German Health Insurance: The Evolution and Current Problems of the Pioneer System

1971 ◽  
Vol 1 (4) ◽  
pp. 315-330 ◽  
Author(s):  
M. Pflanz
Keyword(s):  
Health Insurance ◽  
Political Parties ◽  
Social Health Insurance ◽  
Social Health ◽  
Federal Republic Of Germany ◽  
Sick Fund ◽  
Effectiveness And Efficiency ◽  
The Government ◽  
Rehabilitative Services

The German system of social health insurance is one of the oldest in the world, but it has proven to be astonishingly flexible. Presently about 90 per cent of the population living in the Federal Republic of Germany (FRG) is cared for by social health insurance. The patient does not have a direct economic relationship with the doctor, and the doctor does not deal directly with the sick fund on financial matters. The association of insurance doctors is the intermediate organization between sick funds and the doctor. It is a self–governed organization of insurance doctors supervised by governmental authority. But beyond legislation the government cannot exert direct influence on doctors or sick funds, particularly since the contributions (except for retired people) are paid not by the government but by the insured and their employers. There are deficiencies in the mode of paying the doctor, leading the doctor to perform many unwarranted services. Moreover, there are apparent disadvantages of inadequate integration of preventive, curative, and rehabilitative services, and of hospital, outpatient, and office practice services. The strictly followed regulation on economical prescribing diminishes the quality of the physician's services. Presently, neither the political parties in parliament, nor the federal government, nor the doctors show tendencies to change the system basically. However, there is strong inclination for selective changes. But there is a lack of planning and of good data which might be drawn on for planning and for the evaluation of the quality, effectiveness, and efficiency of the system.

STUDYING THE OPINION OF THE POPULATION ON THE ORGANIZATION AND QUALITY OF DENTAL CARE

Vestnik ◽  
2021 ◽  
pp. 127-132
Author(s):  
Е. Алиакбар ◽  
А.К. Бейсбекова ◽  
А.Н. Нурбакыт ◽  
Д.Н. Маханбеткулова
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Dental Care ◽  
Social Health Insurance ◽  
Dental Service ◽  
Social Health ◽  
High Quality ◽  
Level Of Satisfaction ◽  
Dental Office

В условиях социального медицинского страхования удовлетворенность пациентов полученной медицинской помощью является одним из основных критериев оценки её качества. Цель исследования. Оценить уровень удовлетворенности пациентов, получающих лечение в стоматологическом кабинете. Материал и методы. Был проведен социологический опрос 83 пациентов, получающих лечение в стоматологическом кабинете. Выводы. На основании проведенного нами опроса и полученных результатов выявлено, что в целом респонденты отмечают удовлетворенность стоматологической услугой. Также отмечают высокое качество оказываемых услуг. In the context of social health insurance, the satisfaction of patients with the received medical care is one of the main criteria for assessing its quality. Purpose of the study. Assess the level of satisfaction of patients receiving treatment in the dental office. Material and methods. A sociological survey was conducted of 83 patients receiving treatment in the dental office. Conclusions. Based on our survey and the results obtained, it was revealed that, in general, the respondents note satisfaction with the dental service. They also note the high quality of the services provided.

Application of digital technologies in health insurance for social good of bottom of pyramid customers in India

2019 ◽  
Vol 39 (9/10) ◽  
pp. 752-772
Author(s):  
Bishwajit Nayak ◽  
Som Sekhar Bhattacharyya ◽  
Bala Krishnamoorthy
Keyword(s):  
Risk Management ◽  
Health Insurance ◽  
Digital Technology ◽  
Social Health Insurance ◽  
Social Health ◽  
Strategic Choices ◽  
Content Type ◽  
Study Results ◽  
The Government ◽  
Health Insurers

Purpose Social health insurance framework of any country is the national identifier of the country’s policy for taking care of its population which cannot access or afford quality healthcare. The purpose of this paper is to highlight the strategic imperatives of digital technology for the inclusive social health models for the BoP customers. Design/methodology/approach A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance CXOs was conducted with a semi-structured questionnaire. Using MaxQDA software, the interview transcripts were analyzed by means of thematic content analysis technique and patterns identified based on the expert opinions. Findings A framework for the strategic imperatives of digital technology in social health insurance emerged from the study highlighting three key themes for technology implementation in the social health insurance sector – analytics for risk management, cost optimization for operations and enhancement of customer experience. The study results provide key insights about how insurers can enhance the coverage of BoP population by leveraging technology. Social implications The framework would help health insurers and policymakers to select strategic choices related to technology that would enable creation of inclusive health insurance models for BoP customers. Originality/value The absence of specific studies highlighting the strategic digital imperatives in social health insurance creates a unique value proposition for this framework which can help health insurers in developing a convergence in their risk management and customer delight objectives and assist the government in the formulation of a sustainable social health insurance framework.

scholarly journals Willingness to Join and Pay for Social Health Insurance Scheme Among employees in Debere Berhan Town, Ethiopia

2019 ◽  
Author(s):  
Wassie Negash Mekonnen ◽  
Mesfin Wondaferew ◽  
Adugnaw Birhane Mekonen
Keyword(s):  
Health Insurance ◽  
Willingness To Pay ◽  
Contingent Valuation Method ◽  
Social Health Insurance ◽  
Health Insurance Scheme ◽  
Social Health ◽  
P Value ◽  
Multivariable Logistic Regression Analysis ◽  
Insurance Scheme ◽  
The Government

Abstract Back ground: Social Health Insurance improves access to health services among civil servants by removing catastrophic health expenditure. In Ethiopia, only 7.3% of the population covered by health insurance. Due to this fact the government of Ethiopia initiated Social Health Insurance scheme to be applied in the formal employers and employees with compulsory membership of the scheme. This study therefore aimed to assess willingness to join and pay for social health insurance scheme among government and private employees in Debere Berhan Town, Ethiopia .Methods: Cross-sectional study was conducted .At mean time Stratified sampling technique was used to select 619 employees. A modified dichotomous contingent valuation method (CVM) was applied to elicit employees’ willingness to pay. Bi-variant and multivariable logistic regression analysis was done . Then the result at 95% CI and P value <0.05 was declared as variables have statistically significant association. Results: A total of 619 employees with response rate of 97.8% were participated in the study. About 406 (65%) of the respondents were willing to join to Social Health Insurance scheme. Of which 113 (27.8%) of employees were willing to pay the government proposed 3% premium. The employee’s average willingness to pay for social health insurance scheme was 1.88% of their monthly salary. In this study the odds of respondents who had degree and above (AOR=3.608, 95%CI 1.177-11.061), employees good perception on quality health service (AOR=3.150, 95% CI 1.140-8.699) and employees who perceive benefit packages of social health insurance as enough (AOR=5.229, 95%CI: 2.230-12 .594) were higher than the counter parts. Conclusion: Employees willingness to join of the Social Health Insurance scheme(SHIS) is low and very low number of employees agree to pay the government proposed premium for SHIS. So decision-makers should emphasize to revise the benefit packages and the premiums to be contributed. likewise insurance agency and all responsible bodies should aware the society about the importance of social health insurance for the employees.

scholarly journals SOCIAL HEALTH INSURANCE LITERACY: LESSON LEARNED FROM SOCIAL INSURANCE FOR MATERNITY CARE BY NATIONAL HEALTH INSURANCE PROGRAMME

2019 ◽  
Vol 7 (1) ◽  
pp. 25
Author(s):  
Choirun Nisa' ◽  
Intan Nina Sari
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Maternity Care ◽  
Social Insurance ◽  
Post Partum ◽  
Social Health Insurance ◽  
Social Health ◽  
Health Insurance Literacy ◽  
The Government

Background: Health insurance is a right for all Indonesian citizens. To provide this, the Indonesian government must provide health services that are equitable, fair, and affordable for all levels of society. Before National Health Insurance (JKN) was established, the government launched Social Insurance for Maternity Care or Jaminan Persalinan (Jampersal) as a special health facility for pre-pregnant to post-partum mothers. The JKN program will run well if it is accompanied with good health service literacy of the community.Aims: This study aims to analyze the relationship of social health insurance literacy with the utilization of Jampersal and predict the response towards JKN utilization based on Jampersal mothers. These responses can be used as an input for JKN improvement.Methods: This research is a descriptive study that focuses on the experience of the subjects. The study does so by analyzing Jampersal users’ response and utilizing it for the improvement of JKN. The respondents of this study are Jampersal and non-Jampersal mothers consisting of 75 pregnant and post-partum mothers.Results: The results show that the number of Jampersal users (47%) were less than non Jampersal (53%) with a ratio of 2:3. In addition, literacy about Jampersal of Jampersal mothers' was higher (28 out of 30 people - 93.33%) compared to non Jampersal mothers (29 out of 45 people - 64.44%).Conclusions: This study concludes that there is a lack of promotion of government programs, especially social health insurance. What needs to be done to improve participation and use of social health insurance is to encourage primary healthcare centers to promote the programs. Intervention policy, especially by educating the communities, is necessary for the improvement of JKN literacy.                                                                                                                                                          Keywords: Literacy, Participation, Social health insurance.

scholarly journals Willingness to Pay for Social Health Insurance and Associated Factors among Health Care Providers in Addis Ababa, Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Abel Mekonne ◽  
Benyam Seifu ◽  
Chernet Hailu ◽  
Alemayehu Atomsa
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Willingness To Pay ◽  
Health Care Providers ◽  
Health Professionals ◽  
Addis Ababa ◽  
Social Health Insurance ◽  
Social Health ◽  
Care Providers ◽  
The Government

Background. Cost sharing between beneficiaries and government is critical to attain universal health coverage. The government of Ethiopia introduced social health insurance to improve access to quality health services. Hence, HCP are the ultimate frontline service provider; their WTP for health insurance could influence the implementation of the scheme directly or indirectly. However, there is limited evidence on willingness to pay (WTP) for social health insurance (SHI) among health professionals. Methods. A cross-sectional study was conducted in Addis Ababa, Ethiopia, from May 1st to August 15th, 2019. A total sample of 480 health care providers was selected using a multistage sampling method. The collected data were entered into Epi Info version 7.1 and analyzed with SPSS version 23. Binary and multiple logistic regression analysis was carried out to identify the associated factor outcome variable. The association was presented in odds ratio with 95% confidence interval and significance determined at a P value less than 0.05. Result. A total of 460 health care providers responded to the questionnaire, making a 95.8% response rate. Of the respondents, only 132 (28.7%) were WTP for SHI. Higher educational status [AOR=2.9, 95% CI (1.2-7.3)], higher monthly income [AOR=2.2, 95% CI (1.2-4.3)], recent family illness [AOR=2.4, 95% CI (1.4-4.4)], and a good awareness about SHI [AOR=4.4, 95% CI (2.4-7.8)] showed significant association with WTP for SHI. The main reasons for not WTP were thinking the government should cover the cost, preferring out-pocket payment and the provided SHI scheme does not cover all the health care costs health care providers lost interest in pay for SHI. Conclusion and Recommendation. The majority of health care providers were not willing to pay for the introduced SHI scheme. The provided SHI scheme should be clear and provide special consideration for health care providers as the majority of them receives free health care service from their employer health care institution. Also, the government, health professional associations, and other concerned stakeholders should provide awareness creation programs by targeting low and middle-level health professionals in order to increase WTP for SHI among health care providers.

scholarly journals Cost-effectiveness of timely versus delayed primary total hip replacement in Germany: A social health insurance perspective

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Ruben E. Mujica-Mota ◽  
Leala K. Watson ◽  
Rosanna Tarricone ◽  
Marcus Jäger
Keyword(s):  
Quality Of Life ◽  
Health Insurance ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Social Health Insurance ◽  
Social Health ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Without clinical guideline on the optimal timing for primary total hip replacement (THR), patients often receive the operation with delay. Delaying THR may negatively affect long-term health-related quality of life, but its economic effects are unclear. We evaluated the costs and health benefits of timely primary THR for functionally independent adult patients with end-stage osteoarthritis (OA) compared to non-surgical therapy followed by THR after progression to functional dependence (delayed THR), and non-surgical therapy alone (Medical Therapy), from a German Social Health Insurance (SHI) perspective. Data from hip arthroplasty registers and a systematic review of the published literature were used to populate a tunnel-state modified Markov lifetime model of OA treatment in Germany. A 5% annual discount rate was applied to costs (2013 prices) and health outcomes (Quality Adjusted Life Years, QALY). The expected future average cost of timely THR, delayed THR and medical therapy in women at age 55 were €27,474, €27,083 and €28,263, and QALYs were 20.7, 16.7, and 10.3, respectively. QALY differences were entirely due to health-related quality of life differences. The discounted cost per QALY gained by timely over delayed (median delay of 11 years) THR was €1270 and €1338 in women treated at age 55 and age 65, respectively, and slightly higher than this for men. Timely THR is cost-effective, generating large quality of life benefits for patients at low additional cost to the SHI. With declining healthcare budgets, research is needed to identify the characteristics of those able to benefit the most from timely THR.

scholarly journals Moving to Social Health Insurance Financing and Payment for HIV/AIDS Treatment in Vietnam

2021 ◽  
Vol 14 ◽  
pp. 117863292098884
Author(s):  
Lan Thi Hoang Vu ◽  
Benjamin Johns ◽  
Quyen Thi Tu Bui ◽  
Anh Duong Thuy ◽  
Diu Nguyen Thi ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Inpatient Admission ◽  
Social Health ◽  
Cross Sectional ◽  
Related Services ◽  
Donor Funding ◽  
Outpatient Visits ◽  
The Government ◽  
Hiv Aids

This study estimates the amount antiretroviral therapy (ART) clients paid out of pocket for preventive and treatment services and the percentage of ART clients incurring catastrophic payments during the period when ART services were transitioning from donor funding to domestic social health insurance (SHI) in Vietnam. Using a cross-sectional facility-based survey in 9 provinces, a sample of 582 clients across 18 ART facilities representatives of all facilities where SHI-financed ART was being implemented were interviewed in 2019. Results indicated 13.4% (95% CI: 5.7%, 28.2%) of clients incurred a payment for outpatient ART care. The average out of pocket expenditures for outpatient visits and HIV related outpatient visits was USD $71.2 and $8 per year, respectively. The average out of pocket expenditure for inpatient admission and HIV related inpatient admission was $7.1 and $1.6, respectively. Only 0.1% clients currently experienced HIV-related catastrophic payment at the 25% of total expenditures threshold. The study confirms the transition from donor-financed ART to SHI-financed ART is not causing financial hardship for ART clients. However, more commitment from the Government of Vietnam to strengthen HIV-related services under SHI may be needed in the future, and there is still need to ensure universal SHI coverage among people with HIV/AIDs in Vietnam.

scholarly journals Έλεγχος ποιότητας ιατρικής συνταγογράφησης

2011 ◽  
Author(s):  
Ευφροσύνη Πρινέα
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Medication Errors ◽  
Health Care Providers ◽  
Information Source ◽  
Social Health Insurance ◽  
Social Health ◽  
Care Providers ◽  
The Right

Health care error, fraud, and abuse affect everyone. They contribute to the rising costs of health care and, in some instances, diminish the quality of care that is provided.Most health care providers are honest and are providing the best care that they can, but the small number who aren’t find ways to steal billions of money from the health care system each year. Even more is lost to errors in billing that are never found.Strategic efforts are needed to inform the patients about the right use of the medicines. It is in the best interest of all citizens, to be informed, aware, and involved in stopping and preventing error or fraud. There is an increasing awareness and concern over medication errors. Patient safety and medication errors have become prominent issues on the national health care agenda.Beyond the financial costs associated with medication errors are the consequences often endured by the patient. Medication errors represent real losses to employers and employees - in time, money and quality of life. Medication errors can occur in the process of naming, prescribing, transcribing, dispensing, and administering of medications. Patients themselves can also cause errors by failing to comply with instructions.Design/methodology/approach: A total of: a) 300 questionnaires of patients insured at greek social health insurance organization were examined in relation to written and oral doctor obligations, drug side-effects, chronic health problems of the patients, smoking and alcohol consumption and doctor’s driving counseling (year of study: 2003) b) 1,000 prescriptions were taken as a sampling from a total of 10,000 prescriptions issued in two years (2001 - 2002) by doctors of big social health insurance organization in Athens. The doctors were belonged to many specialties and the quality of doctors prescribing (dosology, obligations, prescription completion, drug interactions) was examined c) about 5,500 prescriptions of social health insurance organization were examined for drugs that were not contained in the drug prescription list and could be written on a prescription only as unique and indispensable drug for the certain disease (characterized by the doctor) (year of study: 2002) d) specialized drugs that imported from abroad for certain patients belonged to big social health insurance organization between 2003 – 2004 and had no other therapeutic choice. e) also, characteristical examples of prescriptions contained very serious mistakes that were found during this study, are presented.Originality/value – The results of this study showed inappropriate prescription of many drugs. Unfortunately, the use of medicines without indication, over appropriate dosology or without the right obligations, is not a rare phenomenon in our days. Physicians are often not able to satisfy the demand of the appropriate prescribing of drugs, because of limited time, lack, or wrong information source, or trying to earn more money from the big pharmaceutical companies.So, intervention methods should be chosen to change physicians prescribing behavior, and to improve the quality of their prescriptions.

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