scholarly journals What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Care Expenditures ◽  
Advantages And Disadvantages ◽  
Care Services ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background:In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. Methods:In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. Results:The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. Conclusion:Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.

scholarly journals What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Care Expenditures ◽  
Advantages And Disadvantages ◽  
Care Services ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background:In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. Methods:In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. Results:The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. Conclusion:Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.

scholarly journals What Kinds of Advantages and Disadvantages Is May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Financing ◽  
Health Care Expenditures ◽  
Negative Consequences ◽  
Advantages And Disadvantages ◽  
Wide Range ◽  
Insurance Funds ◽  
Health Insurance Funds

Abstract Background: Fragmentation in health insurance system is a major concern in health financing. One possible solution to overcome problems resulting from fragmentation is combining risk pools together. This study aims to realize the potential advantages and disadvantages of merging health insurance funds. Methods: In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. The documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the qualitative data. Results: The results of this study indicated that there are diverse positive and negative consequences for merging health insurance funds in Iran. These are categorized into seven categories, including governance/stewardship, financing, population, basic benefit package, structure, operational procedures, and interaction with providers. Control of total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database and reducing fraud and controlling the volume of health care services provided by the providers; interaction of hospitals with single insurance with a single set of instructions for contracting, claiming review and reimbursement; reducing administrative and overhead costs were among the main benefits of merging mentioned by interviewees. The following drawbacks were raised as well: the unwillingness of the social security organization to collect insurance premiums from private workers actively as before; increasing dissatisfaction among population groups enjoying generous basic benefits package at the current situation; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on the providers in case of delay in reimbursement by the single-payer. Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

scholarly journals What Kinds of Advantages and Disadvantages May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Insurance ◽  
Negative Consequences ◽  
Health Insurance System ◽  
Face To Face ◽  
Insurance System ◽  
Advantages And Disadvantages ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background In countries with health insurance system, the number, the size of insurance funds and the amount of risk distribution among them is a major concern. One possible solution to overcome problems resulting from fragmentation is combining risk pools together to create fewer and larger ones, ideally a single pool. This study aims to realize what kind of advantages and disadvantages merging health insurance funds together may bring about to the health insurance system in particular and health system in general. Methods In this qualitative study, nesting purposive sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. Documentary review was used as supplementary source of data collection. Content analysis using the ‘framework method’ was used to analyze the qualitative data. For assuring the quality of results, four trustworthiness criteria including credibility, transferability, dependability and confirmability were used. Results The results of this study indicated that there are diverse positive and negative consequences for merging of health insurance funds in Iran which are categorized into seven categories including governance/stewardship, financing, population, benefit package, structure, operational procedures and interaction with providers. These themes are subdivided further into thirty-seven sub-categories which represent a wide range of different policy aspects which need close attention to deal with the merging of health insurance funds. Conclusions Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks, so to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

scholarly journals The experiences of merging health insurance funds in South Korea, Turkey, Thailand, and Indonesia: a cross-country comparative study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Arash Rashidian ◽  
Anahita Behzadi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Comparative Study ◽  
Health Care Services ◽  
Benefit Package ◽  
Care Services ◽  
Insurance Funds ◽  
The Subject ◽  
Cross Country ◽  
Health Insurance Funds

Abstract Background Fragmentation in health insurance system may lead to inequity in financial access to and utilization of health care services. One possible option to overcome this challenge is merging the existing health insurance funds together. This article aims to review and compare the experience of South Korea, Turkey, Thailand and Indonesia regarding merging their health insurance funds. Methods This was a cross-country comparative study. The countries of the study were selected purposefully based on the availability of data to review their experience regarding merging health insurance funds. To find the most relevant documents about the subject, different sources of information including books, scientific papers, dissertations, reports, and policy documents were studied. Research databases including PubMed, Scopus, Google Scholar, Science Direct and ProQuest were used to find relevant articles. Documents released by international organizations such as WHO and World Bank were analyzed as well. The content of documents was analyzed using a data-driven conventional content analysis approach and all details regarding the subject were extracted. The extracted information was reviewed by all authors several times and nine themes emerged. Results The findings show that improving equity in health financing and access to health care services among different groups of population was one of the main triggers to merge health insurance funds. Resistance by groups enjoying better benefit package and concerns of workers and employers about increasing the contribution rates were among challenges ahead of merging health insurance funds. Improving equity in the health care financing; reducing inequity in access to and utilization of health care services; boosting risk pooling; reducing administrative costs; higher chance to control total health care expenditures; and enhancing strategic purchasing were the main advantages of merging health insurance funds. The experience of these countries also emphasizes that political commitment and experiencing a reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging are required to facilitate implementation of merging health insurance funds. Conclusions Other contributing health reforms should be implemented simultaneously or sequentially in both supply side and demand side of the health system if merging is going to pave the way reaching universal health coverage.

scholarly journals What Kinds of Advantages and Disadvantages May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran

2020 ◽  
Author(s):  
Mohammad Bazyar ◽  
Vahid Yazdi-Feyzabadi ◽  
Nouroddin Rahimi ◽  
Arash Rashidian
Keyword(s):  
Health Insurance ◽  
Negative Consequences ◽  
Health Insurance System ◽  
Face To Face ◽  
Insurance System ◽  
Advantages And Disadvantages ◽  
Wide Range ◽  
Insurance Funds ◽  
Rich Data ◽  
Health Insurance Funds

Abstract Background: In countries with health insurance system, the number, the size of insurance funds and the amount of risk distribution among them is a major concern. One possible solution to overcome problems resulting from fragmentation is combining risk pools together to create fewer and larger ones, ideally a single pool. This study aims to realize what kind of advantages and disadvantages merging health insurance funds together may bring about to the health insurance system in particular and health system in general. Methods: In this qualitative study, nesting purposive sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. Documentary review was used as supplementary source of data collection. Content analysis using the ‘framework method’ was used to analyze the qualitative data. For assuring the quality of results, four trustworthiness criteria including credibility, transferability, dependability and confirmability were used. Results: The results of this study indicated that there are diverse positive and negative consequences for merging of health insurance funds in Iran which are categorized into seven categories including governance/stewardship, financing, population, benefit package, structure, operational procedures and interaction with providers. These themes are subdivided further into thirty-seven sub-categories which represent a wide range of different policy aspects which need close attention to deal with the merging of health insurance funds. Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks, so to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.

scholarly journals A Research on Health Care Sector with Special Reference to Health Insurance in India

2019 ◽  
Vol 8 (4) ◽  
pp. 7418-7425
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Health Care Sector ◽  
Health Index ◽  
Healthy Life ◽  
Care Services ◽  
The People ◽  
Wide Range ◽  
Healthy Life Style

Health care industry is one of the prominent one across the world irrespective of economic, social and cultural background. India, too have bigger and vibrant market for the health care services. Given the challenges, the sector is seeing an enormous growth not just because of health problems but mainly due to growing health awareness and preventive measures taken by the people. For any country, health of its people is an important aspect and for providing healthy life-style, government undertakes many programmes and offers social welfare measures. Health index of a country becomes vital indicator in measuring the nation’s overall development. In this study, we attempt to explore the progress and issues pertain to health care sector with special attention for health insurance policies and the governments’ role in that. The paper covers wide-range of health aspects with regards to measuring the prevailing scenario in health care sector and health insurance in particular.

Race and gender as factors in access to health insurance and utilization of health care services

2014 ◽  
Author(s):  
Susana J. Ferradas ◽  
G. Nicole Rider ◽  
Johanna D. Williams ◽  
Brittany J. Dancy ◽  
Lauren R. Mcghee
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Race And Gender ◽  
Care Services ◽  
Access To Health ◽  
And Gender

scholarly journals Structure and Distribution of Health Care Costs across Age Groups of Patients with Multimorbidity in Lithuania

2021 ◽  
Vol 18 (5) ◽  
pp. 2767
Author(s):  
Laura Nedzinskienė ◽  
Elena Jurevičienė ◽  
Žydrūnė Visockienė ◽  
Agnė Ulytė ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Chronic Disease ◽  
National Health Insurance ◽  
Health Care Services ◽  
Age Groups ◽  
Age Group ◽  
Resource Usage ◽  
Care Services ◽  
Care Costs

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.

scholarly journals Access and participation: What factors influence the provision and utilisation of health care services by children with learning disabilities?

2017 ◽  
Vol 41 (S1) ◽  
pp. S452-S452
Author(s):  
A. Rebowska
Keyword(s):  
Health Care ◽  
Learning Disabilities ◽  
Young People ◽  
Intellectual Disabilities ◽  
Health Care Services ◽  
Healthcare Services ◽  
Children And Young People ◽  
Care Services ◽  
Healthcare Needs ◽  
Wide Range

AimsThe aim of this literature review is to explore the range of factors that influence the degree of access to health care services by children and young people with learning disabilities.BackgroundChildren with learning disabilities are at increased risk of a wide range of health conditions comparing with their peers. However, recent reports by UK government as well as independent charities working with children and young people with learning disabilities demonstrated that they are at risk of poor health outcomes as a result of barriers preventing them from accessing most appropriate services.MethodsComprehensive searches were conducted in six databases. Articles were also obtained through review of references, a search of the grey literature, and contacting experts in the field. The inclusion criteria were for studies evaluating access to healthcare services, identification and communication of health needs, organisational aspects impacting on access and utilisation, staff attitudes where they impacted on access, barriers, discrimination in patients with intellectual disabilities age 0–18. The literature search identified a sample of 36 papers. The marked heterogeneity of studies excluded conducting a meta-analysis.ResultsBarriers to access included problems with identification of healthcare needs by carers and healthcare professionals, communication difficulties, the inadequacy of facilities, geographical and physical barriers, organisational factors such as inflexible appointment times, attitudes and poor knowledge base of healthcare staff.ConclusionThe factors identified can serve as a guide for managers and clinicians aiming to improve access to their healthcare services for children and young people with intellectual disabilities.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document