scholarly journals An Analysis of The National Health Insurance Policy Implementation in 2014 (Presidential Regulation No. 12 And 111/2013 on Health Insurance) from The Regulator’s Position

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Muhammad Arief Hasan ◽  
Puput Oktamianti ◽  
Dumilah Ayuningtyas
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Regional Government ◽  
Health Coverage ◽  
Healthcare Facilities ◽  
Road Map ◽  
Universal Health

Abstract. JKN (National Health Insurance) is a government program that aims to provide health assurance for all Indonesian citizens for a healthy, productive, and prosperous life. In the two years after JKN was implemented, various problems occurred. This research used the qualitative approach with the Edward II implementation theory. Results of the research indicated that there were problems in communication, stemming from the lack of socialization and inharmonic regulations, there was also the problem of the lack of healthcare resources. From the disposition side, the policy makers often obstructs the implementation preparation, this is evident from the information on determining the premium size. From the organization structure, all the stakeholders have been well coordinated. We conclude that we are not ready to implement the JKN. We recommend that mass and effective socialization program to be performed using various methods of communication and involve the community. To reduce the disparity of healthcare services, we recommend that the regional government to establish various healthcare facilities to accelerate health development. There should also be regulations that allocates healthcare staff in every corner of the country to achieve Universal Health Coverage in 2019, as stated in the National Health Insurance Road Map. Keywords: policy analysis, national health insurance, universal health coverage

scholarly journals Ghana’s Journey towards Universal Health Coverage: The Role of the National Health Insurance Scheme

2019 ◽  
Vol 10 (1) ◽  
pp. 94-109 ◽  
Author(s):  
Kipo-Sunyehzi ◽  
Amogre Ayanore ◽  
Dzidzonu ◽  
Ayalsuma Yakubu
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
National Health Insurance Scheme ◽  
Health Insurance Scheme ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Universal Health

: Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.

scholarly journals National health insurance system for universal health coverage: prospects and challenges in Saudi Arabia

2019 ◽  
Vol 6 (11) ◽  
pp. 5006
Author(s):  
Mohammad F. Alharbi
Keyword(s):  
Saudi Arabia ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
Insurance System ◽  
Universal Health

Universal health coverage (UHC) is one of the major health policy objectives to achieve a Nation’s sustainable development. This goal is achieved when all citizens in the country enjoy the highest standards of healthcare at no or low cost. Many countries around the world have achieved UHC through a national health insurance framework and have an extensive range of risks funded by government revenue and contributions from both employers and employees. This study examines the feasibility of developing a National Health Insurance System (NHIS) as a way to achieve UHC in Saudi Arabia. It also highlights the potential role of health insurance in health coverage, improving the quality of care, and use of healthcare. Although establishing a NHIS poses many challenges, addressing them makes it feasible to provide and finance healthcare in the country.

scholarly journals Universal Health Coverage (UHC)

2018 ◽  
Vol 32 (4) ◽  
pp. 322-324
Author(s):  
Samlee Plianbangchang
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Health Care Systems ◽  
Good Health ◽  
Health Coverage ◽  
Content Type ◽  
Universal Health

Purpose The WHO Health for All goal of the year 2000 was unreachable due to a number of irreconcilable factors. However, governments agree that a resolution must be found to effectively cope with increasing health care costs. Furthermore, national health insurance schemes must be properly refined to suit local situations. Workable health policies and strategies for caring and treating sick people through reduced or cost effective methods must be developed as part of a Universal Health Coverage scheme. A review of progress made toward achieving the WHO goal of health for all. The purpose of this paper is to explore the government’s role and responsibilities to educate and support society to achieve optimum health. Design/methodology/approach This is a commentary piece. Findings Participation and involvement of all people of all walks of life in the development and management of their nation’s health care programs is an important requisite of good health for all. This should include financial participation and co-payment into the national health insurance scheme. Furthermore, national health care systems should involve or include the traditional/local and alternative systems of medicine in the most appropriate manner. Health care has to encompass the total range of comprehensive health interventions, inclusive of at least preventive, curative and rehabilitative care. Originality/value This paper provides a review of the current health system constraints and assesses the effectiveness of available options by way of ensuring that a country-specific UHC system may be successfully implemented.

scholarly journals National Health Insurance Fund’s relationship to retail drug outlets: a Tanzania case study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Martha Embrey ◽  
Romuald Mbwasi ◽  
Elizabeth Shekalaghe ◽  
Jafary Liana ◽  
Suleiman Kimatta ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Retail Outlet ◽  
Middle Income ◽  
Middle Income Countries ◽  
Universal Health

Abstract Background Achieving universal health coverage will require robust private sector engagement; however, as many low- and middle-income countries launch prepayment schemes to achieve universal health coverage, few are covering products from retail drug outlets (pharmacies and drug shops). This case study aims to characterize barriers and facilitators related to incorporating retail drug outlets into national prepayment schemes based on the experience of the Tanzanian National Health Insurance Fund’s (NHIF) certification of pharmacies and accredited drug dispensing outlets. Methods We reviewed government documents and interviewed 26 key informants including retail outlet owners and dispensers and central and district government authorities representing eight districts overall. Topics included awareness of NHIF in the community, access to medicines, claims processing, reimbursement prices, and how the NHIF/retail outlet linkage could be improved. Results Important enablers for NHIF/retail outlet engagement include widespread awareness of NHIF in the community, NHIF’s straightforward certification process, and their reimbursement speed. All of the retail respondents felt that NHIF helps their business and their clients to some degree. As for barriers, retailers thought that NHIF needed to provide more information to them and to its members, particularly regarding coverage changes. Some retailers and government officials thought that the product reimbursement prices were below market and not adjusted often enough, and pharmacy respondents were unhappy about claim rejections for what they felt were insignificant issues. All interviewees agreed that one of the biggest problems is poor prescribing practices in public health facilities. They reiterated that prescribers need more supervision to improve their practices, particularly to ensure adherence to standard treatment guidelines, which NHIF requires for approving a claim. In addition, if a prescription has any problem, including a wrong date or no signature, the client must return to the health facility to get it corrected or pay out-of-pocket, which is burdensome. Conclusions Little published information is available on the relationship between health insurance plans and retail providers in low- and middle-income countries. This case study provides insights that countries can use when designing ways to include retail outlets in their health insurance schemes.

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