PRIME MINISTER'S NATIONAL HEALTH PROGRAMME (PMNHP): A COST COMPARISON ANALYSIS

2018 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Shaikh Hussain ◽  
Rubina Hussain ◽  
Assad Hafeez ◽  
Adnan Khan
Keyword(s):  
Health Insurance ◽  
National Health ◽  
Healthcare Providers ◽  
Caesarian Section ◽  
Insurance Companies ◽  
Public And Private ◽  
Normal Delivery ◽  
Private Healthcare ◽  
Significant Difference ◽  
Health Programme

Background: Prime Minister's National Health Programme (PMNHP) is a publically funded cashless scheme at point of service, which was initiated in December 2015 to provide access to universal healthcare to people living below poverty line for indoor secondary and tertiary healthcare services for priority diseases in Pakistan. Objective: Our study aimed to compare prices of PMNHP districts packages, compare PMNHP with average payments made to healthcare providers by various health insurance companies, and compare prices among PMNHP itself, public sector not supported by the programme, and private healthcare not supported by the programme in Islamabad Methods: We conducted this comparative descriptive cross sectional study. For first two objectives, we collected secondary data, and for the third objective, we did convenient sampling of the treated patient (n-158) from PMNHP, public and private hospitals for selected diseases. Results: PMNHP district comparisons showed no significant difference among districts except Normal Delivery (NVD) at Rahim Yar Khan had lowest cost (mean=10111.11). For Diabetes Mellitus, Muzaffarabad had lowest (mean=1733.33), and Quetta had highest (mean=5300). Average price paid to healthcare providers by various insurance companies are on higher side as compared to PMMHP. Price differences were significant among PMNHP, Public Out of Pocket Spending (OOPS) and Private For NVD, [F(2, 27)=3364, p=0.000] with PMNHP (mean=15.000, SD=0.000) Public (OOPS) (mean=2.127, SD=0.221) and Private (mean=14.702, SD=0.658) For caesarian section [F(2,27)=2850, p=0.000], and Cholecystectomy, [F(2, 28)=221, p=0.000]. While in comparison with Private, PMNHP were cost beneficial for caesarian section (mean=32.016, SD=1.31) and Cholecystectomy (m=43.133, SD=6.648). Conclusion: PMNHP district wise packages are almost same among and for all the districts. Program is fairly and competitively priced against public and private healthcare providers, and private health insurance healthcare provider payments. PMNHP design features may be used to extend program in other districts.  

South African health plan will prompt more controversy

2019 ◽  
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Health Coverage ◽  
Access To Health Services ◽  
Content Type ◽  
Private Healthcare ◽  
Health Rights

Subject National Health Insurance (NHI). Significance The long-awaited National Health Insurance (NHI) Bill has been released and is poised to begin its passage through parliament. The Bill contains the biggest health reforms in post-apartheid South Africa and is the first piece of enabling legislation for realising the government’s ambitions for achieving universal health coverage, called NHI. The Bill signals a sharply diminished role for medical schemes, which 8.9 million people use to pre-fund access to private healthcare services. Impacts Given the apartheid-era legacy of inequitable access to health services, opposition to NHI will be cast as being anti-black and anti-poor. With little scope to raise revenue with further tax hikes without undermining compliance, NHI funding will be a perennial problem. Anxiety about the rates government will be willing to offer private healthcare providers could trigger an exodus of doctors and nurses. The NHI Bill rolls back current health rights for migrants, raising the prospects of a future legal challenge.

scholarly journals National health insurance accreditation pattern among private healthcare providers in Ghana

2017 ◽  
Vol 75 (1) ◽  
Author(s):  
Abena Agyeiwaa Lamptey ◽  
Eric Nsiah-Boateng ◽  
Samuel Agyei Agyemang ◽  
Moses Aikins
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Healthcare Providers ◽  
Private Healthcare

scholarly journals Public and private sectors collective response to combat COVID-19 in Malaysia

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ching Siang Tan ◽  
Saim Lokman ◽  
Yao Rao ◽  
Szu Hua Kok ◽  
Long Chiau Ming
Keyword(s):  
Insurance Coverage ◽  
Healthcare Providers ◽  
Screening Tests ◽  
Public Healthcare ◽  
Private Hospitals ◽  
Public And Private ◽  
The Public ◽  
Private Healthcare ◽  
Care Services ◽  
Challenges And Opportunities

AbstractOver the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed “private contractors” who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.

scholarly journals Development of medical insurance in the Russian Federation. At the crossroads. What's next?

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Igor M. Akulin ◽  
Lubov Yu. Zhiguleva
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health ◽  
Insurance Companies ◽  
Health Insurance System ◽  
National Health Care ◽  
Health Insurance Companies ◽  
Compulsory Health Insurance ◽  
The Russian Federation ◽  
Additional Payment

The RF health care reform is gaining momentum. A thorough consideration should be given to the discussion on the need to exclude health insurance companies from the compulsory health insurance system (CHI). Formation of the National Health Care System of Russia is the main problem of the national health care at this stage of reforms. Additional payment for medical services in the CHI by the general public is not advisable. Changes in the regulatory framework of the CHI system is deemed to be the basis for reforming the system of compulsory and voluntary health insurance in Russia.   

Belgium Healthcare System

2020 ◽  
pp. 65-73
Author(s):  
Elena Frolova
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
Care Delivery ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
Small Country ◽  
Public And Private ◽  
Private Healthcare ◽  
High Level ◽  
Very High

Belgium is a small country in northwestern Europe, with a population of 11.4 million people. The country has a very high level of urbanization; up to 97% of the population lives in cities and towns. About 10% of GDP is spent annually on the development of healthcare, which, technically, corresponds to the average European indicators. Based on the results of work in 2018, the Belgian medical care delivery system was recognized as the “most generous healthcare system in Europe”, however, it was rated much lower in terms of quality than the countries that took first places in the ranking. The country has a public and private healthcare system, and both of them are paid. 99% of the population is covered by medical insurance, and children under the age of 18 are covered by parental insurance. All officially employed Belgians and self-employed persons operating in the country must be registered and make contributions to the Belgian Health Insurance Fund. The amount of the monthly contribution to the Health Insurance Fund is fixed, it amounts to 7.35% of the salary.

scholarly journals Prices of medicines for the management of pain, diabetes and cardiovascular diseases in private pharmacies and the national health insurance in Tanzania

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Rashid Bakari Kirua ◽  
Mary Justin Temu ◽  
Amani Thomas Mori
Keyword(s):  
Health Insurance ◽  
Cardiovascular Diseases ◽  
National Health Insurance ◽  
National Health ◽  
Essential Medicines ◽  
High Price ◽  
Sign Test ◽  
Insurance Fund ◽  
Reference Prices ◽  
Significant Difference

Abstract Background High price is a major challenge limiting access to essential medicines especially among the poorest families in developing countries. The study aims to compare the prices of medicines used in the management of pain, diabetes, and cardiovascular diseases in private pharmacies and the National Health Insurance Fund (NHIF) in Tanzania. Pharmacy prices were also compared with the prices of medicines surveyed nationally by WHO/HAI in 2012. Method This cross-sectional study was conducted in Dar es Salaam, Morogoro, Dodoma, and Kilimanjaro regions from February to April 2015. Data were collected from 33 private pharmacies, NHIF and, the HAI database. The study used the WHO/HAI methodology. The analysis was done using non-parametric Kruskal-Wallis and post-hoc pair-wise comparison Dunn test, while a possible change in prices between our survey and 2012 WHO/HAI national survey data was tested using a Sign test in Stata version 16.1. Results Twenty-eight essential medicines, of which 9 are used for management of pain, 7 for diabetes, and 12 for cardiovascular diseases were analyzed. There was a significant difference in the mean pharmacy prices of some medicines between the regions and between the pharmacies and NHIF reference prices. NHIF reference prices were higher than the pharmacy prices for 16 of the 28 medicines. There was a significant increase in the prices of 5 out of the 8 medicines that were also nationally surveyed by the WHO/HAI in 2012. Conclusion The study found that medicine prices in private pharmacies vary a lot between the study regions, which raises equity concerns. Also, there was a significant difference between the pharmacy and the NHIF reimbursement prices, which may expose patients to fraudulent co-payments or hinder timely access to prescribed medicines. Therefore, effective price control policies and regulations for medicines are warranted in Tanzania.

scholarly journals Socio-Cultural Sustainability of Private Healthcare Providers in an Indian Slum Setting: A Bottom-of-the-Pyramid Perspective

2018 ◽  
Vol 10 (12) ◽  
pp. 4702 ◽  
Author(s):  
Federica Angeli ◽  
Shila Teresa Ishwardat ◽  
Anand Kumar Jaiswal ◽  
Antonio Capaldo
Keyword(s):  
Decision Making ◽  
Business Models ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Public Hospitals ◽  
Decision Making Process ◽  
Bottom Of The Pyramid ◽  
Social Entrepreneurs ◽  
Private Healthcare ◽  
Significant Difference

Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers’ decision-making process leading to specific healthcare choices in slum settings, and the relative balance of socio-cultural and socio-economic factors underpinning patients’ preferences. This article adopts a mixed-method approach to investigate the determinants of BOP patients’ choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than top-of-the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed.

Coordination between hospitals and insurers in developing economies: an interpretive structural modeling approach

2020 ◽  
Vol 14 (3) ◽  
pp. 471-490
Author(s):  
Manimay Dev ◽  
Dinesh Kumar ◽  
Dharmendra Patel
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Urban Areas ◽  
Developing Economies ◽  
Health Care Systems ◽  
Healthcare Providers ◽  
Structural Modeling ◽  
Insurance Companies ◽  
Interpretive Structural Modeling ◽  
Content Type

Purpose The purpose of this paper is to identify the factors that influence hospitals’ selection by health-care insurers in India and to establish a hierarchical model representing the relationship among different factors and their influence on the entire scenario. Design/methodology/approach A survey with a set of questionnaires was conducted with different health-care insurer executives of reputed health insurance companies. The data has been gathered by using a five-point Likert scale. Their opinions were converted into a reachability matrix and an interpretive structural modeling was constructed. The final results obtained were verified by using fuzzy Matriced Impacts Croises-Multiplication Applique and Classement analysis. Findings The results suggested three key driving factors, National Accreditation Board for Hospitals & Healthcare Providers accreditation of the hospital, purchasing power of people in the region and national and international recognition of the hospital among the eleven factors selected for the study. Research limitations/implications The research mainly focuses on the health insurance benefits provided by privately owned insurance companies and do not comment on any government’s mass health insurance scheme. Practical implications With a small proportion of people under the umbrella of health insurance in India, these factors will assist and expedite insurer’s effort to penetrate deep into rural and urban areas enhancing availability and escalating affordability. Originality/value This paper presents key factors responsible for better coordination between health-care systems and insurance companies.

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