scholarly journals Health Insurance for Universal Health Coverage in India: A Critical Analysis based on Coverage, Distribution and Predictors from National Family Health Survey – 4 Data

2019 ◽  
Author(s):  
Vikash R Keshri ◽  
Saswata Ghosh
Keyword(s):  
Health Insurance ◽  
Health Survey ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Family Health ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
National Family Health Survey ◽  
National Family ◽  
Universal Health

Abstract Background: The movement for Universal Health Coverage (UHC) is gaining momentum. Health insurance is emerging as one of the favoured means to finance healthcare. The union government of India also started a health insurance scheme in 2018 in the spirit to leap towards UHC. Therefore, this study was carried out with the following objectives. To understand the coverage, distribution, and predictors of health insurance coverage in India. To examine the role of Pradhan Mantri Jan Arogya Yojana (PM-JAY) towards the goal of UHC in India. Methods: We analyzed unit-level data from the fourth round of National Family Health Survey (NFHS-4) to understand the coverage, distribution and predictors of health insurance. We categorized the health insurance schemes into four major categories based on standard categorization . The descriptive and bivariate analysis was conducted to understand the coverage and distribution and logit regression analysis was carried out to understand the predictors. Results: The overall health insurance coverage in India was around 25% out of which 22% is mandatory health insurance. Less than 2% of households reported having any voluntary health insurance. Household wealth and education of the head of households were found to be directly proportional to health insurance coverage. Overall, there was very wide inter-state and inter-class variation in health insurance coverage, which reflect a major void in the existing programmes. Conclusions: To achieve UHC in India, a definite policy direction is needed to protect those groups of citizens, who either not covered or are only partially covered from health insurance scheme. Either the PM-JAY scheme should be expanded for the larger population or an alternative health financing model is to be explored to expand the population coverage. Key-words: Health Insurance, Universal Health Coverage, India, Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana, National Family Health Survey.

scholarly journals Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Leila Doshmangir ◽  
Mohammad Bazyar ◽  
Arash Rashidian ◽  
Vladimir Sergeevich Gordeev
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Equity ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Impact ◽  
Universal Health

Abstract Background Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. Methods This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Results Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. Conclusion To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.

scholarly journals PEMANFAATAN JAMINAN KESEHATAN DALAM PELAYANAN KESEHATAN IBU DI TUJUH KABUPATEN/KOTA DI INDONESIA

2019 ◽  
Vol 18 (2) ◽  
pp. 111-121
Author(s):  
Heny Lestary ◽  
Sugiharti Sugiharti ◽  
Suparmi Suparmi
Keyword(s):  
Health Insurance ◽  
Maternal Health ◽  
Antenatal Care ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Reproductive Age ◽  
Health Coverage ◽  
Delivery Services ◽  
Universal Health

ABSTRACT  Since 2014, Indonesia has been implementing universal health coverage to increase health insurance coverage. However, health insurance utilization by the community for maternal health is still low. This research aimed to determine factors related to the use of health insurance for antenatal care and delivery services among pregnant and childbirth women. The research conducted in 7 districts/cities, namely Kota Bandar Lampung, Kota Palembang, Kabupaten Lebak, Kabupaten Karawang, Kota Semarang, Kota Surabaya, dan Kota Makasar. A total of 517 respondents has been interviewed. The results showed that most respondents aged 21-34 years (68.5%), unemployed (74.7%) and graduated from high school or higher (58.4%). Around 11% of the respondent had health insurance. 73.0% of respondents who had health insurance used it for antenatal care and 88.3% used it for delivery. Multivariate analysis shows that the level of income is related to the use of health insurance for antenatal care and delivery, whereas mothers who have income level higher than Rp 2,000,000 had lower odds to utilize health insurance for antenatal care (OR=0,56; 95%CI:0,35 - 0,91) and delivery (OR=0,52; 95%CI:0,27 - 1,02). Therefore, there is a need for broader socialization of health insurance utilization for antenatal and delivery, especially for couples at reproductive age. Keywords: Health insurance, health services, maternal health   ABSTRAK Pada tahun 2014, Indonesia mulai melaksanakan Universal Health Coverage untuk meningkatkan cakupan jaminan kesehatan. Namun, pemanfaatan jaminan kesehatan oleh masyarakat untuk kesehatan ibu masih rendah. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan pemanfaatan jaminan kesehatan untuk pemeriksaan kehamilan dan pelayanan persalinan pada ibu hamil dan bersalin. Penelitian dilaksanakan di 7 (tujuh) kabupaten/kota, yaitu Kota Bandar Lampung, Kota Palembang, Kabupaten Lebak, Kabupaten Karawang, Kota Semarang, Kota Surabaya, dan Kota Makasar. Sebesar 517 responden yang berhasil diwawancarai. Hasil analisis menunjukkan bahwa sebagian besar responden berumur 21 – 34 tahun (68,5%), tidak bekerja (74,7%) dan berpendidikan tamat SMA+ (58,4%). Sekitar 11,0% responden tidak memiliki jaminan kesehatan. Dari responden yang memiliki jaminan kesehatan, hanya 73,0% di antaranya yang memanfaatkan untuk pemeriksaan kehamilan dan 88,3% memanfaatkan untuk persalinan. Analisis multivariat menunjukkan bahwa tingkat pendapatan berhubungan dengan pemanfaatan jaminan kesehatan untuk pemeriksaan kehamilan, dan persalinan, dimana ibu yang memiliki tingkat pendapatan ≥Rp 2.000.000,- memiliki kemungkinan lebih rendah untuk memanfaatkan jaminan kesehatan untuk pemeriksaan kehamilan (OR=0,56; 95%CI:0,35 - 0,91) maupun persalinan (OR=0,52; 95%CI:0,27 - 1,02). Oleh sebab itu, perlu sosialisasi lebih luas agar memanfaatkan jaminan kesehatan untuk pemeriksaan kehamilan dan persalinan, terutama pada Pasangan Usia Subur (PUS). Kata kunci: Jaminan kesehatan, pelayanan kesehatan, kesehatan ibu

scholarly journals Media Exposure and the Social Determinants of Health Insurance Coverage in Ethiopia 2011 - 2016

2021 ◽  
Author(s):  
Eniola Olatunji ◽  
Sanam Maredia ◽  
Allen Nguyen ◽  
Natalie Freeman ◽  
David J Washburn
Keyword(s):  
Health Insurance ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Media Exposure ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Social ◽  
Universal Health

Background: In a push for universal health coverage, Ethiopia introduced two insurance schemes in 2010. Yet coverage rates remain very low. To encourage greater adoption, policymakers require a better understanding of who chooses to enroll and which promotional efforts are most effective in encouraging enrollment. Objective: Using nationally representative Demographic and Health Surveys, this research assessed the social determinants of health insurance coverage, including media exposure, in Ethiopia from 2011-2016. Methods: This research analyzed health insurance coverage and other sociodemographic and media exposure variables using multivariable logistic regression model. Results: Health insurance coverage increased 3.30 times from 1.48% in 2011 to 4.89% in 2016. In both years, coverage was associated with higher education, older age, higher wealth levels, and exposure to newspaper and television. Compared to those with no exposure to newspaper, those with newspaper exposure at least once a week were 1.80 times (2011) and 1.86 times (2016) more likely to be insured. Similar results were obtained for television exposure. Conclusion: Initiatives that target the poor and less educated will be necessary if Ethiopia is to achieve universal health coverage. This research suggests that, to date, newspaper and television mediums have been effective promotion mechanisms for growing enrollment.

Population Coverage to Reach Universal Health Coverage in Selected Nations: A Synthesis of Global Strategies

2020 ◽  
Author(s):  
Minoo ALIPOURI SAKHA ◽  
Najmeh BAHMANZIARI ◽  
Amirhossein TAKIAN
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Coverage ◽  
Political Commitment ◽  
Population Coverage ◽  
Definite Indicator ◽  
Expanding Population ◽  
Universal Health

Background: This study aimed to provide tailored transferrable lessons for expanding population coverage through a descriptive lens by reviewing the population coverage policies, reforms and strategies in selected nations. Methods: In this comparative short communication, 14 countries with different status of population coverage and political economy that had successful experiences with coverage expansion were selected and categorized in four groups to study their approaches to reach Universal Health Coverage (UHC). Results: Although each country needs to tailor its policies and reforms based on its own contextual factors, the legal right of citizens to social security and health protection are enshrined in most countries' Constitution. Some countries adapted political and economic reforms to evolve their Social Health Insurance schemes. National laws to push governments to adapt UHC as a national strategy for ensuring that every resident is enrolled in health insurance schemes are key policies to reach UHC. Conclusion: A series of reforms are required to provide total population coverage through various approaches. To create an effective insurance coverage, physical merger of all insurance funds is not necessarily required. Further, the share of GDP for health is not a definite indicator to reach UHC. Finally, strong political commitment and citizens’ participation are the key issues in reaching UHC, while considering the poorest, remote and neglected population really matters.  

scholarly journals AN ANALYSIS OF HEALTH PROFILE OF THANJAVUR DISTRICT AS ENVISAGED BY NATIONAL FAMILY HEALTH SURVEY 2019-21

2022 ◽  
pp. 30-38
Author(s):  
Dr.V.Pugazhenthi
Keyword(s):  
Health Insurance ◽  
Sex Ratio ◽  
Health Survey ◽  
Tamil Nadu ◽  
Family Health ◽  
Health Indicators ◽  
The State ◽  
National Family Health Survey ◽  
Country Level ◽  
National Family

National Family Health Survey-5 (NFHS-5) fieldwork for India was conducted in two phases, during the years between 2019 and 2021 by 17 Field Agencies and gathered information from 636,699 households, 724,115 women, and 101,839 men. Information was gathered from 27,929 households, 25,650 women, and 3,372 men from Tamil Nadu and in Thanjavur from 826 households, 687 women, and 83 men. This research paper points out the health indicators in which Thanjavur District improved over the earlier NFHS and over the State as well as Country level averages in the NFHS-5. As per The NFHS -4 the sex ratio has raised marginally to 1053 and in the NFHS-5, sharply raised to 1112. The sex ratio of the country is also remarkably high crossing 1000 mark, first time in the Indian statistical history in the NFHS-5. NFHS-5 reveals positive note that the child sex ratio restoration back to 934. It reflects the changing mindset proliferating in the district towards the female. Amidst the negative mindset towards upbringing girl children in the state of Tamil Nadu, revealed by the reduced child sex ratio of 878 in NFHS -5 from 954 in NFHS-4 in Tamil Nadu a sharp positive increase in the child sex ratio in Thanjavur is fair enough to the fair sex. On the other hand, the reason for the reduction in the child sex ratio in the rest of the state of Tamil Nadu needs an immediate attention comparing the previous NFHS. It is also to be noted here that even the country level child sex ratio also is in increasing trend as per the present NFHS comparing its earlier survey. KEYWORDS: National Family Health survey, Government sponsored health insurance schemes, health insurance, Sex ratio, child sex ratio, AB-PMJAY.

scholarly journals Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

2020 ◽  
Vol 5 (3) ◽  
pp. e002087 ◽  
Author(s):  
Wenjuan Tao ◽  
Zhi Zeng ◽  
Haixia Dang ◽  
Peiyi Li ◽  
Linh Chuong ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Healthcare Reform ◽  
Insurance Coverage ◽  
Secondary Data ◽  
Health Insurance Coverage ◽  
Chinese Government ◽  
Health Coverage ◽  
Average Life Expectancy ◽  
Live Births ◽  
Universal Health

Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and ‘Healthy China 2030’, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.

scholarly journals Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income

2021 ◽  
Vol 12 ◽  
Author(s):  
Mohammed Khaled Al-Hanawi ◽  
Martin Limbikani Mwale ◽  
Ameerah M. N. Qattan
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Propensity Scores ◽  
Family Health ◽  
Public Healthcare ◽  
Health Coverage ◽  
Universal Healthcare ◽  
Using Data ◽  
The Relationship ◽  
Universal Health

Background: Achieving universal health coverage is an important objective enshrined in the 2015 global Sustainable Development Goals. However, the rising cost of healthcare remains an obstacle to the attainment of the universal health coverage. Health insurance is considered an option to reduce out-of-pocket (OOP) expenditure on health and medicine. Nevertheless, the relationship between insurance and the OOP along welfare distributions is not well understood. This study investigates the heterogeneous association between health insurance and OOP expenditure on health and medicine, along income, using data from the Kingdom of Saudi Arabia.Methods: This study used data of 8655 individuals drawn from the Saudi Family Health Survey conducted in 2018. The study adopts Tobit models to account for possible corner solution due to individuals with zero expenditure on health. We minimize the confounding effects of non-random selection into the insurance program by estimating the Tobit equations on a sample weighted by inverse propensity scores of insurance participation. In addition, we test whether the health insurance differently relates to OOP on health and medicine amongst people with access to free medical care as opposed to those without this privilege. The study estimates separate models for OOP expenditure on health and on medicines.Results: Health insurance reduces OOP expenditure on health by 2.0% and OOP expenditure on medicine by 2.4% amongst the general population while increasing the OOP expenditure on health by 0.2% and OOP expenditure on medicine by 0.2%, once income of the insured rises. The relationship between the insurance and OOP expenditure is robust only amongst the citizens, a sub-sample that also has access to free public healthcare. Specifically, the insurance reduces OOP expenditure on health by 3.6% and OOP on medicine by 5.2% and increases OOP expenditure on health by 0.4% and OOP expenditure on medicine by 0.5% once income of the insured increases amongst Saudi citizens. In addition, targeting medicines can lead to greater changes in OOP. The relationship between insurance and OOP is stronger for medicine relative to that observed on health expenditure.Conclusion: Our findings suggest that insurance induces different effects along the income spectrum. Hence, policy needs to be aware of the possible welfare distribution impacts of upscaling or downscaling the coverage of insurance amongst the populations, while pursuing universal healthcare coverage.

scholarly journals The prominent role of informal medicine vendors despite health insurance: a weekly diaries study in rural Nigeria

2020 ◽  
Vol 35 (3) ◽  
pp. 354-363
Author(s):  
Heleen E Nelissen ◽  
Daniëlla Brals ◽  
Hafsat A Ameen ◽  
Marijn van der List ◽  
Berber Kramer ◽  
...  
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Expenditures ◽  
Insurance Status ◽  
Health Coverage ◽  
Rural Nigeria ◽  
Informal Providers ◽  
Insurance Programme ◽  
Universal Health

Abstract In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.

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