scholarly journals Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population

2021 ◽  
Author(s):  
Akram Hernández-Vásquez ◽  
Carlos Rojas-Roque ◽  
Antonio Barrenechea-Pulache ◽  
Guido Bendezu-Quispe
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Household Survey ◽  
Interrupted Time Series ◽  
Health Insurance Coverage ◽  
Interrupted Time Series Analysis ◽  
Cross Sectional ◽  
Treatment Groups ◽  
Quasi Experimental ◽  
National Household Survey

Background: Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the COVID-19 pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. Methods: This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were i) the proportion of individuals who incurred OOP expenditures and ii) the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic. Results: ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (p=0.916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (p=0.073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups. Conclusion: The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures.

PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

2015 ◽  
pp. 89-95
Author(s):  
Thi Hoai Thuong Nguyen ◽  
Hoang Lan Nguyen ◽  
Mau Duyen Nguyen
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Factors Affecting ◽  
The People ◽  
Universal Health Insurance Coverage ◽  
The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

scholarly journals Absence of routine medical consultation among hypertensive and/or diabetic elders: an epidemiological study based on the Brazilian National Household Survey 2008

2015 ◽  
Vol 18 (3) ◽  
pp. 578-594 ◽  
Author(s):  
Daniela Nice Ferreira ◽  
Divane Leite Matos ◽  
Antônio Ignácio de Loyola Filho
Keyword(s):  
Insurance Coverage ◽  
Household Survey ◽  
Behavioral Model ◽  
Health Insurance Coverage ◽  
Population Based ◽  
Geographic Region ◽  
Medical Consultation ◽  
International Studies ◽  
Significance Level ◽  
National Household Survey

OBJECTIVE: This exploratory study aimed to investigate the predisposing, enabling and health need characteristics associated with lack of medical visits in the last 12 months, among 23,620 elderly hypertensive and/or diabetic individuals. METHODS: In this research, we used the theoretical behavioral model of Andersen and Newman for use of health services. The data analyzed were produced by the health supplement of the Brazilian National Household Survey (PNAD) 2008, nationwide. To identify the associations, we used the Poisson regression model, which estimates the prevalence ratios and confidence intervals of 95%, considering the significance level of 5%. RESULTS: The results showed that 10.6% of the study population did not consult the doctor in the period considered, and the prevalence was higher among hypertensive subjects (10.5%) than among diabetic ones (7.1%). The lack of medical consultation was negatively associated with female sex and increasing age (predisposing characteristics), with health insurance coverage (enabling characteristic), worse self-rated health, chronic health conditions selected and the presence of hypertension associated with diabetes (health needs), while the fact of living in the Northeast, North and Midwest appeared positively associated with the event under investigation. CONCLUSION: These results corroborate those observed in national and international studies and show evidence of inequality and inequity in the use of medical consultation for this population, based on the findings related to health plan coverage and geographic region.

scholarly journals Public health insurance and birth outcomes: evidence from Punjab, Pakistan

2020 ◽  
Author(s):  
Najam uz Zehra Gardezi
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Low Income ◽  
Fixed Effects ◽  
Insurance Coverage ◽  
Birth Certificate ◽  
Household Survey ◽  
Public Health Insurance ◽  
Health Seeking ◽  
Cross Sectional

Abstract Public health insurance targeted towards low-income households has gained traction in many developing countries. However, there is limited evidence as to the effectiveness of these programs in countries where institutional constraints may limit participation by the eligible population. This paper evaluates a recent health insurance initiative introduced in Pakistan and discusses whether eligibility for the programme improves maternal health seeking behaviour. The Prime Minister National Health Program provides free insurance coverage to low-income families. The programme is in the early phases of implementation and has, since 2016, only been rolled out in a few eligible districts within the country. This allows for a comparison of eligible households in districts where the programme has been introduced to those that are eligible to receive insurance at a future date. Using repeated cross-sectional data from multiple rounds of representative household survey, a difference-in-difference model has been estimated. Results show that at least for a specific beneficiary group (i.e. pregnant women), there has been a positive increase in utilization of hospital services. Furthermore, we provide evidence using mother fixed effects that the programme increased the likelihood of a child’s birth being documented. Since possession of a birth certificate can secure civic rights for a child, this is an unintended but positive outcome of the programme.

scholarly journals Prevalence and factors associated with health insurance coverage in resource-poor urban settings in Nairobi, Kenya: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031543 ◽  
Author(s):  
Peter O Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri F Mohamed ◽  
Hermann Pythagore Pierre Donfouet ◽  
Martin K Mutua
Keyword(s):  
Health Insurance ◽  
Primary Outcome ◽  
Insurance Coverage ◽  
Scale Up ◽  
Household Head ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Insurance Cover

ObjectiveTo determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.DesignThe data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars’ study conducted between June and July 2018.SettingThe Lown scholars’ survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.ParticipantsA total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.Primary outcome measureThe primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.ResultsThe prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).ConclusionsHealth insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya’s ‘Big Four Agenda’ for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.

scholarly journals Private health insurance coverage-related lawsuits

2020 ◽  
Vol 73 (3) ◽  
Author(s):  
Ana Beatriz Perez Afonso ◽  
Mayra Gonçalves Menegueti ◽  
Thamiris Ricci de Araújo ◽  
Lucieli Dias Pedreschi Chaves ◽  
Ana Maria Laus
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Medical Procedures ◽  
Cross Sectional ◽  
Positron Emission ◽  
Percutaneous Rhizotomy ◽  
Using Data ◽  
National Regulatory Agency

ABSTRACT Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators. Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. Conclusions: the lawsuits were filed because of the operators’ refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

Understanding Subnational Variation in Chinese Social Health Insurance

2020 ◽  
pp. 134-159
Author(s):  
Xian Huang
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Insurance Coverage ◽  
Social Health ◽  
Cross Sectional ◽  
Insurance Benefits ◽  
Social Risks ◽  
Political Economies ◽  
Regional Comparisons

Chapter 6 investigates the coverage and generosity of Chinese social health insurance in the first decade of the 2000s, with a focus on the regional (i.e., cross-provincial) variation using a cross-sectional time-series research design. First, a cluster analysis provides supportive evidence for the existence of four models of social health insurance expansion in China. The clustering of Chinese provinces in social health insurance expansion also corresponds to the differences among local political economies. Second, the chapter makes detailed inter-regional comparisons and intra-regional studies to reconstruct the mechanism linking a local political economy to the local distributive patterns of health insurance benefits—that is, local socioeconomic conditions shape local leaders’ policy preferences and choices for allocating social health insurance benefits in their jurisdictions. Finally, a regression analysis demonstrates significant correlations between local social risks and social health insurance coverage, and between local fiscal resources and social health insurance generosity.

Why Do Hispanics Have So Little Employer-Sponsored Health Insurance?

2007 ◽  
Vol 44 (3) ◽  
pp. 257-279 ◽  
Author(s):  
James D. Reschovsky ◽  
Jack Hadley ◽  
Len Nichols
Keyword(s):  
Human Capital ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Household Survey ◽  
Health Insurance Coverage ◽  
Spanish Speakers ◽  
National Data ◽  
Spanish Speaking ◽  
English Speaking ◽  
Employer Health Insurance

This paper investigates low rates of employer health insurance coverage among Hispanics using national data from the Community Tracking Study Household Survey. Interview language served as a proxy for the degree of assimilation. Findings indicate that English-speaking Hispanics are more similar to whites in their labor market experiences and coverage than they are to Spanish-speaking Hispanics. Spanish-speakers' very low human capital (including their inability to speak English) results in much less access to job-based insurance. Though less important, Spanish-speaking Hispanics' demand for employer-sponsored insurance appears lower than that of English-speaking Hispanics or whites. Results suggest that language and job training may be the most effective way to bolster Hispanics' insurance coverage.

The Incidence of Health Shocks, Formal Health Insurance, and Informal Coping Mechanisms

2016 ◽  
Vol 15 (6) ◽  
pp. 665-695
Author(s):  
Samuel Amponsah
Keyword(s):  
Developing Countries ◽  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Household Survey ◽  
Health Insurance Coverage ◽  
Coping Mechanisms ◽  
Health Shocks ◽  
Economics Of Health ◽  
The Impact

In recent years, both theoretical and empirical research has accumulated in development economics literature regarding household behavior in response to shocks in developing countries. The literature especially has explored deeply the impact of weather-related shocks—such as droughts and floods—and the efficiency of informal mechanisms to cope with these shocks. In sharp contrast, our knowledge on the economics of health shocks in low-income developing countries is rather limited. A few studies have documented that low incomes and poor health insurance coverage account for catastrophic medical expenditures in the event of a health shock. This study uses a combination of Ghanaian household survey datasets to examine the different coping mechanisms employed by uninsured households to protect themselves from the incidence of health shocks. In addition, it explores the impact of formal health insurance (the National Health Insurance Scheme) on households’ out-of-pocket spending and catastrophic health expenditures.

Lack of Community Insurance and Mammography Screening Rates Among Insured and Uninsured Women

2008 ◽  
Vol 26 (11) ◽  
pp. 1865-1870 ◽  
Author(s):  
José A. Pagán ◽  
David A. Asch ◽  
Cynthia J. Brown ◽  
Carmen E. Guerra ◽  
Katrina Armstrong
Keyword(s):  
Health Insurance ◽  
Mammography Screening ◽  
Negative Impact ◽  
Insurance Coverage ◽  
Local Population ◽  
Household Survey ◽  
Health Insurance Coverage ◽  
Health Insurance Status ◽  
The Past ◽  
Individual Health

Purpose To evaluate whether the proportion of the local population without health insurance coverage is related to whether women undergo mammography screening. Methods Survey data on 12,595 women 40 to 69 years of age from the 2000 to 2001 Community Tracking Study Household Survey were used to analyze the relation between community lack of insurance and whether the respondent had a mammogram within the past year. Results Women age 40 to 69 were less likely to report that they had a mammogram within the last year if they resided in communities with a relatively high uninsurance rate, even after adjusting for other factors. After adjusting for individual insurance and other factors, a 10-percentage-point decrease in the proportion of the local insured population is associated with a 17% (95% CI, 13% to 21%) decrease in the odds that a woman age 40 to 69 years will undergo mammography screening within a year. Conclusion Women living in communities with high uninsurance are substantially less likely to undergo mammography screening. These results are consistent with the view that the negative impact of uninsurance extends to everyone in the community regardless of individual health insurance status.

scholarly journals Prevalence of Self-Reported Chronic Diseases and Health Services Utilization by Ethnic Minorities in Manaus Metropolitan Region

2018 ◽  
Vol 28 (1) ◽  
pp. 49 ◽  
Author(s):  
Raquel Rodrigues Ferreira Rocha de Alencar ◽  
Tais Freire Galvao ◽  
Bruno Vianei Real Antonio ◽  
Marcus Tolentino Silva
Keyword(s):  
Health Insurance ◽  
Chronic Diseases ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Population Based ◽  
Metropolitan Region ◽  
Care Utilization ◽  
Cross Sectional ◽  
Probabilistic Sampling ◽  
Significant Difference

<p class="Pa8"><strong>Objectives: </strong>To assess the prevalence of, and associated factors to, self-reported chronic diseases and health care utilization by eth­nicity in the Manaus Metropolitan Region.</p><p class="Pa8"><strong>Methods: </strong>We conducted a cross-sectional, population-based survey from May through August 2015. Using probabilistic sampling in three stages, we recruited adults aged ≥18 years. Ethnicity was self-identified as White, Black, Yellow, Brown (Brazilian mixed-race), and Indigenous. We calculated adjusted prevalence ratios (PR) and 95% CI of chronic diseases and health service utiliza­tion for each ethnic minority and compared the data using Poisson regression with data from White respondents.</p><p class="Pa8"><strong>Results: </strong>In this study, we interviewed 4,001 people. Of these, 15.9% were White, 7.5% Black, 3.4% Yellow, 72.1% Brown, and 1.0% Indigenous. Indigenous respondents had the highest prevalence of self-reported hypertension (29.4%), diabetes (12.3%) and hypercholesterolemia (17.0%) among the ethnic respondent groups. Compared with the White population, Browns had less health insurance coverage (PR=.76; 95% CI: .62-.93) and reported hypertension (PR=.84; 95% CI: .72-0.98) and diabetes (PR=.69; 95% CI: .51-.94) less frequently. Yellows visited the doctor more frequently than Whites (PR=1.13; 95% CI: 1.04-1.22), with no significant difference in prevalence of diseases.</p><p class="Default"><strong>Conclusions: </strong>Indigenous respondents had higher prevalence rates of the investigated diseases. Compared with Whites, Brown respondents had lower rates of self-reported arterial hypertension and diabetes, as well as lower rates of private health insurance coverage.</p><p class="Default"><em>Ethn Dis. </em>2018;28(1):49-54; doi:10.18865/ed.28.1.49</p>

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