scholarly journals Equity in Health Benefit Utilization and Financial Risk Protection in Outpatient and Inpatient Care: Baseline Survey of Two Socioeconomic Groups of a Pilot Primary Care Benefits Scheme in the Catchment Areas of a University-Based Health Facility

2020 ◽  
Vol 53 (1) ◽  
Author(s):  
Jose Rafael A. Marfori ◽  
Antonio Miguel L. Dans ◽  
Mica Olivine C. Bastillo ◽  
Ramon Pedro P. Paterno ◽  
Mia P. Rey ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Facility ◽  
Financial Risk ◽  
Health Benefit ◽  
Income Group ◽  
The Philippines ◽  
Financial Risk Protection ◽  
Risk Protection

Background. Health inequities in the Philippines are driven by health workforce maldistribution and health system fragmentation. These can be addressed by strengthening primary care through central social health insurance (PhilHealth) coverage. However, high reported PhilHealth population coverage and health provider accreditation have not necessarily increased health benefit utilization or financial risk protection. Objective. This study aims to examine the impact of an enhanced, comprehensive primary care benefits package at a university-based health facility. This paper reports baseline utilization of health services and health benefits, and out-of-pocket health spending in two socioeconomic strata of the catchment population, for outpatient and inpatient services. Methods. A questionnaire-guided survey was done among randomly selected faculty (higher income group) and non-faculty (lower income group) employees to determine the frequencies and costs of using outpatient and inpatient health services, and amounts paid out-of-pocket. Results. Annually, both groups had approximately 1 consultation/patient and about 15 hospitalizations per 100 families annually. For hospitalizations, non-faculty inpatients utilized health insurance more frequently than faculty inpatients (75.7% vs. 66.7%), but paid higher out-of-pocket proportions (73.3% or Php 92,479/hospitalization vs. 57.4% or Php 16,273/hospitalization). For outpatient care, health benefit utilization rates were higher among non-faculty (12.4% vs 2.1% of consultations) although low overall, with similar total (Php 2,319 vs Php 1,741) and out-of-pocket expenses (100%). Conclusion. These findings confirm inequities in accessing outpatient and inpatient health services and utilizing health insurance benefits in the target population.

Healthcare System Challenges in Asia

2019 ◽  
Author(s):  
Winnie Yip
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Financial Risk ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
The Philippines ◽  
Social Health ◽  
Equitable Access ◽  
Financial Risk Protection ◽  
Risk Protection

Important health system challenges in the east and southeast Asian countries/territories of Japan, South Korea, Taiwan, Hong Kong, Malaysia, China, Thailand, Vietnam, Indonesia, the Philippines, Laos, Myanmar, and Cambodia exist. The most commonly adopted health system among these areas is social health insurance. The high-income, aging societies of Japan, South Korea, and Taiwan have adopted single-payer/single-pipe systems with a single uniform benefit package and a single fee schedule for paying providers for services included in the benefit package. All three have achieved universal coverage with relatively equitable access to affordable care. All grapple with overutilization, aging populations, and hospital-centric and curative-focused care that is ill-suited for addressing an increasing chronic disease burden. Rising patient expectations and demand for expensive technologies contribute to rising costs. Korea also faces comparatively poorer financial risk protection. China, Thailand, Vietnam, Indonesia, and the Philippines have also adopted social health insurance, though not single-payer systems. China and Thailand have established noncontributory schemes, whereby the government heavily subsidizes poor and non-poor populations. General tax revenue is used to extend coverage to those outside formal-sector employment. Both countries use multiple, unintegrated schemes to cover their populations. Thailand has improved access to care and financial risk protection. While China has improved insurance coverage, financial risk protection gains have been limited due to low levels of service coverage, fee-for-service payment systems, poor gatekeeping, and the fee schedule that incentivizes overprescription of tests and medicine. Indonesia, Vietnam, and the Philippines use contributory schemes. Government revenue provides insurance coverage for the poor, near-poor, and selected vulnerable populations; the rest of the population must contribute to enroll. Therefore, expanding insurance coverage to the informal sector has been a significant challenge. Instead of social health insurance, Hong Kong and Malaysia have two-tiered health systems where the public sector is financed by general tax revenue and the private sector is financed primarily by out-of-pocket payments and limited private insurance. There is universal access to care; free or subsidized, good-quality public-sector services provide financial risk protection. However, Hong Kong and Malaysia have fragmented delivery systems, weak primary care, budgetary strains, and inequitable access to private care (which may offer shorter wait times and better perceived quality). Laos, Cambodia, and Myanmar’s health systems feature high out-of-pocket spending, low government investment in health, and reliance on external aid. User fees, low insurance coverage, unequal distribution of health services, and fragmented financing pose pressing challenges to achieving equitable access and adequate financial risk protection. These countries/territories are diverse in terms of demographics, epidemiological profiles, and stages of economic development, and thus they face different health system challenges and opportunities. This diversity also suggests that these nations/territories will utilize different types of health systems to achieve universal health coverage, whereby all people have equitable access to affordable, good-quality care with adequate financial risk protection.

Making Thailand’s UHC ‘SAFE’ (sustainable, affordable, fair and efficient)

2020 ◽  
Vol 20 (2) ◽  
pp. 231-236
Author(s):  
Somsak Chunharas
Keyword(s):  
Health Services ◽  
Financial Risk ◽  
National Development ◽  
Financial Risk Protection ◽  
Thai Population ◽  
Health Security ◽  
Strategic Purchasing ◽  
Strategic Approach ◽  
Public Sector Health ◽  
Risk Protection

Thai UHC has been established through national efforts to learn from international as well as national development of how to build a system-wide financial risk protection for the Thai population while also ensuring effective coverage of health services. One of the key strategic approach is establishing a strategic purchasing organization called national health security office (NHSO) since 2002. Many lesson have been learnt and shared here hoping that they are generic enough to guide actions and policy decisions either for countries starting UHC or those who have had some models going on. For example, a professionally run strategic purchasing body with certain degree of autonomy is key but the needs to harmonize multiple schemes are also challenging, technically as well as politically. The effective use of and support for existing public sector health services systems is another key lesson. The challenge of making the systems sustainable, affordable fair and efficient have been with us since the very beginning and we shares some of the approaches to address this issue to ensure that UHC will be properly supported politically, professionally managed while maintaining a well balanced demand side with the view to ensure that UHC is creating better health and not merely more access to services.

Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection

Health Policy ◽  
2011 ◽  
Vol 99 (3) ◽  
pp. 203-209 ◽  
Author(s):  
Priyanka Saksena ◽  
Adélio Fernandes Antunes ◽  
Ke Xu ◽  
Laurent Musango ◽  
Guy Carrin
Keyword(s):  
Health Insurance ◽  
Access To Care ◽  
Financial Risk ◽  
Financial Risk Protection ◽  
Risk Protection

scholarly journals What has been the progress in addressing financial risk in Uganda?  Analysis of catastrophe and impoverishment due to health payments

2020 ◽  
Author(s):  
Brendan Kwesiga ◽  
Tom Aliti ◽  
Pamela Nabukhonzo ◽  
Susan Najjuko ◽  
Peter Byawaka ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Financial Risk ◽  
Poverty Line ◽  
Financial Risk Protection ◽  
Quality Health Care ◽  
Targeted Interventions ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
The Impact

Abstract Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. This study aims to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion: There is a need for targeted interventions to reduce OOP payments, especially among those most affected to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further.

scholarly journals Financial Risk Protection for Neurosurgical Care in Indonesia and the Philippines: A Primer on Health Financing for the Global Neurosurgeon

2021 ◽  
Vol 8 ◽  
Author(s):  
Kevin Paul Ferraris ◽  
Maria Eufemia C. Yap ◽  
Maria Cristina G. Bautista ◽  
Dewa Putu Wisnu Wardhana ◽  
Sri Maliawan ◽  
...  
Keyword(s):  
Public Health ◽  
Financial Incentives ◽  
Financial Risk ◽  
Health Financing ◽  
Economic Incentives ◽  
The Philippines ◽  
Financial Risk Protection ◽  
Implementation Framework ◽  
Provider Perspectives ◽  
Risk Protection

Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity, quality, and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings, we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally, the surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, conditional cash transfers similarly leverages on financial incentives on the part of patients to reward certain health-seeking behaviors that significantly influence clinical outcomes. These health financing strategies are formulated in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.

scholarly journals What has been the progress in addressing financial risk in Uganda?  Analysis of catastrophe and impoverishment due to health payments

2020 ◽  
Author(s):  
Brendan Kwesiga ◽  
Tom Aliti ◽  
Pamela Nabukhonzo Kakande ◽  
Peter Byawaka ◽  
Susan Najjuko ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Financial Risk ◽  
Poverty Line ◽  
Financial Risk Protection ◽  
Quality Health Care ◽  
Targeted Interventions ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
The Impact

Abstract Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. This study aims to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion: There is a need for targeted interventions to reduce OOP payments, especially among those most affected to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, mandatory prepayment through health insurance will be needed to reduce the burden of OOP health spending further.

scholarly journals Financial Risk Protection from Social Health Insurance

2016 ◽  
Author(s):  
Kayleigh Barnes ◽  
Arnab Mukherji ◽  
Patrick Mullen ◽  
Neeraj Sood
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Social Health Insurance ◽  
Social Health ◽  
Financial Risk Protection ◽  
Risk Protection
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