scholarly journals DEVELOPMENT OF STATE PROGRAMS OF UNIVERSAL HEALTH INSURANCE, STAGES OF REGULATION AND CHALLENGES: GEORGIAN EXPERIENCE

2021 ◽  
pp. 271-283
Author(s):  
Zurab ZURABASHVİLİ ◽  
Khaliana CHİTADZE ◽  
Davit TCHİOTASHVİLİ
Keyword(s):  
Health Insurance ◽  
Universal Health Insurance ◽  
State Programs ◽  
Universal Health

scholarly journals Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042084
Author(s):  
I-Anne Huang ◽  
Yiing-Jenq Chou ◽  
I-Jun Chou ◽  
Yu-Tung Huang ◽  
Jhen-Ling Huang ◽  
...  
Keyword(s):  
Health Insurance ◽  
Paediatric Population ◽  
Population Based ◽  
Universal Health Insurance ◽  
Cross Sectional ◽  
Single Payer ◽  
Insurance Programme ◽  
Ed Visits ◽  
Cross Sectional Design ◽  
Universal Health

ObjectivesEmergency services utilisation is a critical policy concern. The paediatric population is the main user of emergency department (ED) services, and the main contributor to low acuity (LA) ED visits. We aimed to describe the trends of ED and LA ED visits under a comprehensive, universal health insurance programme in Taiwan, and to explore factors associating with potentially unnecessary ED utilisation.Design and settingWe used a population-based, repeated cross-sectional design to analyse the full year of 2000, 2005, 2010 and 2015 National Health Insurance claims data individually for individuals aged 18 years and under.ParticipantsWe identified 5 538 197, 4 818 213, 4 401 677 and 3 841 174 children in 2000, 2005, 2010 and 2015, respectively.Primary and secondary outcome measuresWe adopted a diagnosis grouping system and severity classification system to define LA paediatric ED (PED) visits. Generalised estimating equation was applied to identify factors associated with LA PED visits.ResultsThe annual LA PED visits per 100 paediatric population decreased from 10.32 in 2000 to 9.04 in 2015 (12.40%). Infectious ears, nose and throat, dental and mouth diseases persistently ranked as the top reasons for LA visits (55.31% in 2000 vs 33.94% in 2015). Physical trauma-related LA PED visits increased most rapidly between 2000 and 2015 (0.91–2.56 visits per 100 population). The dose–response patterns were observed between the likelihood of incurring LA PED visit and either child’s age (OR 1.06–1.35 as age groups increase, p<0.0001) or family socioeconomic status (OR 1.02–1.21 as family income levels decrease, p<0.05).ConclusionDespite a comprehensive coverage of emergency care and low cost-sharing obligations under a single-payer universal health insurance programme in Taiwan, no significant increase in PED utilisation for LA conditions was observed between 2000 and 2015. Taiwan’s experience may serve as an important reference for countries considering healthcare system reforms.

BPJS Kesehatan Memberikan Jaminan Kesehatan Terhadap Pasien Atau Masyarakat

2021 ◽  
Vol 7 (2) ◽  
pp. 146-154
Author(s):  
Aidha Puteri Mustikasari
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Social Security ◽  
The State ◽  
Universal Health Care ◽  
Universal Health Insurance ◽  
Universal Health ◽  
Provide Health Insurance

Abstrak. Kepesertaan BPJS Kesehatan pada tahun 2020 tidak akan mencakup 90% penduduk Indonesia, namun rencana Universal Health Care Implementation (UHC) telah direncanakan sejak tahun sebelumnya. Di masa pandemi Covid, sejumlah besar status kepesertaan BPJS Kesehatan  dicabut karena terlambat, padahal masyarakat membutuhkan layanan kesehatan dan asuransi dengan kondisi yang ada. Kajian ini bersifat norma deskriptif , dibahas dalam konteks kepesertaan BPJS kesehatan, dan cukup  menggunakan prinsip asuransi dengan hanya memberikan jaminan kepada peserta, tetapi negara mengikuti kewajiban UUD 1945 yaitu memberikan jaminan kesehatan dan pelayanan kepada warga negara. Untuk mendukung keberadaan jaminan kesehatan universal, Indonesia perlu menerapkan formulir kepesertaan dan  sanksi untuk ketentuan wajib  peserta jaminan sosial yang efektif dan efisien. Abstract. BPJS Health membership in 2020 will not cover 90% of Indonesia's population, but the Universal Health Care Implementation (UHC) plan has been planned since the previous year. During the Covid pandemic, a large number of BPJS Health membership statuses were revoked because they were late, even though people needed health services and insurance with the existing conditions. This study is descriptive in nature, discussed in the context of BPJS health participation, and it is sufficient to use the insurance principle by only providing guarantees to participants, but the state follows the obligations of the 1945 Constitution, namely to provide health insurance and services to citizens. To support the existence of universal health insurance, Indonesia needs to implement an effective and efficient membership form and sanctions for mandatory provisions for social security participants.

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