A Policy Proposal for Incorporating the National Health Insurance into Public Finance System Based on Government Health Expenditure Estimates

2020 ◽  
Vol 15 (2) ◽  
pp. 171-200
Author(s):  
Inhwa Park ◽  
Keyword(s):  
Public Finance ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Policy Proposal ◽  
Finance System ◽  
Government Health ◽  
Government Health Expenditure

scholarly journals Financial Burden and Health-seeking Behaviors Related to Chronic Diseases Under the National Health Insurance Scheme in Bolikhamxay Province, Lao PDR: A Cross-sectional Study

2021 ◽  
Author(s):  
TOMOO ITO ◽  
Sengchanh Kounnavong ◽  
Chiaki Miyoshi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Financial Burden ◽  
Lao Pdr ◽  
Health Seeking ◽  
Chronic Patients ◽  
National Health Insurance System ◽  
Cross Sectional

Abstract BackgroundFinancial protection is a key dimension of universal health coverage. In 2016, Lao PDR implemented a National Health Insurance system covering the entire population of certain provinces. This cross-sectional study investigated the health-seeking behavior and financial burden of households, including those with chronic patients, post coverage. MethodThe study was conducted in Bolikhamxay province from January 15 to February 13, 2019. In total, 487 households, selected via stratified random sampling, were surveyed, and questionnaire-based interviews were conducted. Health care service utilization and financial burden were examined.ResultsA total of 370 households had at least one member with some type of self-reported health problem within the last 3 months prior to the interview, while 170 had at least one member with a chronic condition. More than 75% of the households accessed a health facility when a member experienced health problems. The prevalence of catastrophic health expenditure (health expenditure/income between 20% and 40%) was 25.1% (threshold of 20%) and 16.2% (threshold of 40%). Through logistic regression, we found that the major factors determining financial catastrophes owing to health problems were household members with chronic illness, hospitalization, household poverty status, family size (both 20% and 40% thresholds), visiting a private facility (20% threshold), and distance from the province to the referral hospital (40% threshold).ConclusionsThe National Health Insurance system has positively impacted households’ access to health facilities. However, catastrophic health expenditure remains high, especially among chronic patients. Facilities under the National Health Insurance should be strengthened to provide more services, including care for chronic conditions.

scholarly journals Financial Burden and Health-seeking Behaviors Related to Chronic Diseases Under the National Health Insurance Scheme in Bolikhamxay Province, Lao PDR: a Cross-sectional Study

2021 ◽  
Author(s):  
Tomoo Ito ◽  
Chiaki Miyoshi ◽  
Sengchanh Kounnavong
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Financial Burden ◽  
Lao Pdr ◽  
Health Seeking ◽  
Chronic Patients ◽  
National Health Insurance System ◽  
Cross Sectional

Abstract Background: Financial protection is a key dimension of universal health coverage. In 2016, Lao PDR implemented the National Health Insurance system covering the entire population of certain provinces. This cross-sectional study investigated households’ health-seeking behavior and their financial burden with chronic patients, post coverage. Method: The study was conducted in Bolikhamxay province from January 15 to February 13, 2019. In total, 487 households, selected via stratified random sampling, were surveyed, and questionnaire-based interviews conducted. Health care service utilization and financial burden were examined.Results: Totally, 370 households had at least one member with some type of self-reported health problem within the last 3 months prior to the interview, while 170 had at least one member with a chronic condition. More than 75% of the households accessed a health facility when a member experienced health problems. We observed that the prevalence of catastrophic health expenditure (health expenditure/income between 20% and 40%) was 25.1% (threshold of 20%) and 16.2% (threshold of 40%). Through logistic regression, we found that the major factors determining financial catastrophes owing to health problems were household members with chronic illness, hospitalization, household poverty status, family size (both 20% and 40% thresholds), visiting a private facility (20% threshold), and distance from provincial top referral hospital (40% threshold).Conclusions: The National Health Insurance system has positively impacted households’ access to health facilities. However, catastrophic health expenditure remains high, especially among chronic patients. Facilities under National Health Insurance should be strengthened to provide more services, including care for chronic conditions.

scholarly journals Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana

2019 ◽  
Vol 34 (9) ◽  
pp. 694-705 ◽  
Author(s):  
Lucia Fiestas Navarrete ◽  
Simone Ghislandi ◽  
David Stuckler ◽  
Fabrizio Tediosi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Financial Risk ◽  
Financial Protection ◽  
Medical Needs ◽  
Medical Spending ◽  
Out Of Pocket Payments ◽  
The Impact

Abstract A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012–13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (−5 p.p. vs −9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (−10 p.p. vs. −6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC.

scholarly journals Estimating the effectiveness of national health insurance in covering catastrophic health expenditure: Evidence from South Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255677
Author(s):  
Hyunwoo Jung ◽  
Junhyup Lee
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Low Cost ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Catastrophic Health Expenditure ◽  
Cost Burden ◽  
Out Of Pocket Payments

The catastrophic health expenditure (CHE) indicator has been used to measure the medical cost burden of households. Many countries have institutionalized their health insurance systems to reduce out-of-pocket payments, the main contributor to the financial burden. However, there is no method to estimate how the insurance coverage reduces the CHE. This study proposes an approach to evaluate the effectiveness of insurance in reducing the CHE impacts in terms of incidence and gap, which are based on a modified calculation method of CHE. Additionally, we apply these methods to data from the Korea Health Panel Survey (2011–2016). The results are as follows. First, under the setting of a threshold of 10%, the CHE incidence rate was 19.26% when the Korean national health insurance benefits reduced the CHE’s incidence for 15.17% of the population in 2017. Second, the results of the concentration index of CHE showed that the intensity approach of CHE is better than the incidence approach. Third, the new approach we applied revealed that health insurance reduces the burden of CHE to some degree, although it was not an efficient way to reduce CHE. In conclusion, this study provides new policy approaches to save the finances of national health insurance and reduce the intensity of CHE at the same time by raising the low-cost burden of medical services and lowering that of high cost. Moreover, we suggest that policymakers should focus on income level of the households rather than specific diseases.

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