scholarly journals Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage

2019 ◽  
Author(s):  
Shahin SOLTANI ◽  
Amirhossein TAKIAN ◽  
Ali AKBARI SARI ◽  
Reza MAJDZADEH ◽  
Mohammad KAMALI
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Health Coverage ◽  
Access To Health Services ◽  
Financial Barriers ◽  
Access To Health ◽  
People With Disability ◽  
Universal Health

Background: Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran. Methods: In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran. Results: We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD). Conclusion: Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD. 

scholarly journals “Living long in India”– India’s progress towards Universal Health Coverage

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Balraj ◽  
H Brand
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Indian Population ◽  
Healthcare Services ◽  
Fiscal Year ◽  
Health Coverage ◽  
Indian States ◽  
Universal Health

Abstract Issue There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these issues and achieve Universal Health Coverage (UHC), India launched the healthcare scheme ‘Ayushman Bharat’ (“long live India”) in 2018. Description The Ayushman Bharat (AB) scheme has two components which include 1) transforming the existing primary healthcare centers (PHC) under the control of State Governments and 2) the National Health Protection Scheme (NHPS) also known as “ModiCare” - a health insurance. The scheme aims to transform nearly 150.000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. NHPS covers the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. The coverage will be approximately €6.400 per year per beneficiary family; 60% of the costs are borne by the Centre and 40% by the States. Results Approximately €127 million have already been allocated by the Centre towards the AB scheme for the fiscal year 2018-19. Till date, around 29 million health insurance cards have been issued, approximately 1,8 million beneficiaries have been admitted and around 15.291 hospitals have been empaneled under NHPS. However, there is no data available validating the usage of the health services yet. Few Indian states are yet to implement the AB scheme. Lessons For the first time, attempts have been made to provide affordable healthcare services to the Indian population under a single common initiative. However, the AB scheme fails to cover outpatient health services, which are an important part of OOP expenses in India. Main message The effort to launch Ayushman Bharat in a big, democratic and diverse country like India has to be lauded, which not only aims to make healthcare services affordable but also aligns itself to the concept of UHC.

scholarly journals An Analysis of The National Health Insurance Policy Implementation in 2014 (Presidential Regulation No. 12 And 111/2013 on Health Insurance) from The Regulator’s Position

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Muhammad Arief Hasan ◽  
Puput Oktamianti ◽  
Dumilah Ayuningtyas
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Regional Government ◽  
Health Coverage ◽  
Healthcare Facilities ◽  
Road Map ◽  
Universal Health

Abstract. JKN (National Health Insurance) is a government program that aims to provide health assurance for all Indonesian citizens for a healthy, productive, and prosperous life. In the two years after JKN was implemented, various problems occurred. This research used the qualitative approach with the Edward II implementation theory. Results of the research indicated that there were problems in communication, stemming from the lack of socialization and inharmonic regulations, there was also the problem of the lack of healthcare resources. From the disposition side, the policy makers often obstructs the implementation preparation, this is evident from the information on determining the premium size. From the organization structure, all the stakeholders have been well coordinated. We conclude that we are not ready to implement the JKN. We recommend that mass and effective socialization program to be performed using various methods of communication and involve the community. To reduce the disparity of healthcare services, we recommend that the regional government to establish various healthcare facilities to accelerate health development. There should also be regulations that allocates healthcare staff in every corner of the country to achieve Universal Health Coverage in 2019, as stated in the National Health Insurance Road Map. Keywords: policy analysis, national health insurance, universal health coverage

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.

scholarly journals In search of universal health coverage – highlighting the accessibility of health services for students with disabilities in Ghana: a qualitative study

2019 ◽  
Author(s):  
Eric Abodey ◽  
Irene Vanderpuye ◽  
Isaac Mensah ◽  
Eric Badu
Keyword(s):  
Health Services ◽  
Students With Disabilities ◽  
Universal Health Coverage ◽  
Health Workers ◽  
Policy Formulation ◽  
Health Coverage ◽  
Access To Health Services ◽  
Accessibility Of Health Services ◽  
The Government ◽  
Universal Health

Abstract Background: Accessibility to health services for students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health services for students with disabilities. This study, therefore, aims to explore the accessibility of health services for students with disabilities, in the quest of achieving universal health coverage in Ghana. Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data. Results : The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health services. The barriers faced by students with disabilities are unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health services. Conclusion : The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the NHIS scheme should be revised to adequately address the needs of people with disabilities.

scholarly journals Towards Universal Health Coverage: An Analysis of the Health Insurance Coverage in Nigeria

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Yusuff Olanrewaju Azeez ◽  
Yusuf Olalekan Babatunde ◽  
Damilola Babatunde ◽  
Joseph Olasupo ◽  
Elizabeth Alabi ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
Informal Sector ◽  
Universal Health Coverage ◽  
National Health Insurance Scheme ◽  
Health Insurance Scheme ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Universal Health

Context: Achieving universal health coverage requires a Health Insurance Scheme that minimizes out-of-pocket expenditure, guarantees the provision of essential health services, and covers majority of the population. This study examines the NHIS, it's success, failures, efforts so far towards achieving UHC and overall, examines if Nigeria is progressing towards the achievement of universal health coverage. Evidence Acquisition: We conducted a narrative review of published articles on National Health Insurance Scheme (NHIS) coverage in Nigeria. Pubmed and Google Scholar were searched with the following keywords: National Health Insurance Scheme (NHIS), Success, Failure, Universal Health Coverage (UHC). Results: NHIS has failed in its inclusiveness and covers only about 5% of the general population, mainly from the formal sector while most from the informal sector are excluded. Certain factors such as the inadequate legal framework for a successful scheme, optional enrollment policy, poor funding and lack of political will are responsible for the failure of the NHIS. Conclusions: Revising the NHIS to cover all segments of the society including remote areas and ensuring the insured have access to health services at all hospitals and health centers across the country is essential in attaining the third sustainable development goal in Nigeria. Also, there is need for intensify public awareness programs to enlighten the people and relevant groups on the positive values of the scheme. The attributes of the scheme should be well publicized in a way that both the formal and informal sector would understand clearly. This might involve the use of all local languages spoken in different parts of the country.

Achieving Universal Health Coverage as a Goal of Vietnam’s Socio-Economic Development

2021 ◽  
Vol 27 (4) ◽  
pp. 269-280
Author(s):  
Zh. V. Pisarenko ◽  
Thi Mai Doan
Keyword(s):  
Health Care ◽  
Economic Development ◽  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Vulnerable Groups ◽  
Health Coverage ◽  
Financing System ◽  
Socio Economic Development ◽  
Universal Health

Aim. The presented study aims to analyze and identify the “bottlenecks” Vietnam may face on the way to achieving the goal of universal health coverage of the country’s population.Tasks. The authors analyze the situation regarding the implementation of sustainable development goals in terms of ensuring the availability of health services; assess the situation regarding the availability of health services in Vietnam; assess the potential of health insurance to achieve universal health coverage as a goal of Vietnam’s socio-economic development.Methods. This study uses statistical, empirical, and comparative analysis.Results. Achieving the goal of universal health coverage in the country requires more than just financing health care. It reflects the importance of ensuring equal access to quality health services and enforcing the right to health, especially for vulnerable groups. The authors analyze population coverage, the organization of the financing system, and the cost of medical care for households. Funding for health programs in Vietnam is increasing. However, due to the enduring poverty in the country, households spending a large share of their own funds on health services, and the number of challenges associated with the COVID-19 new coronavirus pandemic, there is still a risk of not achieving the goal of universal coverage in the near term.Conclusions. To achieve the set goal, Vietnam needs to introduce effective mechanisms of compulsory and voluntary health insurance (VHI). This additional financial protection is seen as a way to enable more people to use the necessary services without the risk of catastrophic health care costs, thus effectively approaching the goal of universal health coverage for the citizens of the Socialist Republic of Vietnam (SRV).

scholarly journals Achieving universal health coverage in small island states: could importing health services provide a solution?

2018 ◽  
Vol 3 (1) ◽  
pp. e000612 ◽  
Author(s):  
Mariyam Suzana ◽  
Helen Walls ◽  
Richard Smith ◽  
Johanna Hanefeld
Keyword(s):  
Health Services ◽  
Universal Health Coverage ◽  
Economies Of Scale ◽  
Health Workers ◽  
Health Indicators ◽  
Small Island ◽  
Health Coverage ◽  
Access To Health Services ◽  
Medical Travel ◽  
Universal Health

BackgroundUniversal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option.MethodsAnalysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu.FindingsMedical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS.InterpretationOur findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control.

Health equity funds as the pathway to universal coverage in Cambodia: care seeking and financial risk protection

2020 ◽  
Author(s):  
Theepakorn Jithitikulchai ◽  
Isabelle Feldhaus ◽  
Sebastian Bauhoff ◽  
Somil Nagpal
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Equity ◽  
Universal Coverage ◽  
Healthcare Services ◽  
Care Seeking ◽  
Health Coverage ◽  
Access To Health Services ◽  
Financial Risk Protection ◽  
Access To Health

Abstract Cambodia has developed the health equity fund (HEF) system to improve access to health services for the poor, and this strengthens the health system towards the universal health coverage goal. Given rising healthcare costs, Cambodia has introduced several innovations and accomplished considerable progress in improving access to health services and catastrophic health expenditures for the targeted population groups. Though this is improving in recent years, HEF households remain at the higher risk of catastrophic spending as measured by the higher share of HEF households with catastrophic health expenses being at 6.9% compared to the non-HEF households of 5.5% in 2017. Poverty targeting poses another challenge for the health system. Nevertheless, HEF appeared to be more significantly associated with decreased out-of-pocket expenditure per illness among those who sought care from public providers. Increasing population and cost coverages of the HEF and effectively attracting beneficiaries to the public sector will further enhance the financial protection and pave the pathway towards universal coverage. Our recommendations focus on leveraging the HEF experience for expanding coverage and increasing equitable access, as well as strengthening the quality of healthcare services.

scholarly journals Workshop: Access to health services in health systems providing universal coverage

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Expert Panel ◽  
Health Coverage ◽  
Access To Health Services ◽  
Research Teams ◽  
Access To Health ◽  
Universal Health

Abstract Universal health coverage (UHC) is part of the global WHO strategy to improve health. UHC and equity in access to care fall within the shared principles and values of EU health systems. However, as reported in 2016 by the Expert panel on effective ways of investing in health (EXPH), significant amount of unmet needs persisted both between and within EU member states. Access to health services encompasses the dimensions of affordability, user experience and availability of services with potential barriers arising at individual, providers or health systems levels. Health needs are constantly evolving as a consequence of population ageing and of health care technology development. Consequently access to care does not simply mean availability of a single component of care, but rather to an array of pertinent, coordinated, cost-effective and timely primary and specialized health and social interventions. Measuring performance in that respect is beyond the ability of commonly used “national level” indicators of access. Available research suggests that achieving ubiquitous access to optimal care across territories and populations (eg socioeconomic groups) is hard to achieve. This applies to the whole spectrum of health interventions, from preventive care such as immunizations to multidisciplinary interventions required for the management of chronic diseases. In this context, the workshop proposes to present examples of policy initiatives and results from research projects focusing on access and use of health care conducted in a variety of settings. The aims are to share knowledge about methods used in measuring variations of access, to improve understanding of their determinants and to identify avenues for improving performance. The workshop is proposed by a multidisciplinary and international group of research teams. It will start with a short introduction from the chair (5 minutes, Olivier Grimaud) followed by five presentations (10 minutes) addressing the issues of variations in access and use of care from different research teams and in a variety of settings. The first presentation will report on an innovative policy aiming at improving UHC in India. The following presentations will illustrate the challenges of providing access in high income countries, including, Scotland, France and Australia. In the last part of the workshop (30 minutes) comments from Prof Helmut Brand (former expert panel member of the EXPH) will introduce a general discussion with the audience moderated by the chair. Key messages Even when the conditions for universal health coverage are in place, providing equitable access to quality care remains a challenge. Understanding variations in access to care would help improve performance and equity.

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