Does Health Insurance Impede Trade In Health Care Services?

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.

Download Full-text

Umowy o udzielanie świadczeń opieki zdrowotnej zawierane przez Narodowy Fundusz Zdrowia (leczenie w ramach ubezpieczenia zdrowotnego) a leczenie na zasadach komercyjnych. Implikacje prawne i praktyczne

10.31338/2544-3135.si.2020-86.9 ◽

2021 ◽

pp. 141-151

Author(s):

Paweł Lipowski

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Providers ◽

Health Care Services ◽

Legal Status ◽

Healthcare Services ◽

Care Providers ◽

Care Services ◽

Public Payer ◽

Universal Health

The aim of this study is to identify the legal characteristics of contracts for the health care services provided by a public payer, i.e. the National Health Fund (NFZ) as part of treatment covered by universal health insurance, as compared to those provided by the health care providers with public or private legal status. This issue is discussed in relation to the legal conditions for the treatment of patients on a commercial basis in those institutions (private or public) which have contracts for the provision of healthcare services under the general health insurance (so-called contracts). The discussion is presented based on author’s own observations, resulting both from his scientific studies in the field of medical law and his work in various entities operating in the health care system.

Download Full-text

COMMUNITY-BASED HEALTH INSURANCE SCHEME IN A RURAL COMMUNITY OF NORTH WEST NIGERIA: A ROADMAP TO ACHIEVING UNIVERSAL HEALTH COVERAGE.

Kanem Journal of Medical Sciences ◽

10.36020/kjms.2020.1402.004 ◽

2020 ◽

Vol 14 (2) ◽

pp. 125-130

Author(s):

Lawal A ◽

◽

Gobir AA ◽

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Services ◽

Health Insurance Scheme ◽

Willingness To Participate ◽

Insurance Scheme ◽

Community Based ◽

Quality Health Care ◽

Community Based Health Insurance ◽

Care Services

Background: Community Based Health Insurance (CBHI) scheme is aimed at reducing out of pocket spending on health care services, ensuring final risk protection to all, especially the poor and the most vulnerable, improvement of quality of health care services, access and utilization as well as the promotion of equity. Objective: This research was aimed at determining willingness to participate in a community-based health insurance scheme among rural households in Katsina State. Method: A cross-sectional descriptive study was conducted in December 2016 among households of Batagarawa LGA, Katsina State. We used a pre-tested, electronic, semi-structured interviewer-administered questionnaire to obtain data from households that were selected using a multistage sampling technique and we analyzed the data using STATA version 13. Results: Most, (28.5%) of the respondents were in the age range of 30-39 years with a mean age of 35.5 years. Males were the dominant household heads (93%). Most were married (90%). Most, (90.5%) of households were willing to pay for a community-based health insurance scheme with a median premium of 100 Naira per household member per month. Conclusions: The high proportion of households willing to pay for the scheme should inform the decision of policy makers to design and maintain Community Based Health Insurance Scheme to improve access to and utilization of quality health care services.

Download Full-text

The shared experiences of insured members and the uninsured in health care access and utilization under Ghana’s national health insurance scheme: Evidence from the Hohoe Municipality

PLoS ONE ◽

10.1371/journal.pone.0244155 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244155

Author(s):

Suraiya Umar ◽

Adam Fusheini ◽

Martin Amogre Ayanore

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Access ◽

Health Care Services ◽

National Health Insurance Scheme ◽

Insurance Scheme ◽

Financial Barriers ◽

Care Access ◽

Care Services ◽

Barriers To Health

Background The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 to remove financial barriers and to promote equitable access to health care services. Post implementation has been characterized by increases in access and utilization of services among the insured. The uninsured have been less likely to utilize services due to unaffordability of health care costs. In this study, we explored the experiences of the insured members of the NHIS, the uninsured and health professionals in accessing and utilizing health care services under the NHIS in the Hohoe Municipality of Ghana. Methods Qualitative in-depth interviews were held with twenty-five NHIS insured, twenty-five uninsured, and five health care professionals, who were randomly sampled from the Hohoe Municipality to collect data for this study. Data was analyzed using thematic analysis. Results Participants identified both enablers or motivating factors and barriers to health care services of the insured and uninsured. The major factors motivating members to access and use health care services were illness severity and symptom persistence. On the other hand, barriers identified included perceived poor service quality and lack of health insurance among the insured and uninsured respectively. Other barriers participants identified included financial constraints, poor attitudes of service providers, and prolonged waiting time. However, the level of care received were reportedly about the same among the insured and uninsured with access to quality health care much dependent on ability to pay, which favors the rich and thereby creating inequity in accessing the needed quality care services. Conclusion The implication of the financial barriers to health care access identified is that the poor and uninsured still suffer from health care access challenges, which questions the efficiency and core goal of the NHIS in removing financial barrier to health care access. This has the potential of undermining Ghana’s ability to meet the Sustainable Development Goal 3.8 of universal health coverage by the year 2030.

Download Full-text

Effect of Child Health Insurance Plan Enrollment on the Utilization of Health Care Services by Children Using a Public Safety Net System

PEDIATRICS ◽

10.1542/peds.110.5.940 ◽

2002 ◽

Vol 110 (5) ◽

pp. 940-945 ◽

Cited By ~ 24

Author(s):

S. Eisert ◽

P. Gabow

Keyword(s):

Health Care ◽

Health Insurance ◽

Child Health ◽

Public Safety ◽

Health Care Services ◽

Safety Net ◽

Insurance Plan ◽

Health Insurance Plan ◽

Care Services ◽

Child Health Insurance

Download Full-text

Wealth Status, Health Insurance, and Maternal Health Care Utilization in Africa: Evidence from Gabon

BioMed Research International ◽

10.1155/2020/4036830 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

N’doh Ashken Sanogo ◽

Sanni Yaya

Keyword(s):

Health Care ◽

Health Insurance ◽

Maternal Health ◽

Health Care Services ◽

Insurance Coverage ◽

Maternal Health Care ◽

Care Utilization ◽

Services Utilization ◽

Maternal Health Care Utilization ◽

Care Services

Background. To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. Methods. The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)—2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women’s utilization of health care. Results. Mean (+/− SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p≤0.001), facility-based delivery (Conc. Index = 0.069; p≤0.001), and postnatal care (Conc. Index = 0.075; p≤0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). Conclusion. Women enrollment in health insurance and improved household’s financial status can improve key maternal health services utilization.

Download Full-text

Health Insurance Cards and Health Care Services Utilization: Evidence From Children in Mountainous Regions of Vietnam

Global Pediatric Health ◽

10.1177/2333794x19843917 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1984391 ◽

Cited By ~ 1

Author(s):

Nhu Van Ha ◽

Van Thi Anh Nguyen ◽

Bui Thi My Anh ◽

Thanh Duc Nguyen

Keyword(s):

Health Care ◽

Health Insurance ◽

Associated Factors ◽

Health Care Services ◽

Health Care Policy ◽

Care Policy ◽

Insurance Reform ◽

Care Services ◽

Free Health Care ◽

Services Use

Health insurance reform for children younger than 6 years of age was implemented in 2005. The study aimed to describe the health insurance card status, health care services use, and associated factors. The cross-sectional study was conducted with 210 Hmong mothers of children younger than 6 years of age, and of those, 118 mothers having an ill child in the previous 4 weeks were selected in this study. Descriptive statistics and multiple logistic regression were applied to predict the associated factors. In all, 42.9% of children had health insurance cards and 45.8% ill children accessed public health facilities. The factors included children’s age, mothers’ knowledge of the free health care policy, mothers’ knowledge about one sign of lung infection of their children associated with health insurance status, and health care services use. In conclusion, the 2005 reform of child health insurance policy has brought a modest impact on insurance coverage of children younger than 6 years of age and health care services use. Mothers’ knowledge of free health care policy should be improved.

Download Full-text

Children's Receipt of Health Care Services and Family Health Insurance Patterns

The Annals of Family Medicine ◽

10.1370/afm.1040 ◽

2009 ◽

Vol 7 (5) ◽

pp. 406-413 ◽

Cited By ~ 34

Author(s):

J. E. DeVoe ◽

C. J. Tillotson ◽

L. S. Wallace

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Services ◽

Family Health ◽

Care Services ◽

Family Health Insurance

Download Full-text

Health Care Access Among Essential Critical Infrastructure Workers, 31 States, 2017-2018

Public Health Reports ◽

10.1177/0033354921996688 ◽

2021 ◽

pp. 003335492199668

Author(s):

Winifred L. Boal ◽

Jia Li ◽

Sharon R. Silver

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Access ◽

Access To Health Care ◽

Health Care Services ◽

Personal Health ◽

The Past ◽

Care Access ◽

Care Services ◽

Access To Health

Objectives Essential workers in the United States need access to health care services for preventive care and for diagnosis and treatment of illnesses (coronavirus disease 2019 [COVID-19] or other infectious or chronic diseases) to remain healthy and continue working during a pandemic. This study evaluated access to health care services among selected essential workers. Methods We used the most recent data from the Behavioral Risk Factor Surveillance System, 2017-2018, to estimate the prevalence of 4 measures of health care access (having health insurance, being able to afford to see a doctor when needed, having a personal health care provider, and having a routine checkup in the past year) by broad and detailed occupation group among 189 208 adults aged 18-64. Results Of all occupations studied, workers in farming, fishing, and forestry occupations were most likely to have no health insurance (46.4%). Personal care aides were most likely to have been unable to see a doctor when needed because of cost (29.3%). Construction laborers were most likely to lack a personal health care provider (51.1%) and to have not had a routine physical checkup in the past year (50.6%). Compared with workers in general, workers in 3 broad occupation groups—food preparation and serving; building and grounds cleaning and maintenance; and construction trades—had significantly lower levels of health care access for all 4 measures. Conclusion Lack of health insurance and underinsurance were common among subsets of essential workers. Limited access to health care might decrease essential workers’ access to medical testing and needed care and hinder their ability to address underlying conditions, thereby increasing their risk of severe outcomes from some infectious diseases, such as COVID-19. Improving access to health care for all workers, including essential workers, is critical to ensure workers’ health and workforce stability.

Download Full-text