End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes

ObjectivesThe National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives.MethodsWe analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013.ResultsAmong PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90).ConclusionsImplementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

Background: The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households’ decisions to enrol and renew membership in these schemes. Methods: We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. Results: Results revealed that household’s socioeconomic status, husband’s employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. Conclusion: While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.

THE IMPLEMENTATION OF INDONESIAN NATIONAL HEALTH INSURANCE PROGRAMME: HOW SATISFIEDWERETHE INSURED PARTICIPANTS AND THE HEALTHCARE PROVIDERS?

This study examined how satisfied the insured participants and the healthcare providers were with the services provided by the BPJS Health. The study took place in 24 cities/districts in Indonesia. The data was collected through face-to-face interviews with 17,820 insured participants and 1,170 healthcare providers.The survey revealed that the participantswere satisfied with the services they had obtained from the providers. However, the participants at the primary healthcare facilities hada significantly lower satisfaction level than those at the secondary healthcare facilities. Better facilities and medical equipment, better services from medics and paramedics, better drugs availability and quality, along with assurance in obtaining a proper and timeline treatment, all contributed to the higher satisfaction level. Policy makers need to consider making an improvement on the facilities and service qualities at the primary healthcare facilities in order to enhance the participants’ trust. Otherwise, the referral system implementation under the NHI system might not be effectively implemented as participants prefer to get a treatment from secondary healthcare facilities. This study suggests that empathy attributes are the key factor in building satisfaction level. Special attentions need to be given on the “human” aspect of the service providers.

Masking Poverty and Entitlement: RSBY in Selected Districts of West Bengal

In 2008, India launched a flagship national health insurance programme, the Rashtriya Swasthya Bima Yojana (RSBY) for those living below the poverty line (BPL). 1 Using qualitative methods and thematic analysis, this exploratory study of poor women from three selected districts of West Bengal sought to gauge reasons for low registration and factors affecting choice of institutional healthcare among those who had registered for the RSBY. In particular, we sought to understand the underlying factors, if any, which affect judgements on institutional healthcare.

Indonesia's liberal reform reveals growth priorities

Subject Outlook for foreign direct investment into Indonesia's economy. Significance The government last month revised its Negative Investment List, opening 35 new sectors to foreign direct investment (FDI), especially in the services and trade segments. With these reforms, the government hopes to attract 594.8 trillion rupiah (43.52 billion dollars) of new investment this year. Impacts Firms supporting e-commerce operations, for example through developing secure payment systems, have good prospects. Land clearance hurdles facing toll road projects are unlikely to be resolved easily. The national health insurance programme will help Indonesia harness its demographic dividend.