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.

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 Social Health Security Program in Nepal: Opportunities and Challenges

2019 ◽  
Vol 2 (2) ◽  
pp. 59-69
Author(s):  
Ruku Panday
Keyword(s):  
Health Insurance ◽  
Social Insurance ◽  
Social Health Insurance ◽  
Social Health ◽  
Insurance Companies ◽  
Senior Managers ◽  
Health Security ◽  
Non Profit ◽  
Insurance Program ◽  
The Social

The study aims to assess the opportunities and challenges of the health insurance program carried out by Health Insurance Board as a social insurance program by Government of Nepal. Data have been collected through in-depth interview with 21 persons including the social health insurance policyholders, and non-policyholders who are inhabitants of Rantanagar Municipality- 6, and Bharatapur Metropolitan City- 10 of Chitwan district. Besides, experts in insurance and senior managers of insurance companies were also interviewed. It has followed the interpretive-naturalistic approach with the method of interviewing. As per the opinion of respondents HIP is effective in cost reduction of rich, and access to health service for poor. In government hospitals policyholders suffer from prolonging waiting, lack of facilities and experts and in private hospitals there is undue expenditure and discrimination in expert service. Even though the objective of the social health program is established social justice, cash-payer and insurance-payers are discriminated; corroborating the nature of neoliberal society. There are still uninsured persons because of ignorance, lack of premium, and distrust of HI service. The study suggests that HI service should be delivered through non-profit hospitals, the highest quality without discrimination of cashpayer and insurance-payer, and prolonged waiting.

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system

The Lancet ◽  
2015 ◽  
Vol 386 (10002) ◽  
pp. 1484-1492 ◽  
Author(s):  
Qingyue Meng ◽  
Hai Fang ◽  
Xiaoyun Liu ◽  
Beibei Yuan ◽  
Jin Xu
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Social Health Insurance ◽  
Social Health ◽  
The Social

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.

IDENTIFIKASI PERMASALAHAN FINANSIAL PADA JAMINAN SOSIAL KESEHATAN NASIONAL

INFO ARTHA ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. 111-119 ◽  
Author(s):  
Mas'udin Mas'udin
Keyword(s):  
Health Insurance ◽  
Financial Distress ◽  
Social Health Insurance ◽  
Social Health ◽  
Z Score ◽  
Financial Problem ◽  
Health Security ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Score Model

The national social health security program (JKN) is a government program that aims to provide social insurance of health care for all Indonesian people. Within three years of implementation, the JKN program has provided many benefits to the community. However, there is a financial problem indicated by the financial statements of social health insurance program, which is estimated experiencing financial distress. This study aims to identify financial problem of social health insurance program. The research used mix method that is quantitative and qualitative method with sequence explanatory design. Data is taken from Healthcare and Social Security Agency (BPJS) financial statement year 2014 - 2016, and analyzed using Altman (Z-Score) model and Zmijewski (X-Score) model. The result of the study shows that the social health security program has financial distress. Program jaminan kesehatan nasional (JKN) merupakan program Pemerintah yang bertujuan memberikan kepastian jaminan kesehatan yang menyeluruh bagi seluruh rakyat Indonesia. Dalam tiga tahun pelaksanaannya, program JKN telah memberikan banyak manfaat bagi masyarakat. Namun laporan keuangan program jaminan sosial kesehatan menunjukkan adanya permasalahan finansial, yang diduga mengalami financial distress. Penelitian ini bertujuan untuk mengidentifikasi permasalahan finansial program jaminan sosial kesehatan. Metode penelitian yang digunakan mix method, yaitu kuantitatif dan kualitatif dengan desain urutan pembuktian (sequential explanatory). Data bersumber dari laporan keuangan BPJS Kesehatan tahun 2014 s.d 2016, dan dianalisis menggunakan model Altman (Z-Score) dan model Zmijewski (X-Score). Hasil studi menunjukkan bahwa Program Jaminan Sosial Kesehatan mengalami financial distress.

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