scholarly journals Illness, Healthcare, and Health Insurance: Socio-economic Perspective in Nepalese Context

2019 ◽  
Vol 2 (2) ◽  
pp. 1-9
Author(s):  
Devaraj Acharya ◽  
Bishnu Prasad Wagle ◽  
Radha Bhattarai
Keyword(s):  
Social Justice ◽  
Health Insurance ◽  
Healthcare Expenditure ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Utilization Of Health Services ◽  
The Family ◽  
Insurance Programme ◽  
The Government ◽  
Health Insurance Programme

The Government of Nepal has introduced a health insurance programme since 2016. The main essence of the program is to reduce the gap in the utilization of health services between poor and rich, to reduce the out-of pocket expenditure while receiving the healthcare services, and to protect the family from poverty due to catastrophic healthcare expenditure. Researchers review the policy, programme and existing practice Data from Health Insurance Board shows that the programme appears not so effective in many districts but it looks successful in some districts where private healthcare providers are existing as a referral hospital. It is still unanswered whether the HIP is going to boost industrialists in the name of basic rights, health equity and social justice. The paper studies socio-economic and political perspectives of healthcare and health insurance with reference to Nepal and concludes that the healthcare system needs to reform for real welfare, social justice, and citizens' access and right to healthcare.

scholarly journals Occurrence of Medical Cases and Utilisation among Enrollees of Private Health Insurance Programme in Kaduna, Nigeria

2020 ◽  
pp. 30-37
Author(s):  
Oni, Oluwatobi Dapo ◽  
Zakari, Mustapha Mohammed ◽  
Okemmiri, Innocentia Chidinma
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Health Coverage ◽  
Primary Case ◽  
Health Maintenance ◽  
Insurance Programme ◽  
Chi Square Analysis ◽  
Health Insurance Programme

Aims: This study examines the occurrence of various medical cases presented by enrollees that have subscribed to access healthcare from a network of healthcare providers (HCPs) managed by a Health Maintenance Organisation (HMO) under its Private Health Insurance Programme (PHIP). Study Design:  A descriptive cross-sectional design was employed. Methodology: Secondary data from collected or submitted medical encounters in form of bills of registered enrollees (principals and their dependants) who have visited and received treatment from their chosen healthcare providers in Kaduna State between the month of January and December 2019 were purposively compiled and analysed. Cases were classified using the National Health Insurance Scheme (NHIS) Operational Guideline. Frequency tables, charts, percentages and Chi-Square analysis were used with the aid of Statistical Package for Social Sciences (SPSS) 22 at P=.05 level of significance. Results: A total of 11,156 medical cases were recorded after attrition, 9,525 (85.38%) primary cases and 1,632 (14.62%) secondary cases. Malaria (41.23%) and Respiratory Tract Infection (11.98%) led the primary case table while Hypertension (3.83%) Urology related cases (2.49%) and Diabetes (0.79%) were among the leading secondary cases. Female enrollees had slightly more cases and therefore higher tendencies to seek medical treatment than their male counterpart even though there was no significant relation between gender and type of case. Conclusion: The study concludes that the awareness and utilization of healthcare services are gradually growing among enrollees under the Private Health Insurance Programme (PHIP). In ensuring that there is an improvement in the health sector of Nigeria and achieving universal health coverage, focus should be on the primary healthcare services with high consideration for research, proper data management and periodic sharing of trends, observations and outcome of researches with the growing health community.

Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS

2020 ◽  
Vol 35 (3) ◽  
pp. 346-353
Author(s):  
Erniaty Erniaty ◽  
Harun Harun
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
New Public Management ◽  
Healthcare Services ◽  
Unintended Consequences ◽  
Healthcare Sector ◽  
Social Security Administration ◽  
Insurance Programme ◽  
The Impact ◽  
Health Insurance Programme

Abstract This study critically evaluates the adoption of a universal healthcare system recently introduced by the Indonesian government in 2014. Our study is driven by the lack of critical analysis of social and political factors and unintended consequences of New Public Management, which is evident in the healthcare sector reforms in emerging economies. This study not only examines the impact of economic and political forces surrounding the introduction of a universal health insurance programme in the country but also offers insights into the critical challenges and undesirable outcomes of a fundamental reform of the healthcare sector in Indonesia. Through a systematic and detailed review of prior studies, legal sources and reports from government and media organizations about the implementation and progress of an UHC health insurance programme in Indonesia, the authors find that a more democratic political system that emerged in 1998 created the opportunity for politicians and international financial aid agencies to introduce a universal social security administration agency called Badan Penyelenggara Jaminan Sosial (BPJS). Despite the introduction of BPJS to expand the health services’ coverage, this effort faces critical challenges and unintended outcomes including: (1) increased financial deficits, (2) resistance from medical professionals and (3) politicians’ tendency to blame BPJS’s management for failing to pay healthcare services costs. We argue that the adoption of the insurance system was primarily motivated by politicians’ own interests and those of international agencies at the expense of a sustainable national healthcare system. This study contributes to the healthcare industry policy literature by showing that a poorly designed UHC system could and will undermine the core values of healthcare services. It will also threaten the sustainability of the medical profession in Indonesia. The authors offer several suggestions for devising better policies in this sector in the developing nations.

scholarly journals Role of information, education, and communication in enrollment of health insurance: A case of Nepal

2019 ◽  
Author(s):  
Devaraj Acharya ◽  
Bhimsen Devkota ◽  
Kamal Gautam ◽  
Radha Bhattarai
Keyword(s):  
Health Insurance ◽  
Household Head ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Background Characteristics ◽  
Wealth Status ◽  
Cross Sectional ◽  
The Family ◽  
Insurance Programme ◽  
The Government

Abstract Background Most of the studies have indicated that various programmes were failing due to lack of appropriate information, education, and communication [IEC] to the target audiences. But still unanswered that which methods or means of communication could be the most powerful for changing behaviour, decision making,and or desired action. The paper aims to assess the effects of IEC on the enrollment of health insurance in Nepal.Methods A cross-sectional study, with randomly selected 810 [405 enrolled and 405 not-enrolled] households, was conducted at Baglung and Kailali districts of Nepal in 2018 using pretested structured interview tool. Background characteristics of family and respondents, and exposure to the means of communication were independent variables; and enrollment of health insurance was the dependent variable. Univariate, bivariate, and multivariate analyses were done to interpret the data.Results Data show that socio-demographics and exposure to communication were associated with the enrollment of health insurance. Demographic characteristics of the respondents and households particularly household head, age, wealth status, ability to feed the family, and presence of chronic diseases in the family were significantly associated with the enrollment of health insurance. Similarly, exposure to communication and media such as knowledge on health insurance and contribution amount of health insurance, having health insurance related books or guidelines, participation in training and workshop, discussion with peers and neighbours, exposure to health insurance related messages from radio and television, seen hoarding board, newspaper, and health insurance related pamphlet, brochure, and posters were significantly associated with enrollment in health insurance. Knowledge about health insurance and contribution amount, having health insurance related books and guidelines, and discussion with peers and neighbours appeared to be the positive and significant predictors for enrollment in health insurance scheme.Conclusion Communication and interaction with peers and neighbours about health insurance scheme of the government could lead to higher participation in health insurance programme. It would be better to incorporate this strategy while planning policies and interventions on health insurance.

scholarly journals Refugees and Sustainable Health Development in Iran

2021 ◽  
Vol 24 (1) ◽  
pp. 27-34
Author(s):  
Mohammad Mehdi Kiani ◽  
Khatere Khanjankhani ◽  
Afsaneh Takbiri ◽  
Amirhossein Takian
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Free Access ◽  
Health Coverage ◽  
Structured Interviews ◽  
Health Insurance Status ◽  
The Mean ◽  
The Government

Background: Refugees’ access to quality healthcare services might be compromised, which can in turn hinder universal health coverage (UHC), and achieving Sustainable Development Goal (SDG), ultimately. Objective: This article aims to illustrate the status of refugees’ access to healthcare and main initiatives to improve their health status in Iran. Methods: This is a mixed-method study with two consecutive phases: qualitative and quantitative. In the qualitative phase, through a review of documents and semi-structured interviews with 40 purposively-selected healthcare providers, the right of refugees to access healthcare services in the Iranian health system was examined. In the quantitative phase, data on refugees’ insurance coverage and their utilization from community-based rehabilitation (CBR) projects were collected and analyzed. Results: There are international and upstream policies, laws and practical projects that support refugees’ health in Iran. Refugees and immigrants have free access to most healthcare services provided in the PHC network in Iran. They can also access curative and rehabilitation services, the costs of which depend on their health insurance status. In 2015, the government allowed the inclusion of all registered refugees in the Universal Public Health Insurance (UPHI) scheme. Moreover, the mean number of disabled refugees using CBR services was 786 (±389.7). The mean number of refugees covered by the UPHI scheme was 112,000 (±30404.9). Conclusion: The United Nations’ SDGs ask to strive for peace and reducing inequity. Along its pathway towards UHC, despite limited resources received from the international society, the government of Iran has taken some fundamental steps to serve refugees similar to citizens of Iran. Although the initiative looks promising, more is still required to bring NGOs on board and fulfill the vision of leaving no one behind.

scholarly journals Association of information, education, and communication with enrolment in health insurance: a case of Nepal

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Devaraj Acharya ◽  
Bhimsen Devkota ◽  
Kamal Gautam ◽  
Radha Bhattarai
Keyword(s):  
Health Insurance ◽  
Structured Interview ◽  
Control Group ◽  
Background Characteristics ◽  
Decision Making Capacity ◽  
The Family ◽  
Insurance Programme ◽  
The Government ◽  
Household Heads ◽  
Health Programmes

Abstract Background Many studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal. Methods We employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable. Results Data showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41–60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17–44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09–8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61–8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34–2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI. Conclusion Knowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.

scholarly journals Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
S. M. A. Hanifi ◽  
Aazia Hossain ◽  
Asiful Haidar Chowdhury ◽  
Shahidul Hoque ◽  
Mohammad Abdus Selim ◽  
...  
Keyword(s):  
Health Services ◽  
Rural Area ◽  
Service Providers ◽  
Healthcare Providers ◽  
Community Support ◽  
Healthcare Services ◽  
Public Health Services ◽  
Community Clinics ◽  
Community Awareness ◽  
The Government

Abstract Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention. Results Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs. Conclusion CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.

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