Governing healthcare: the case of Universal Health Insurance – by competition

2017 ◽  
Author(s):  
Cliona Loughnane
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Access To Care ◽  
Equal Access ◽  
Universal Health Insurance ◽  
Social State ◽  
The Social ◽  
Liberal Government ◽  
The Government ◽  
Universal Health

In 2011, the Government committed to the introduction of Universal Health Insurance (UHI) ‘with equal access to care for all’ by 2016 (Government of Ireland 2011: 2). This chapter explores how proposals to implement a system in which every member of the population would be expected to take out health insurance – and mooted by politicians as a way to end Ireland’s two-tier health system – exhibited particular characteristics of advanced liberal modes of governing.Specifically, drawing on Rose and Miller’s (1992) conceptualisation of the ‘aspirations’ of advanced liberal government – governing at a distance, the management of risk, engendering individuals to take responsibility through choice, and the fragmentation of the social state into multiple communities – this chapter demonstrates how while a political rhetoric may have stressed the significance of UHI as a basis for promoting solidarity and fairness, it is hard to avoid the conclusion that the policy would have represented a further shift towards the marketization of Irish healthcare.

Personal Cost

2019 ◽  
pp. 81-165
Author(s):  
Alex Rajczi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Universal Health Insurance ◽  
Health Insurance System ◽  
Insurance System ◽  
Personal Cost ◽  
The Social ◽  
Theories Of Justice ◽  
Personal Costs ◽  
Universal Health

Some people object to social minimum programs, including certain health care programs, because they believe the programs impose excessive taxes and other personal costs on those who fund them. This chapter argues that the most plausible philosophical reconstruction of this objection would rely on a personal cost principle which says that, in general, the proper level of the social minimum is at least partly a function of whether the benefits provided by the social minimum programs outweigh the costs, when judged on a scale that assigns disproportionate weight to those who bear the costs. It is argued that the personal cost principle can find a place within several plausible theories of justice, and that, in addition, the benefits of a well-designed universal health insurance system outweigh its costs.

scholarly journals Health needs: a temporary analysis of the social representations of the concept

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Winckler ◽  
F Zioni ◽  
G Johson
Keyword(s):  
Political Participation ◽  
Health System ◽  
Social Representations ◽  
Public Policies ◽  
Civil Society Organizations ◽  
Health Needs ◽  
The Social ◽  
The Right ◽  
Brazilian Health System ◽  
Universal Health

Abstract Background This study aims to analyse the social representations of health needs in a Brazilian municipality, questioning the capacity that public policies developed and implemented by the Brazilian Health System (SUS) had to meet these needs. Methods Qualitative case study in which the data were analysed by: 1) the Health Needs Taxonomy (Matsumoto, 1999), as an instrument for assessing health needs, formatting the interview guide and organizing the empirical data; 2) the Theory of Social Representations (Jovchelovitch, 2000), to capture health needs; 3) Content Analysis (Bardin, 2004), as an instrument of analysis and comparison of perceived needs. The methodological path used was the same in the two moments in which this research is based (2009 and 2016). The entire municipal territory was analyzed and 26 representatives of civil society organizations were interviewed. Results Based on the results given, we state that health is a permanent and timeless need, but the mediations for its satisfaction have changed historically. The interface between quantitative indicators and subjectivity in assessing needs reveals the authoritarian architecture of its decision-making process, which has ruined the necessary democracy for prioritising and meeting those needs. The asymmetrical relationships present in the Brazilian society have both undermined the collective character of health needs and promoted the distance between who care and who are cared for. Most of the priorities listed by the interviewees in 2009 remain composing the social context of the municipality in 2016. Conclusions The challenges for comprehensive health care remain critical given both the decrease in popular political participation and in institutional spaces, which leads to the annulment of the right to a universal health. Interdisciplinary and participatory diagnostics remain essential to understand the complexity of social changes and the challenges for the consolidation of meeting health needs. Key messages The capacity that public policies developed and implemented by the Brazilian Health System (SUS) had to meet these needs. The challenges for meeting health needs remain critical given both the decrease in political participation and in institutional spaces, which leads to the annulment of the right to a universal health.

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.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

scholarly journals Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042084
Author(s):  
I-Anne Huang ◽  
Yiing-Jenq Chou ◽  
I-Jun Chou ◽  
Yu-Tung Huang ◽  
Jhen-Ling Huang ◽  
...  
Keyword(s):  
Health Insurance ◽  
Paediatric Population ◽  
Population Based ◽  
Universal Health Insurance ◽  
Cross Sectional ◽  
Single Payer ◽  
Insurance Programme ◽  
Ed Visits ◽  
Cross Sectional Design ◽  
Universal Health

ObjectivesEmergency services utilisation is a critical policy concern. The paediatric population is the main user of emergency department (ED) services, and the main contributor to low acuity (LA) ED visits. We aimed to describe the trends of ED and LA ED visits under a comprehensive, universal health insurance programme in Taiwan, and to explore factors associating with potentially unnecessary ED utilisation.Design and settingWe used a population-based, repeated cross-sectional design to analyse the full year of 2000, 2005, 2010 and 2015 National Health Insurance claims data individually for individuals aged 18 years and under.ParticipantsWe identified 5 538 197, 4 818 213, 4 401 677 and 3 841 174 children in 2000, 2005, 2010 and 2015, respectively.Primary and secondary outcome measuresWe adopted a diagnosis grouping system and severity classification system to define LA paediatric ED (PED) visits. Generalised estimating equation was applied to identify factors associated with LA PED visits.ResultsThe annual LA PED visits per 100 paediatric population decreased from 10.32 in 2000 to 9.04 in 2015 (12.40%). Infectious ears, nose and throat, dental and mouth diseases persistently ranked as the top reasons for LA visits (55.31% in 2000 vs 33.94% in 2015). Physical trauma-related LA PED visits increased most rapidly between 2000 and 2015 (0.91–2.56 visits per 100 population). The dose–response patterns were observed between the likelihood of incurring LA PED visit and either child’s age (OR 1.06–1.35 as age groups increase, p<0.0001) or family socioeconomic status (OR 1.02–1.21 as family income levels decrease, p<0.05).ConclusionDespite a comprehensive coverage of emergency care and low cost-sharing obligations under a single-payer universal health insurance programme in Taiwan, no significant increase in PED utilisation for LA conditions was observed between 2000 and 2015. Taiwan’s experience may serve as an important reference for countries considering healthcare system reforms.

Sign in / Sign up

Export Citation Format

Share Document