scholarly journals Policy options to integrate HIV services into Social Health Insurance (JKN) in Indonesia

2019 ◽  
Vol 10 (1) ◽  
pp. 67-76
Author(s):  
Mardiati Nadjib ◽  
Purwa Kurnia Sucahya ◽  
Mondastri Korib ◽  
Ratih Oktarina ◽  
Pujiyanto Pujiyanto ◽  
...  
Keyword(s):  
Health Insurance ◽  
Research Question ◽  
Social Health Insurance ◽  
Hiv Treatment ◽  
Hiv And Aids ◽  
Social Health ◽  
Health Coverage ◽  
Benefit Package ◽  
Hiv Services ◽  
Hiv Aids

Latar belakang: Setelah sekian tahun bergantung pada sumber pendaaan luar negeri, pembiayaan Program HIV AIDS di Indonesia diharapkan menggunakan sumber pendanaan dalam negeri. Skema Jaminan Kesehatan Semesta atau Jaminan Kesehatan Nasional (JKN) yang dimulai tahun 2014 menanggung pengobatan termasuk infeksi oportunistik. Pertanyaan penelitian apakah paket manfaatnya dapat mencakup intervensi kesehatan masyarakat seperti HIV tanpa menghambat penyediaan pelayanan? Implementasi untuk Program HIV yang selama ini disubsidi Pemerintah memerlukan kehati-hatian. Studi ini bertujuan untuk menganalisis skenario terkait biaya dan utilisasi pada pelayanan HIV guna mendukung kebijakan yang potensial untuk mengintegrasikan intervensi HIV ke dalam paket manfaat JKN. Metode: Penelitian ini menganalisis paket manfaat dan mekanisme pembiayaan terkait pelayanan HIV, keanggotaan JKN, target populasi kunci, serta estimasi premi untuk pelayanan HIV hingga tahun 2019. Studi observasional ini menghasilkan data biaya dan utilisasi dari tingkat nasional dan daerah sebagai data dasar. Peneliti membangun model dan menganalisis skenario proyeksi biaya dan utilisasi dari beragam program aktivitas HIV serta konsekuensinya. Hasil: Skenario dikembangkan berdasarkan kelengkapan paket manfaat dan komponen mana yang bisa dijamin dalam JKN.Pelayanan yang terkait HIV saat ini sebagian besar dijamin oleh pemerintah mulai dari Konseling dan Tes HIV Sukarela (KTS) hingga pengobatan Infeksi Oportunistik. Pengobatan dan perawatan kemungkinan dapat dijamin oleh JKN, dengan bantuan pemerintah untuk pencegahan dan pelayanan ART. Kesimpulan: Skenario dengan paket manfaat dasar akan membutuhkan biaya medis yang rasional per pasien per bulan, tergantung pada kelengkapan paket manfaat. Sebuah peta jalan yang jelas perlu disusun untuk memastikan seluruh pelayanan terjangkau dan berkualitas baik.  Kata kunci: Jaminan kesehatan semesta, pelayanan HIV, dan Opsi Kebijakan   Abstract   Background: HIV and AIDS program in Indonesia is planned to be financed by domestic sources after depending on external sources for many years. Indonesia has started its Social Health Insurance scheme so called Jaminan Kesehatan Nasional (JKN) program in 2014, that covers HIV treatment including opportunistic infection. Research question is whether JKN could expand its benefit package to public health interventions without hampering service provision. Converting HIV program that has been subsidizied by the Government needs careful considerations. The study aimed to assess scenarios on cost and utilization to support decision on integration of HIV interventions into the JKN benefit package. Methods: The study assessed the current coverage and funding mechanisms for HIV-related services, JKN membership, key target populations, and estimated premium for HIV services up to 2019. We captured cost and utilization from national and subnational levels as the baseline through an observational study. Researchers developed model and scenarios on the projection of cost and utilization of various HIV program activities and its consequences. Results: We developed scnearios based on benefit covered by JKN. current services mostly covered by government. The Care and treatment could be possibly covered by the JKN, with support from government for prevention and ART. Conclusion: The scenarios show that provision of HIV services within the basic benefits package of JKN would require a reasonable cost per member per month, depending on the comprehensiveness of the benefit. A clear roadmap should be developed to ensure all services provided are affordable and in good quality.  Keywords: Universal Health Coverage, HIV AIDS, Policy Option

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.

Supplementary Health Insurance and Regulation of Healthcare Systems

2019 ◽  
Author(s):  
Brigitte Dormont
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Social Insurance ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Social Health ◽  
Managed Competition ◽  
Benefit Package ◽  
Care Services ◽  
Supplementary Health Insurance

Most developed nations provide generous coverage of care services, using either a tax financed healthcare system or social health insurance. Such systems pursue efficiency and equity in care provision. Efficiency means that expenditures are minimized for a given level of care services. Equity means that individuals with equal needs have equal access to the benefit package. In order to limit expenditures, social health insurance systems explicitly limit their benefit package. Moreover, most such systems have introduced cost sharing so that beneficiaries bear some cost when using care services. These limits on coverage create room for private insurance that complements or supplements social health insurance. Everywhere, social health insurance coexists along with voluntarily purchased supplementary private insurance. While the latter generally covers a small portion of health expenditures, it can interfere with the functioning of social health insurance. Supplementary health insurance can be detrimental to efficiency through several mechanisms. It limits competition in managed competition settings. It favors excessive care consumption through coverage of cost sharing and of services that are complementary to those included in social insurance benefits. It can also hinder achievement of the equity goals inherent to social insurance. Supplementary insurance creates inequality in access to services included in the social benefits package. Individuals with high incomes are more likely to buy supplementary insurance, and the additional care consumption resulting from better coverage creates additional costs that are borne by social health insurance. In addition, there are other anti-redistributive mechanisms from high to low risks. Social health insurance should be designed, not as an isolated institution, but with an awareness of the existence—and the possible expansion—of supplementary health insurance.

scholarly journals Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Obinna Onwujekwe ◽  
Nkoli Ezumah ◽  
Chinyere Mbachu ◽  
Felix Obi ◽  
Hyacinth Ichoku ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Health Financing ◽  
Catastrophic Health Expenditure ◽  
Social Health ◽  
Health Coverage ◽  
Health Maintenance ◽  
Use Of Resources ◽  
Regulatory Frameworks ◽  
Legal Frameworks

Abstract Background Various attempts to examine health financing mechanisms in Nigeria highlight the fact that there is no single mechanism that fits all contexts and people. This paper sets out findings of an in-depth assessment of different health financing mechanisms in Nigeria. Methods The study was undertaken in the Federal Capital territory of Nigeria and two States (Niger and Kaduna). Data were collected through review of government documents, and in-depth interviews of purposively selected respondents. Data analysis was guided by a conceptual framework which draws from various approaches for assessing health financing mechanisms. Data was examined for current practices, what needs to change and how the change can happen. Results Health financing mechanisms in Nigeria do not operate optimally. Allocation and use of resources are neither evidence-based nor results-driven. Resources are not allocated equitably or in a manner that minimizes wastage and improves efficiency. None of the mechanisms effectively protects individuals/households from catastrophic health expenditure. Issues with social health insurance cut across legal frameworks and use of Health Maintenance Organisations (HMOs) as purchasers. The concomitant effect is that attainment of Universal Health Coverage is greatly compromised. In order to improve efficiency of health financing mechanisms, government needs to allocate more funds for purchasing health services; this spending must be based on evidence (strategic), and appropriately tracked. The legislation that established National Health Insurance Scheme should be amended such that social health insurance becomes mandatory for all citizens. Implementation of the latter should be complemented by revision of benefit package, strict oversight and regulation of HMOs. Conclusion In order to improve health financing in the country, legal and regulatory frameworks need to be revised. Efficient utilization of resources could be improved through strategic purchasing arrangements and strict oversight.

Universal health coverage and user charges

2013 ◽  
Vol 8 (4) ◽  
pp. 529-535 ◽  
Author(s):  
Peter C. Smith
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Social Health Insurance ◽  
Social Health ◽  
World Health ◽  
World Health Report ◽  
Health Coverage ◽  
User Charges ◽  
Universal Health

AbstractThere has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.

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 Governance and Purchasing Function under Social Health Insurance in Nepal: Looking Back and Moving Forward

2017 ◽  
Vol 15 (1) ◽  
pp. 85-87
Author(s):  
Vishnu Prasad Sapkota ◽  
Umesh Prasad Bhusal
Keyword(s):  
Health Insurance ◽  
Social Protection ◽  
Service Providers ◽  
Social Health Insurance ◽  
Social Health ◽  
Health Coverage ◽  
Health Security ◽  
The Social ◽  
Development Committee ◽  
Health Services Needs

Nepal is pursuing Social Health Insurance as a way of mobilizing revenues to achieve Universal Health Coverage. The Social Health Insurance governance encourages service providers to maintain quality and efficiency in services provision by practicing strategic purchasing. Social Health Security Programme is a social protection program which aspires to achieve the goals of Social Health Insurance. Social Health Security Development Committee needs to consider following experiences to function as a strategic purchaser. The Social Health Security Development Committee need to be an independent body instead of falling under Ministry of Health. Similarly, purchasing of health services needs to be made strategic, i.e., Social Health Security Development Committee should use its financial power to guide the provider behavior that will eventually contribute to achieving the goals of quality and efficiency in service provision. The other social health security funds should be merged with Social Health Security Development Committee and develop a single national fund. Finally, the state has to regulate and monitor the performance of the SHI agency.

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