers and determines how the arrangements function from a strategic purchasing perspective within the FSSHIP.MethodsA qualitative study undertaken in Enugu state, Nigeria, data were gathered through reviews of documents, 17 in-depth interviews (IDIs) with NHIS, HMOs and healthcare providers and two focus group discussions (FGDs) with FSSHIP enrolees. A strategic purchasing lens was used to guide data analysis.ResultsThe purchasing function was not being used strategically to influence provider behaviour and improve efficiency and quality in healthcare service delivery. For the purchaser–provider relationship, these actions are: accreditation of healthcare providers; monitoring of HMOs and healthcare providers and use of appropriate provider payment mechanisms for healthcare services at every level. The government lacks resources and political will to perform their stewardship role while provider dissatisfaction with payments and reimbursements adversely affected service provision to enrolled members. Underlying this inability to purchase, health services strategically is the two-tiered purchasing mechanism wherein NHIS is not adequately exercising its stewardship role to monitor and guide HMOs to fulfil their roles and responsibilities as purchasing administrators.ConclusionsPurchasing under the FSSHIP is more passive than strategic. Governance framework requires strengthening and clarity for optimal implementation so as to ensure that both levels of purchasers undertake strategic purchasing actions. Additional strengthening of NHIS is needed for it to have capacity to play its stewardship role in the FSSHIP.

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