scholarly journals Towards Universal Health Coverage: Designing a Community Based Intervention to Scale Up Coverage with Health Insurance, in A-Duiem Administrative Unit, Sudan 2018-2019

2021 ◽  
Vol 6 (1) ◽  
pp. 12-18
Author(s):  
Samia Y. I. Habbani ◽  
◽  
Egbal A. B. A. Karaig ◽  
Sumaia M. Al-Fadil ◽  
Maisa El-Fadul ◽  
...  
Keyword(s):  
Health Insurance ◽  
Community Engagement ◽  
Statistical Significance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
P Value ◽  
Community Based ◽  
Significant Difference ◽  
Administrative Unit ◽  
Awareness Raising

Background: Community engagement has proved effective in increasing access to healthcare including health insurance, in developed and developing countries. Aim: The study aims at designing and testing the effectiveness of engaging the community in awareness-raising and increment of health insurance coverage. Methods: The study was a social interventional community-based study, conducted in A-Duiem Administrative Unit, A-Duiem Locality, Sudan. Baseline data on enrollment in health insurance was collected from 800 heads of households, whereas data on knowledge and attitudes about health insurance was collected from 420 heads of non-insured households using a standardized questionnaire. Strategies to scaleup health insurance through community engagement was collected from community leaders, local authorities, and health insurance policymakers through in-depth interviews and focus group discussions. The community promotion package of health insurance was implemented for one year and post-intervention data were collected from 420 heads of households. Quantitative data were analyzed using SPSS version 20. Statistical significance was set at p<0.05 when the confidence interval was 95%. Qualitative data was analyzed manually using the thematic approach. Results: The study showed significant improvement in the knowledge of the heads of the non-insured households about health insurance after the intervention; knowledge about the enrollment process and service’s package has increased from 34.4% to 61.8% and from 55.8% to 84.7% respectively (p-value 0.0001 in both). The health insurance coverage increased by 17.3% with a significant difference and p-value at 0.0001. Conclusion: The study concluded that community members have a considerable role in awareness-raising and scaling up of health insurance coverage if they are properly organized, trained, monitored, and supervised. The insufficient commitment of local officials in the unit was a challenge to address during further testing and expansion of the experience.

scholarly journals Prevalence of Self-Reported Chronic Diseases and Health Services Utilization by Ethnic Minorities in Manaus Metropolitan Region

2018 ◽  
Vol 28 (1) ◽  
pp. 49 ◽  
Author(s):  
Raquel Rodrigues Ferreira Rocha de Alencar ◽  
Tais Freire Galvao ◽  
Bruno Vianei Real Antonio ◽  
Marcus Tolentino Silva
Keyword(s):  
Health Insurance ◽  
Chronic Diseases ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Population Based ◽  
Metropolitan Region ◽  
Care Utilization ◽  
Cross Sectional ◽  
Probabilistic Sampling ◽  
Significant Difference

<p class="Pa8"><strong>Objectives: </strong>To assess the prevalence of, and associated factors to, self-reported chronic diseases and health care utilization by eth­nicity in the Manaus Metropolitan Region.</p><p class="Pa8"><strong>Methods: </strong>We conducted a cross-sectional, population-based survey from May through August 2015. Using probabilistic sampling in three stages, we recruited adults aged ≥18 years. Ethnicity was self-identified as White, Black, Yellow, Brown (Brazilian mixed-race), and Indigenous. We calculated adjusted prevalence ratios (PR) and 95% CI of chronic diseases and health service utiliza­tion for each ethnic minority and compared the data using Poisson regression with data from White respondents.</p><p class="Pa8"><strong>Results: </strong>In this study, we interviewed 4,001 people. Of these, 15.9% were White, 7.5% Black, 3.4% Yellow, 72.1% Brown, and 1.0% Indigenous. Indigenous respondents had the highest prevalence of self-reported hypertension (29.4%), diabetes (12.3%) and hypercholesterolemia (17.0%) among the ethnic respondent groups. Compared with the White population, Browns had less health insurance coverage (PR=.76; 95% CI: .62-.93) and reported hypertension (PR=.84; 95% CI: .72-0.98) and diabetes (PR=.69; 95% CI: .51-.94) less frequently. Yellows visited the doctor more frequently than Whites (PR=1.13; 95% CI: 1.04-1.22), with no significant difference in prevalence of diseases.</p><p class="Default"><strong>Conclusions: </strong>Indigenous respondents had higher prevalence rates of the investigated diseases. Compared with Whites, Brown respondents had lower rates of self-reported arterial hypertension and diabetes, as well as lower rates of private health insurance coverage.</p><p class="Default"><em>Ethn Dis. </em>2018;28(1):49-54; doi:10.18865/ed.28.1.49</p>

scholarly journals Out of pocket expenditure among Rashtriya Swasthya Bima Yojana beneficiary and non-beneficiary patients admitted to a tertiary care centre, Berhampur, India: a comparative study

2019 ◽  
Vol 6 (2) ◽  
pp. 376
Author(s):  
Sushree Priyadarsini Satapathy ◽  
Nivedita Karmee ◽  
Durga Madhab Satapathy ◽  
Radha Madhab Tripathy
Keyword(s):  
Health Insurance ◽  
Life Support ◽  
Insurance Coverage ◽  
Tertiary Care ◽  
Total Sample ◽  
Health Insurance Coverage ◽  
P Value ◽  
Indian Government ◽  
Tertiary Care Centre ◽  
Cross Sectional

Background: RSBY, a health insurance scheme, was launched by the Indian government to protect BPL families from incurring financial liabilities which are likely to occur due to hospitalization. Objectives was to compare over all OOPE among RSBY beneficiaries and non-beneficiaries and to estimate its extent during hospitalization in different domains among RSBY beneficiaries and non-beneficiaries.Methods: It was a cross-sectional study conducted for 2 months (January-February 2018) among BPL families residing in Ganjam district, Odisha. Multistage random sampling was done. Total sample size was 256, the number of beneficiaries and non beneficiaries taken was 128 each.Results: Non beneficiaries incurred higher overall OOPE higher i.e. 95.3% than the Beneficiaries and it was found to be statistically significant with x²=74.8 and P-value <0.001. Among beneficiaries out of pocket expenditure was found in 46.1% of the study population. 45.3% of beneficiaries had to borrow partially from friends and relatives to fulfil their hospital related expenses followed by 32% borrowing fully for their treatment. Among beneficiaries, most out of pocket expenditure was for life support services as they sought treatment mostly for surgical conditions.Conclusions: Health insurance coverage should be improved by increasing enrolment. People should be made aware about the services covered under the schemes.

scholarly journals Determinants of Non-Insurance in A-Duiem Administrative Unit, White Nile State, Sudan 2018

2020 ◽  
Vol 5 (3) ◽  
pp. 42-48
Author(s):  
Samia Y. I. Habbani ◽  
◽  
Egbal A. B. A. Karaig ◽  
Elfatih M. Malik ◽  
Sumaia M. Al-Fadil ◽  
...  
Keyword(s):  
Health Insurance ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Insurance Coverage ◽  
Community Organizations ◽  
Health Insurance Coverage ◽  
Community Leaders ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Administrative Unit

Background Population knowledge and attitudes toward health insurance are important factors that facilitate health insurance coverage. National studies on these parameters are limited. Aim This study aims at assessing determinants of non-insurance in A-Duiem Administrative Unit and calculating as a secondary objective the household’s health insurance coverage. Methods The study was a descriptive cross-sectional community-based conducted in A-Duiem Administrative Unit, Sudan. It collected quantitative data from non-insured households and qualitative data by interviewing community leaders and conducting focus group discussions with community organizations members. Quantitative data analyzed using the Statistical Package for Social Sciences (SPSS) version 20, and the thematic analysis for the qualitative data. Results The study interviewed 419 non-insured households’ heads and thirteen community leaders and conducted eight focus group discussions with sixty community organizations members. Around 37.9% (95% CI: 33.4-42.7) of the heads of the non-insured households did not know the health insurance, while only 2.4% (95% CI: 1.5-4.7) had good knowledge. The knowledge of non-insured community leaders and members of the community organizations was moderate. The study participants showed positive attitudes towards health insurance, as 97% (95% CI: 95.1-98.4) of the heads of the non-insured households wanted to join the health insurance and 65% (95% CI: 59.2-70.1) of them stated that they could pay its premium. Most of the community leaders and members of the community organizations had health insurance cards. Those who were not enrolled, have limited knowledge about health insurance while almost all believe they should join it. The study identified 52.4% of non-insured households (95% CI: 48.9-55.8). The study showed low health insurance coverage among families, despite their positive attitude. This is mostly attributed to poor awareness of the heads of the non-insured households about health insurance. The National Health Insurance Fund (NHIF) should address this gap through effective communication strategies using motivated community institutions

scholarly journals Household catastrophic health expenditure and its effective factors: a case of Iran

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ramin Ravangard ◽  
Faride Sadat Jalali ◽  
Mohsen Bayati ◽  
Andrew J. Palmer ◽  
Abdosaleh Jafari ◽  
...  
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
World Health ◽  
P Value ◽  
Cross Sectional ◽  
Supplementary Health Insurance ◽  
Multiple Logistic Regression Modeling

Abstract Background The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018. Methods The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the “WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. Households living below the poverty line before paying for health services were excluded from the study. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modeling in SPSS 23.0 at the significance level of 5%. Results The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR = 3.14, P-value < 0.001), households with disabled members (OR = 27.98, P-value < 0.001), households with children under 5 years old (OR = 2.718, P-value = 0.02), and those without supplementary health insurance coverage (OR = 1.87, P-value = 0.01). Conclusion CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

scholarly journals Community Based Health Insurance Enrollment and Associated Factors in Sidama Region, Ethiopia

2020 ◽  
Author(s):  
Berhanu Bifato ◽  
Amanuel Ayele ◽  
Muse Rike ◽  
Dalecha Dangura
Keyword(s):  
Health Insurance ◽  
Confidence Interval ◽  
Low Income ◽  
Associated Factors ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
P Value ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Insurance Enrollment

Abstract Background: Community based health insurance is accepted as a capable tool of health system improvement and improves the health status of enrollees. Its mechanisms look for to protect low-income households from health related risks through mutual risk sharing at the community level. Even though Government’s efforts, the Community based health insurance enrolment rate remained low. Objective: To assess the community based health insurance enrollment and associated factors in Sidama Region, Ethiopia.Methods: A community based cross-sectional study was conducted in Sidama Region, 2020 using a pretested structured questionnaire. The study was conducted in randomly selected 770 households. The data entry was made by using Epi-info 2007 software. The data was analyzed by using SPSS version 20. Logistic regression statistical model was used to compute odds ratio with its 95% confidence interval to test the associations between dependent and independent variables. Then variables found to have P<0.25 in the bi-variable analysis taken as candidate for multivariable analysis. A P-value of 0.05 with a confidence interval of 95% was used to declare level of statistical significance. Result: Among 770 sampled households, 762 were interviewed and the response rate was 98.9%. About 20.2% of the respondents were enrolled in the scheme. Covariates such as፡ ages 31-59 years(AOR :2.62, 95% CI :1.48-4.66)and >=60 years(AOR : 2.87, 95% CI :1.23-6.74), households who had no formal education(AOR:1.66, 95% CI:1.02-2.72),affordability of premium (AOR:0.28, 95% CI: 0.15-0.54), knowledge on CBHI(AOR: 3.53; 95% CI: 1.21, 10.27) and perceived quality(AOR: 0.52, 95% CI: 0.25-0.87) had statistically significant association with community based health insurance enrollment.Conclusion: The prevalence of community based health insurance enrollment was low. This study identified the need to create knowledge and bring behavioral change in the community on the scheme in general. This study also revealed that regular contribution issue needs improvement based on affordability of households and building their trust on the program and efforts should be devoted to enhance quality of healthcare services to increase the enrollment.

scholarly journals Household Catastrophic Health Expenditure and Its Effective Factors: A Case of Iran

2020 ◽  
Author(s):  
Abdosaleh Jafari ◽  
Farideh Sadat Jalali ◽  
Mohsen Bayati ◽  
Andrew J. Palmer ◽  
Peivand Bastani ◽  
...  
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
World Health ◽  
P Value ◽  
Cross Sectional ◽  
Significance Level ◽  
Supplementary Health Insurance

Abstract Background:The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018.Methods:The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the "WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modelling in SPSS 23.0 at the significance level of 5%. Results:The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR=3.14, P-value<0.001), households with disabled members (OR=27.98, P-value<0.001), households with children under 5 years old (OR=2.718, P-value=0.02), and those without supplementary health insurance coverage (OR=1.87, P-value=0.01).Conclusion:CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

scholarly journals Counties with lower insurance coverage are associated with both slower vaccine rollout and higher COVID-19 incidence across the United States

2021 ◽  
Author(s):  
Emily Lindemer ◽  
Mayank Choudhary ◽  
Gregory Donadio ◽  
Colin Pawlowski ◽  
Venky Soundararajan
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Vaccination Rate ◽  
Incidence Rates ◽  
P Value ◽  
Spearman Correlation ◽  
Vaccination Rates ◽  
Vaccination Period

Efficient and equitable vaccination distribution is a priority for effectively outcompeting the transmission of COVID-19 globally. A recent study from the Centers for Disease Control and Prevention (CDC) identified that US counties with high social vulnerability according to metrics such as poverty, unemployment, low income, and no high school diploma, have significantly lower rates of vaccination compared to the national average1. Here, we build upon this analysis to consider associations between county-level vaccination rates and 68 different demographic, socioeconomic, and environmental factors for 1,510 American counties with over 228 million individuals for which vaccination data was also available. Our analysis reveals that counties with high levels of uninsured individuals have significantly lower COVID-19 vaccination rates (Spearman correlation: -0.264), despite the fact that the CDC has mandated that all COVID-19 vaccines are free and cannot be denied to anyone based upon health insurance coverage or immigration status. Furthermore, we find that the counties with high levels of uninsured individuals tend to have the highest COVID-19 incidence rates in March 2021 relative to December 2020 (Spearman correlation: 0.388). Among the 68 factors analyzed, insurance coverage is the only factor which is highly correlated with both vaccination rate and change in COVID-19 incidence during the vaccination period (|Spearman correlation| > 0.25). We also find that counties with higher percentages of Black and Hispanic individuals have significantly lower vaccination rates (Spearman correlations: -0.128, -0.136) and lesser declines of COVID-incidence rates (Spearman correlations: 0.334, 0.330) during the vaccination period. Surprisingly however, after controlling for race, we find that the association between lack of insurance coverage and vaccination rate as well as COVID-19 incidence rates is largely driven by counties with a majority white population. Among the counties with high proportions of white residents (top 10% decile), the association between insurance coverage and vaccination rate is significant (Spearman correlation: -0.210, p-value: 0.002), but among counties with low proportions of white residents (bottom 10% decile) this association is not significant (Spearman correlation: 0.072, p-value: 0.088). Taken together, this study highlights the fact that intricate socioeconomic factors are correlated not just to COVID-19 vaccination rates, but also to COVID-19 incidence fluctuations, underscoring the need to improve COVID-19 vaccination campaigns in marginalized communities. The strong positive correlation between low levels of health insurance coverage and low vaccination rates is particularly concerning, and calls for improved public health messaging to emphasize the fact that health insurance is not required to be eligible for any of the FDA-authorized COVID-19 vaccines in the United States.

Health Insurance Coverage and Physician Use Among Children With Disabilities: Findings From Probability Samples in Five Metropolitan Areas

PEDIATRICS ◽  
1987 ◽  
Vol 79 (1) ◽  
pp. 89-98
Author(s):  
John A. Butler ◽  
Judith D. Singer ◽  
Judith S. Palfrey ◽  
Deborah K. Walker
Keyword(s):  
Health Insurance ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Children With Disabilities ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Physician Visits ◽  
Significant Difference ◽  
Privately Insured

The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that (1) health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P &lt; .05); (2) Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P &lt; .001), but there was no similar statistically significant difference between blacks and whites; and (3) wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various lowprevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.

scholarly journals Has the Health Insurance Coverage of Scaling Contributed Positively to Periodontal Health in Korea?

2020 ◽  
Vol 17 (22) ◽  
pp. 8537
Author(s):  
Jin-Sun Choi
Keyword(s):  
Health Insurance ◽  
Health Management ◽  
Periodontal Diseases ◽  
Statistical Significance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Treatment Needs ◽  
Dental Biofilm ◽  
Periodontal Tissues ◽  
Periodontal Index

This study aimed to evaluate the effectiveness of the health insurance coverage of dental scaling (introduced in 2013) using the Community Periodontal Index of Treatment Needs parameter among Korean adults aged 20 years or older. We used the Korea National Health and Nutrition Examination Survey data from before and after 2013 to analyze the statistical significance and associations of the covariates with the prevalence of healthy periodontal tissues, prevalence of people in need of scaling, and prevalence of periodontal diseases. The results showed that the prevalence of healthy periodontal tissues increased by 4.9% (from 34.2% to 39.1%), the number of people in need of scaling decreased by 5% (from 65.9% to 60.9%), and the prevalence of periodontal diseases increased by 7.2% (from 23.4% to 30.6%). Moreover, after the scaling coverage policy, the odds ratio of the prevalence of healthy periodontal tissues was 1.10 times higher, the prevalence of the need for scaling was 1.5 times higher, and the prevalence of periodontal diseases was 0.90 times lower. Therefore, the state should formulate policies that provide dental biofilm management through a disclosing agent, impart education about oral hygiene, and develop a health management system that enables the concurrent management of periodontal diseases and systemic diseases.

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