scholarly journals Legal and Policy Requirements of Basic Health Insurance Package to Achieve Universal Health Coverage in a developing country

2019 ◽  
Author(s):  
Ramin Hayati ◽  
Zahra Kavosi ◽  
Peivand Bastani ◽  
Mohammad Javad Kabir ◽  
Ghasem Sobhani ◽  
...  
Keyword(s):  
Health Insurance ◽  
Policy Making ◽  
National Level ◽  
Universal Health Insurance ◽  
Health Coverage ◽  
Basic Health Insurance ◽  
Basic Health ◽  
Provision Of Services ◽  
Services Implementation ◽  
Universal Health

Abstract Objectives This study has analyzed the policy-making requirements related to Basic health insurance package at the national level with a systematic view. Results All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness of the documents. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to Basic health insurance package were summarized into 11 main themes and 54 subthemes. The main themes include financing benefit package, necessity to determine the package, organizational structure, tariffing and purchasing the packages, services covered by the package, expanded coverage of population, provision of services, implementation rules, premium, integration of policies. According to the results, there is a growing trend in the themes related to Basic health insurance package in terms of the development of legal mechanisms in the last two decades. Provisions are almost comprehensive: as it was described, notable points in this regard are discussions related to the administration and implementation of these cases, monitoring, and finally controlling them.

scholarly journals Legal and policy requirements of basic health insurance package to achieve universal health coverage in a developing country

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Ramin Hayati ◽  
Mohammad Javad Kabir ◽  
Zahra Kavosi ◽  
Peivand Bastani ◽  
Ghasem Sobhani ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Level ◽  
Third Party ◽  
Health Coverage ◽  
Health Providers ◽  
Financial Barriers ◽  
Basic Health Insurance ◽  
Basic Health ◽  
Provision Of Services ◽  
Universal Health

Abstract Objectives This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. Results All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

scholarly journals Legal and Policy Requirements of Basic Health Insurance Package to Achieve Universal Health Coverage in a developing country

2019 ◽  
Author(s):  
Ramin Hayati ◽  
Zahra Kavosi ◽  
Peivand Bastani ◽  
Mohammad Javad Kabir ◽  
Ghasem Sobhani ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Level ◽  
Third Party ◽  
Health Coverage ◽  
Health Providers ◽  
Financial Barriers ◽  
Basic Health Insurance ◽  
Basic Health ◽  
Provision Of Services ◽  
Universal Health

Abstract Objectives: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. Results: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into 3 main themes and 11 subthemes. The main themes include three kinds of requirements at three level of Third party insurer, Health care provider and Citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

scholarly journals Legal and Policy Requirements of Basic Health Insurance Package to Achieve Universal Health Coverage in a developing country

2019 ◽  
Author(s):  
Ramin Hayati ◽  
Mohammad Javad Kabir ◽  
Zahra Kavosi ◽  
Peivand Bastani ◽  
Ghasem Sobhani ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Level ◽  
Third Party ◽  
Health Coverage ◽  
Health Providers ◽  
Financial Barriers ◽  
Basic Health Insurance ◽  
Basic Health ◽  
Provision Of Services ◽  
Universal Health

Abstract Objectives: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. Results: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into 3 main themes and 11 subthemes. The main themes include three kinds of requirements at three level of Third party insurer, Health care provider and Citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

scholarly journals Urgensi Kebijakan Jaminan Kesehatan Semesta (Universal Health Coverage) bagi Penyelenggaraan Pelayanan Kesehatan Masyarakat di Masa Pandemi Covid-19

2020 ◽  
Vol 3 (2) ◽  
pp. 272-299
Author(s):  
FC. Susila Adiyanta
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
National Health System ◽  
Universal Health Insurance ◽  
Health Coverage ◽  
Health Administration ◽  
Global Pandemic ◽  
Universal Health

Tujuan penelitian ini untuk mengetahui urgensi dan relevansi kebijakan Pemerintah dalam memperbaiki ekosistem penyelenggaraan kesehatan masyarakat dengan penguatan JKN sebagai skema asuransi kesehatan sosial yang bersifat wajib sebagai akibat adanya kesejangan antara iuran dengan  manfaat yang komprehensif di masa wabah pandemi global Covid-19. Hasil penelitian menunjukkan bahwa: 1) kebijakan skema Jaminan Kesehatan Semesta (Universal Health Coverage, UHC) dalam SJSN-KIS mempunyai urgensi sebagai pemenuhan penyelenggaraan jaminan kesehatan yang terjangkau oleh seluruh lapisan masyarakat secara adil dan merata sesuai amanat konstitusi; 2) Skema sistem Jaminan Kesehatan Semesta (Universal Health Coverage, UHC) Sistem UHC telah dimodifikasi oleh Pemerintah untuk diselaraskan dengan kondisi dan tujuan penyelenggaraaan kesehatan nasional yang profesional, efisien dan efektif, dan menjangkai seluruh lapisan masyarakat;3) Skema Jaminan Kesehatan Semesta (Universal Health Coverage, UHC) yang terintegrasi antara Sistem Jaminan Sosial Nasional (SJSN) dan Sistem Kesehatan Nasional (SKN) sangat relevan  bagi penyelenggaraan kesehatan masyarakat berdasarkan kerjasama, solidaritas dan empati semua warga di masa pandemi global Covid-19. Kata kunci: Universal Health Coverage, penyelenggaraan kesehatan masyarakatAbstract The purpose of this study is to study the urgency and relevance of Government policies in improving the public health ecosystem by strengthening JKN as a health insurance needed to improve the compatibility between contributions and useful benefits in the future of the global pandemic outbreak Covid-19. The results of the study show that: 1) the policy on universal health insurance requirements (Universal Health Coverage, UHC) in the SJSN-KIS has urgency as fulfilling the implementation of health insurance that is affordable to the whole community and in accordance with the mandate of the constitution; 2) Scheme of the Universal Health Insurance System (Universal Health Coverage, UHC) The UHC system is supported by the Government to be aligned with the requirements and objectives of national health care that are professional, efficient and effective, and reaches all communities; 3) The Universal Health Coverage Scheme (Universal Health Coverage, UHC) which is integrated between the National Social Security System (SJSN) and the National Health System (SKN) is very relevant for the implementation of public health through cooperation, solidarity, and empathy for all citizens in the global pandemic -19. Keywords: universal health coverage, public health administration

Prepayment schemes

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Three Dimensions ◽  
World Health ◽  
Health Coverage ◽  
Public And Private ◽  
Revenue Collection ◽  
Otto Von Bismarck ◽  
Health Organization ◽  
Universal Health

This chapter considers two different ways of organizing revenue collection in statutory healthcare schemes: social health insurance and taxation. The two models are commonly referred to as ‘Bismarck vs Beveridge’ after the men associated with the origin of these systems: the first German chancellor Otto von Bismarck (1815–1898), and the British economist Lord William Beveridge (1879–1963). The differences between these two compulsory prepayment schemes are discussed and compared with private health insurance. Based on a simple diagram introduced by the World Health Organization, three dimensions of coverage are illustrated. Some policy dilemmas are highlighted when attempting to achieve universal health coverage. Finally, various combinations of public and private prepayment schemes are discussed.

scholarly journals Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand

2021 ◽  
Vol 6 (2) ◽  
pp. e004117
Author(s):  
Aniqa Islam Marshall ◽  
Kanang Kantamaturapoj ◽  
Kamonwan Kiewnin ◽  
Somtanuek Chotchoungchatchai ◽  
Walaiporn Patcharanarumol ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Civil Servant ◽  
Social Health ◽  
Health Coverage ◽  
Medical Benefit ◽  
The Social ◽  
Universal Health ◽  
Universal Coverage Scheme

Participatory and responsive governance in universal health coverage (UHC) systems synergistically ensure the needs of citizens are protected and met. In Thailand, UHC constitutes of three public insurance schemes: Civil Servant Medical Benefit Scheme, Social Health Insurance and Universal Coverage Scheme. Each scheme is governed through individual laws. This study aimed to identify, analyse and compare the legislative provisions related to participatory and responsive governance within the three public health insurance schemes and draw lessons that can be useful for other low-income and middle-income countries in their legislative process for UHC. The legislative provisions in each policy document were analysed using a conceptual framework derived from key literature. The results found that overall the UHC legislative provisions promote citizen representation and involvement in UHC governance, implementation and management, support citizens’ ability to voice concerns and improve UHC, protect citizens’ access to information as well as ensure access to and provision of quality care. Participatory governance is legislated in 33 sections, of which 23 are in the Universal Coverage Scheme, 4 in the Social Health Insurance and none in the Civil Servant Medical Benefit Scheme. Responsive governance is legislated in 24 sections, of which 18 are in the Universal Coverage Scheme, 2 in the Social Health Insurance and 4 in the Civil Servant Medical Benefit Scheme. Therefore, while several legislative provisions on both participatory and responsive governance exist in the Thai UHC, not all schemes equally bolster citizen participation and government responsiveness. In addition, as legislations are merely enabling factors, adequate implementation capacity and commitment to the legislative provisions are equally important.

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