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.

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.

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.

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 International Constructions of Social Security and Public Health: Policy Intersections 1920–1970

Gesnerus ◽  
2017 ◽  
Vol 74 (2) ◽  
pp. 205-215
Author(s):  
James A. Gillespie
Keyword(s):  
Health Policy ◽  
Health Insurance ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
Social Insurance ◽  
Early Years ◽  
Health Security ◽  
Global Health Policy ◽  
The Social

The problems of national health insurance played a prominent, but shifting role in the formation of global health policy. This paper uses the work of Geneva based organizations from the end of the First World War to the 1970s to explore the crossing points between health policy and social security. From its formation the League of Nations Health Organisation had an uneasy dialogue with the social insurance and security approaches adopted by the International Labour Organization and the International Social Security Association. When the social insurance concerns of the interwar year broadened into ‘social security’, largely led by the ILO, this debate spilled over into conflicts over the leadership of global social policy and carried over into the early years of WHO. Conflicts centred on the difficult relationship between national health insurance and the other elements of what became the welfare state. The paper identifies the difficulties of constructing a global policy space for action on health security.

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 Factors Affecting Enrollment in Government Health Insurance Program in Kailali District

2019 ◽  
Vol 17 (3) ◽  
pp. 388-393
Author(s):  
Deepak Raj Paudel
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Chronic Illness ◽  
Social Health Insurance ◽  
Social Health ◽  
Factors Affecting ◽  
Government Health ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Insurance Enrollment

Background: Health care financial burden on households is high in Nepal. High health care expenditure is a major obstacle in achieving universal health coverage. The health insurance is expected to reduce healthcare expenditure. However, only small segments of the population are covered by health insurance in Nepal.This study assessed the factors affecting enrollment in government health insurance program in the first piloted district, Kailali, Nepal.Methods: A cross-sectional survey was conducted among 1048 households located in 26 wards of Kailali district after 21 months of the implementation of social health insurance program, Nepal. The sample was selected in two stages, first stage being the selection of wards and second, being the households.Results: The higher level of household economic status was associated with increased odds of enrollment in health insurance program (ORs=4.99, 5.04, 5.13, 8.05, for second, third, fourth, and the highest quintile of households, respectively). A higher level of head’s education was associated with increased odds of health insurance enrollment (ORs = 1.58, 1.78, 2.36, for primary, secondary, tertiary education, respectively). Presence of chronic illness in the household was positively associated with increased odds of health insurance enrollment (OR= 1.29). Conclusions: The poor and low educated groups were less benefited by social health insurance program in Kailali district, Nepal. Hence, policymakers should focus to implement income-based premium scheme for ensuring equal access to healthcare.Since household with chronic illness leads to high odds of being enrolled, a compulsory health insurance scheme can make the program financially sustainable.Keywords: Enrollment; health expenditure; health insurance; inequality; Nepal.

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.

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