scholarly journals Facilitators and barriers affecting general practitioners’ choice to work in primary care units in Austria

2021 ◽  
Author(s):  
Sarah Burgmann ◽  
Sebastian Huter ◽  
Hannes Mayerl ◽  
Muna E. Abuzahra ◽  
Andrea Siebenhofer
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Qualitative Content Analysis ◽  
Health Care Systems ◽  
Social Health Insurance ◽  
Work Life ◽  
Social Health ◽  
Medical Work ◽  
Remuneration System ◽  
Facilitators And Barriers

Abstract Background General practitioner (GP) workforce shortages are a global threat to primary health care systems. In Austria, nearly 75 % of qualified GPs are not working as contracted GPs within the social health insurance system. This study aims to explore the facilitators and barriers for non-contracted GPs to work in a primary care unit (PCU). Methods We conducted twelve semi-structured, problem-focused interviews among purposively sampled non-contracted GPs. To extract categories of facilitators and barriers for working in a PCU, transcribed interviews were inductively coded using qualitative content analysis. These subcategories were then grouped into categories of thematic criteria and mapped on the macro-, meso-, micro-, and individual levels. Results We identified 36 factors, including 18 facilitators and 18 barriers. Most facilitators were located on the micro-level, while most barriers were located on the macro-level. Teamwork, which allows focus on professional medical work, shared responsibilities, flexibility in working time and work-life balance, mainly make PCUs attractive as workplaces and correspond with individual demands. By contrast, the absence of a clear vision for reform and insufficient implementation produce general ignorance and resistance. The conditions of contracts with social health insurance providers, including the remuneration system, requirements for PCUs and high workload with little time for individual patient care, are seen as inflexible and discouraging. Combined with insufficient vocational training and the low perceived status of GPs and PHC generally, GPs voiced concerns about being an entrepreneur and businessperson. Conclusions Targeted and proactive measures are necessary to attract non-contracted GPs to leave their current individual work-life arrangement and consider working in a PCU, especially considering the higher perceived risks. Multi-faceted efforts are needed to approach factors on all levels. Addressing system barriers should include a reform strategy with a clearly stated mission, defined PHC role, and tangible stakeholder commitment, as well as a modernized remuneration system and supportive measures to equip GPs with essential competences and skills. Proactive communication and exchange could promote the already existing attractive working conditions in PCUs and attract non-contracted GPs into the public sector.

Social Health Insurance in Europe: Basic Concepts and New Principles

2019 ◽  
Vol 44 (4) ◽  
pp. 665-677
Author(s):  
Claus Wendt
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Social Insurance ◽  
Health Care Systems ◽  
Social Health Insurance ◽  
Social Health ◽  
Traditional Values ◽  
The Public ◽  
Recent Developments ◽  
Care Systems

Abstract This article discusses recent developments in and new principles of European social health insurance (SHI). It analyses how privatization policies and competition have altered social insurance and whether financial difficulties are caused by social insurance features not evident in other types of health care systems. There is little if any evidence that SHI causes higher cost increases than other types of systems. The comparison of five European SHI systems demonstrates that despite cost containment policies these countries do not experience a trust crisis in health care or loss in support among the public. The author shows that SHI has moved toward universal health care and that the traditional values of solidarity and social security have even been strengthened over the past decades.

Umverteilungseffekte in der Finanzierung von Gesundheitsleistungen / Redistribution Effects of Health Care Financing

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Florian Buchner ◽  
Rebecca Deppisch ◽  
Jürgen Wasem
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Systems ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Health Care Expenditures ◽  
Social Health ◽  
Financing System ◽  
Out Of Pocket Payments ◽  
Care Systems

SummaryHealth care systems are financed through a mixture of different components: taxes, contributions to social health insurance, premiums to private health insurance, out of pocket payments by patients. These components can be combined differently leading to specific effects of interpersonal redistribution. This can be compared between different countries. In such a comparison the redistributional impact of the German health care systems is rather regressive - which is basically caused by the opportunity for people with high income to leave social health insurance. In comparison to a health insurance system with risk rated premiums, financing of the German social health insurance leads to interpersonal redistribution from higher to lower income, from the young to the elderly, from healthy to sick and from singles to families with children. The pay-as-you-go character of the system leads especially in combination with an aging population and technological change to burden for future generations. In comparison to a system in which each region finances its own health care expenditures, there are also considerable interregional redistributions. The financing system in Germany is not conceptually consistent. Reform proposals (unified health insurance for all; flat rate premiums) tackle these inconsistencies.

scholarly journals Healthcare Systems and Variation in Healthcare Utilization at the End of Life Across Countries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 560-560
Author(s):  
Jennifer Ailshire ◽  
Cristian Herrar ◽  
Margarita Maria Osuna
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Service ◽  
End Of Life ◽  
Low Income ◽  
Health Care Systems ◽  
Social Health Insurance ◽  
Social Health ◽  
Care Utilization ◽  
Care Systems

Abstract With rapid population ageing, providing better end-of-life care (EOLC) is becoming a source of social demand and financial pressure for public and private budgets in many countries. This paper uses data from harmonized end-of-life interviews in the HRS family of studies to assesses variation in health care utilization across different income groups and how they differ across different health care systems. Hospital stay did not vary across health care systems, but nursing home stays were lower in countries with either national or statist social health insurance systems. Hospice use was low in all countries, but particularly in national and social health insurance systems. Lower income was associated with greater use of nursing homes in both the private and social health care systems. Low income was also associated with greater use of hospice in national health service, but lower use in social health service.

scholarly journals Evolution of Public Health Expenditure Financed by the Romanian Social Health Insurance Scheme From 1999 to 2019

2021 ◽  
Vol 9 ◽  
Author(s):  
Ciprian-Paul Radu ◽  
Bogdan Cristian Pana ◽  
Daniel Traian Pele ◽  
Radu Virgil Costea
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health System ◽  
Structural Changes ◽  
Emergency Services ◽  
Health Sector ◽  
Social Health Insurance ◽  
Social Health ◽  
State And Local ◽  
The Impact

The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends; five including Medical devices, Dialysis, and Homecare services showed ascendant trends; and four including Dentistry and Emergency services showed descendant trends. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania.

scholarly journals The impact of social health insurance on rural populations

2021 ◽  
Author(s):  
Colin Green ◽  
Bruce Hollingsworth ◽  
Miaoqing Yang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Social Health Insurance ◽  
Social Health ◽  
Rural Populations ◽  
Access To Health Services ◽  
Access To Health ◽  
The Impact

AbstractImproving health outcomes of rural populations in low- and middle-income countries represents a significant challenge. A key part of this is ensuring access to health services and protecting households from financial risk caused by unaffordable medical care. In 2003, China introduced a heavily subsidised voluntary social health insurance programme that aimed to provide 800 million rural residents with access to health services and curb medical impoverishment. This paper provides new evidence on the impact of the scheme on health care utilisation and medical expenditure. Given the voluntary nature of the insurance enrolment, we exploit the uneven roll-out of the programme across rural counties as a natural experiment to explore causal inference. We find little effect of the insurance on the use of formal medical care and out-of-pocket health payments. However, there is evidence that it directed people away from informal health care towards village clinics, especially among patients with lower income. The insurance has also led to a reduction in the use of city hospitals among the rich. The shift to village clinics from informal care and higher-level hospitals suggests that the NRCMS has the potential to improve efficiency within the health care system and help patients to obtain less costly primary care. However, the poor quality of primary care and insufficient insurance coverage for outpatient services remains a concern.

Which Therapeutic Progress Shall be Paid by Social Health Insurance?

2007 ◽  
Author(s):  
Jürgen Wasem ◽  
Hans-Dieter Nolting ◽  
Yvonne Grabbe ◽  
Stefan Loos
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Social Health

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.

scholarly journals Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044322
Author(s):  
Wenqi Fu ◽  
Jufang Shi ◽  
Xin Zhang ◽  
Chengcheng Liu ◽  
Chengyao Sun ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Social Health Insurance ◽  
Poverty Line ◽  
Post Treatment ◽  
Social Health ◽  
Daily Consumption ◽  
Out Of Pocket Payments ◽  
Per Capita

ObjectivesTo determine the incidence and intensity of household impoverishment induced by cancer treatment in China.DesignAverage income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment.ParticipantsCancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded.Data sourcesA household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling.Findings5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666–4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024–0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China.ConclusionsThe financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.

scholarly journals Social health insurance for the poor: lessons from a health insurance programme in Karnataka, India

2018 ◽  
Vol 3 (1) ◽  
pp. e000582 ◽  
Author(s):  
Neeraj Sood ◽  
Zachary Wagner
Keyword(s):  
Health Insurance ◽  
Financial Burden ◽  
Tertiary Care ◽  
Substantial Reduction ◽  
Unmet Need ◽  
Social Health Insurance ◽  
Well Being ◽  
Poverty Line ◽  
Social Health ◽  
The Poor

Life-saving technology used to treat catastrophic illnesses such as heart disease and cancer is often out of reach for the poor. As life expectancy increases in poor countries and the burden from chronic illnesses continues to rise, so will the unmet need for expensive tertiary care. Understanding how best to increase access to and reduce the financial burden of expensive tertiary care is a crucial task for the global health community in the coming decades. In 2010, Karnataka, a state in India, rolled out the Vajpayee Arogyashree scheme (VAS), a social health insurance scheme focused on increasing access to tertiary care for households below the poverty line. VAS was rolled out in a way that allowed for robust evaluation of its causal effects and several studies have examined various impacts of the scheme on poor households. In this analysis article, we summarise the key findings and assess how these findings can be used to inform other social health insurance schemes. First, the evidence suggests that VAS led to a substantial reduction in mortality driven by increased tertiary care utilisation as well as use of better quality facilities and earlier diagnosis. Second, VAS significantly reduced the financial burden of receiving tertiary care. Third, these benefits of social health insurance were achieved at a reasonable cost to society and taxpayers. Several unique features of VAS led to its success at improving health and financial well-being including effective outreach via health camps, targeting expensive conditions with high disease burden, easy enrolment process, cashless treatment, bundled payment for hospital services, participation of both public and private hospitals and prior authorisation to improve appropriateness of care.

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