scholarly journals Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chinyere Mbachu ◽  
Chinyere Okeke ◽  
Chinonso Obayi ◽  
Agnes Gatome-Munyua ◽  
Nkechi Olalere ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Health Financing ◽  
The State ◽  
Social Health ◽  
Defined Benefit ◽  
Data Systems ◽  
Government Documents ◽  
Provider Payment ◽  
Document Review

Abstract Background Tracking general trends in strategic purchasing of health financing mechanisms will highlight where country demands may exist for technical support and where progress in being made that offer opportunities for regional learning. Health services in Abia State, Nigeria are funded from general tax-revenues (GTR), and a new state social health insurance scheme (SSHIS) is proposed to overcome the failings of the GTR and expand coverage of services. This study examined purchasing functions within the GTR and the proposed SSHIS to determine if the failings in GTR have been overcome, identify factors that shape health purchasing at sub-national levels, and provide lessons for other states in Nigeria pursuing a similar intervention. Methods Data was collected through document review and key informant interviews. Government documents were retrieved electronically from the websites of different organizations. Hard copies of paper-only files were retrieved from relevant government agencies and departments. Interviews were conducted with seven key personnel of the State Ministry of Health and State Health Insurance Agency. Thematic analysis of data was based on a strategic health purchasing progress tracking framework which delves into the governance arrangements and information architecture needed for purchasing to work well; and the core purchasing decisions of what to buy; who to buy from; and how to buy. Results There are differences in the purchasing arrangements of the two schemes. Purchaser-provider split does not exist for the GTR, unlike in the proposed SSHIS. There are no data systems for monitoring provider performance in the GTR-funded system, unlike in the SSHIS. Whereas GTR is based on a historical budgeting system, the SSHIS proposes to use a defined benefit package, which ensures value-for-money, as the basis for resource allocation. The GTR lacks private sector engagement, provider accreditation and contracting arrangements while the SSHIS will accredit and engage private providers through selective contracting. Likewise, provider payment is not linked to performance or adherence to established standards in the GTR, whereas provider payment will be linked to performance in the SSHIS. Conclusions The State Social Health Insurance has been designed to overcome many of the limitations of the budgetary allocation to health. This study provides insights into the enabling and constraining factors that can be used to develop interventions intended to strengthen the strategic health purchasing in the study area, and lessons for the other Nigeria states with similar characteristics and approaches.

scholarly journals Framing universal health coverage in Kenya: an interpretive analysis of the 2004 Bill on National Social Health Insurance

2020 ◽  
Author(s):  
Adam D Koon ◽  
Benjamin Hawkins ◽  
Susannah H Mayhew
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Health Financing ◽  
Social Health ◽  
Health Coverage ◽  
Structured Interviews ◽  
Financing Policy ◽  
Economic Liberalism ◽  
Interpretive Analysis ◽  
Document Review

Abstract In 2004, President Mwai Kibaki of Kenya refused to sign a popular Bill on National Social Health Insurance into law. Drawing on innovations in framing theory, this research provides a social explanation for this decision. In addition to document review, this study involved interpretive analysis of transcripts from 50 semi-structured interviews with leading actors involved in the health financing policy process in Kenya, 2014–15. The frame-critical analysis focused on how actors engaged in (1) sensemaking, (2) naming, which includes selecting and categorizing and (3) storytelling. We demonstrated that actors' abilities to make sense of the Bill were largely influenced by their own understandings of the finer features of the Bill and the array of interest groups privy to the debate. This was reinforced by a process of naming, which selects and categorizes aspects of the Bill, including the public persona of its primary sponsor, its affordability, sustainability, technical dimensions and linkages to notions of economic liberalism. Actors used these understandings and names to tell stories of ideational warfare, which involved narrative accounts of policy resistance and betrayal. This analysis illustrates the difficulty in enacting sweeping reform measures and thus provides a basis for understanding incrementalism in Kenyan health policy.

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.

scholarly journals Catastrophic Health Expenditures and Mental Health in Older Chinese People: The Role of Social Health Insurance

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 121-121
Author(s):  
Wei Yang ◽  
Bo Hu
Keyword(s):  
Mental Health ◽  
Health Insurance ◽  
Fixed Effects ◽  
Mental Health Problems ◽  
Social Health Insurance ◽  
Health Financing ◽  
Catastrophic Health Expenditure ◽  
Social Health ◽  
Protective Effects ◽  
Healthcare Needs

Abstract Catastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the impacts of CHE on people’s mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether and to what extent social health insurance (SHI) can lessen the impacts of CHE on mental health among older people aged over 60 in China. The data come from three waves of the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, and 2015, N = 13,166). We built fixed-effects quantile regression models to analyse the data. We found that incurring CHE has significantly detrimental effects on older people’s mental health, whereas the SHI demonstrates a protective effect. The observed protective effects of SHI are the strongest among those with relatively mild mental health problems, i.e., people whose CES-D scores are below the 50th percentile. Our findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for those with higher healthcare needs.

scholarly journals Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Obinna Onwujekwe ◽  
Nkoli Ezumah ◽  
Chinyere Mbachu ◽  
Felix Obi ◽  
Hyacinth Ichoku ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Health Financing ◽  
Catastrophic Health Expenditure ◽  
Social Health ◽  
Health Coverage ◽  
Health Maintenance ◽  
Use Of Resources ◽  
Regulatory Frameworks ◽  
Legal Frameworks

Abstract Background Various attempts to examine health financing mechanisms in Nigeria highlight the fact that there is no single mechanism that fits all contexts and people. This paper sets out findings of an in-depth assessment of different health financing mechanisms in Nigeria. Methods The study was undertaken in the Federal Capital territory of Nigeria and two States (Niger and Kaduna). Data were collected through review of government documents, and in-depth interviews of purposively selected respondents. Data analysis was guided by a conceptual framework which draws from various approaches for assessing health financing mechanisms. Data was examined for current practices, what needs to change and how the change can happen. Results Health financing mechanisms in Nigeria do not operate optimally. Allocation and use of resources are neither evidence-based nor results-driven. Resources are not allocated equitably or in a manner that minimizes wastage and improves efficiency. None of the mechanisms effectively protects individuals/households from catastrophic health expenditure. Issues with social health insurance cut across legal frameworks and use of Health Maintenance Organisations (HMOs) as purchasers. The concomitant effect is that attainment of Universal Health Coverage is greatly compromised. In order to improve efficiency of health financing mechanisms, government needs to allocate more funds for purchasing health services; this spending must be based on evidence (strategic), and appropriately tracked. The legislation that established National Health Insurance Scheme should be amended such that social health insurance becomes mandatory for all citizens. Implementation of the latter should be complemented by revision of benefit package, strict oversight and regulation of HMOs. Conclusion In order to improve health financing in the country, legal and regulatory frameworks need to be revised. Efficient utilization of resources could be improved through strategic purchasing arrangements and strict oversight.

HEALTH INSURANCE IN ACEH

2021 ◽  
Author(s):  
Irwan Saputra
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Social Health Insurance ◽  
Social Health ◽  
Fee For Service ◽  
Payment Method ◽  
Care Services ◽  
Provider Payment ◽  
Aceh Province

The implementation of social health insurance programme in Aceh Province of Indonesia as a mechanism to achieve universal health care coverage, equitable access and good quality in health care services requires a sustainable financial resource for a longterm period. Government of Aceh Province has established the Social Health Insurance (SHI) programme to cover the whole population of Aceh (4.6 Million) since 1 st June 2006. The SHI programme is called “Jaminan Kesehatan Aceh (JKA)”. Fee-forservice has been used in this programme as the provider payment method from year 2006 to year 2013. Based on the official reports from Aceh government and other sources, the health care expenditure increases every year even though the provisions of health care services were not still not optimum. Many countries faced similar problems with the use of fee-for-service. Hence, WHO recommended the use of prospective payment method in SHI. To ensure sustainability of JKA, reform in the health financing system need to be carried out by introducing more efficient provider payment method such as prospective payment. This book will evaluate the implementation of JKA programme and to compare the hospital tariff based on fee- for- service with prospective method using Indonesia Case Base Group (INA-CBG). This study employs both qualitative and quantitative methods. In-depth interviews were carried out among selected stakeholders involved in the designing and implementing JKA. The quantitative study was conducted to assess income of three selected hospitals (Type B, C and D) reimbursed using 602 INACBG groups from 17,547 cases.

scholarly journals Is universal and uniform health insurance better for China? Evidence from the perspective of supply-induced demand

2018 ◽  
Vol 15 (1) ◽  
pp. 56-71 ◽  
Author(s):  
Jianxing Yu ◽  
Yue Qiu ◽  
Ziying He
Keyword(s):  
Health Insurance ◽  
Current System ◽  
Social Health Insurance ◽  
Social Health ◽  
Fee For Service ◽  
Medical Expenses ◽  
Induced Demand ◽  
Payment Methods ◽  
Provider Payment ◽  
Insured Patients

AbstractChina has achieved nearly universal social health insurance (SHI) coverage by implementing three statutory schemes, but gaps and differences in benefit levels are apparent. There is wide agreement that China should merge the three schemes into a universal and uniform SHI. However, data on the medical expenses of all inpatients in 2014 at a public Tier-three hospital suggests that supply-induced demand (SID) is a serious concern and that, under the design of the current schemes, a higher benefit level has a greater impact on the total expenses of insured patients. Thus, if SID is not effectively controlled, a universal and uniform SHI may be more harmful than beneficial in China. Finally, we suggest that China should substitute the existing fee-for-service design with a suite of bundled provider payment methods; furthermore, China should replace its current system of pricing drugs that encourages hospitals and doctors to use costlier medications.

Which Therapeutic Progress Shall be Paid by Social Health Insurance?

2007 ◽  
Author(s):  
Jürgen Wasem ◽  
Hans-Dieter Nolting ◽  
Yvonne Grabbe ◽  
Stefan Loos
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Social Health
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