Work Accident and Sickness Benefits

This entry traces past and present trends in the institutional development of income transfers in the case of work accident and sickness. The focus is mainly on OECD or European countries, but in some instances, references are made to a wider array of countries or continents. The entry begins with a review of the history of work accident insurance; in most countries, this was the first social insurance programme to be created. The history of this early programme highlights a number of factors behind the development of later programmes. The latter part of the entry focuses on sickness insurance. Again, we begin with historical developments, focusing in particular on the universalism and generosity of benefits. We then move on to discuss the extent to which sickness benefits have, in recent years, been targets for retrenchment. The final section tentatively discusses future trajectories of these two income maintenance programmes.

Lowering drug prices and enhancing pharmaceutical affordability: an analysis of the national volume-based procurement (NVBP) effect in China

To cope with the increasing healthcare costs brought about by the universal health insurance programme, national volume-based procurement (NVBP) was implemented in China to reduce drug prices. However, the impact of NVBP remains unknown. We reported the effects of the NVBP pilot programme on medication affordability and discussed the challenges and recommendations for further reforms. A total of 25 molecules won the bidding in the NVBP pilot programme, and price cuts ranged from 25% to 96%. Medication affordability was measured as the number of days’ wages needed to pay for a course of treatment, and the medication was identified as affordable if the cost of a treatment course was less than the average daily wage. After the NVBP, the proportion of affordable drugs increased from 33% to 67%, and the mean affordability improved from 8.2 days’ wages to 2.8 days’ wages. Specifically, for rural residents, the proportion of affordable drugs increased from 13% to 58%, and the mean affordability improved from 15.7 days’ wages to 5.3 days’ wages. For urban residents, the proportion of affordable drugs increased from 54% to 71%, and the mean affordability improved from 5.9 days’ wages to 2.0 days’ wages. Implementing the NVBP substantially improved medication affordability. In future reforms, a multifaceted approach addressing all issues in the health system is needed to enhance medicine access.

OVERVIEW OF SOCIAL INSURANCE IN MALAYSIA: INVALIDITY PENSION SCHEME (IPS)

Social insurance is a public insurance programme that provides protection against various economic risks such as loss of income due to sickness, old age, invalidity, death, or unemployment, where participation is made to be compulsory. Social insurance is regarded as a type of social security, and the two terms are sometimes used interchangeably. Social insurance programmes differ from private insurance in several ways. Firstly, the contributions are normally compulsory and may be made by the insured’s employer, by the state, as well as by the insured himself. Benefits are also not as strictly tied to contributions as is the case with private insurance. For example, to make the programmes serve certain social purposes, some contributors are included among the beneficiaries even though they may not have contributed for the required period of time. Next, benefits may be increased in response to the rising cost of living, which reduces the amount between contributions and benefits. The main objective of this study is to understand the contribution and benefits of social insurance coverage under the Social Security Organisation (SOCSO)’s Invalidity Pension Scheme (IPS).

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

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.

Association of information, education, and communication with enrolment in health insurance: a case of Nepal

Background Many studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal. Methods We employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable. Results Data showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41–60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17–44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09–8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61–8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34–2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI. Conclusion Knowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.

Public Service Announcements for Health Insurance in Nepal: Perspectives from Health Belief Model

Public Service Announcement (PSA) is an advertisement to inform the people sponsored by the public company or the governmental agencies. There were several PSAs implemented to inform the people about health insurance (HI). Data from the Health Insurance Board showed low enrolment with high dropout in health insurance programme (HIP). It was found that the PSAs could not attract the people. Therefore, we assessed the PSAs used for the HIP and amomg them, three Radio/FM jingles, eight TV spots, hoarding board, newspapers, and brochure were evaluated using the Health Belief Model (HBM). We found the almost all PSAs have not covered the constructs of HBM. Most of the PSAs have included primarily perceived benefits and perceived susceptibility but missed to include perceived severity, perceived threats, and self-efficacy. Only benefits focused message could not attract the people. Therefore, we recommend that all PSAs need to have all the features of HBM in the PSA messages while notifying and informing the people.

Occurrence of Medical Cases and Utilisation among Enrollees of Private Health Insurance Programme in Kaduna, Nigeria

Aims: This study examines the occurrence of various medical cases presented by enrollees that have subscribed to access healthcare from a network of healthcare providers (HCPs) managed by a Health Maintenance Organisation (HMO) under its Private Health Insurance Programme (PHIP). Study Design: A descriptive cross-sectional design was employed. Methodology: Secondary data from collected or submitted medical encounters in form of bills of registered enrollees (principals and their dependants) who have visited and received treatment from their chosen healthcare providers in Kaduna State between the month of January and December 2019 were purposively compiled and analysed. Cases were classified using the National Health Insurance Scheme (NHIS) Operational Guideline. Frequency tables, charts, percentages and Chi-Square analysis were used with the aid of Statistical Package for Social Sciences (SPSS) 22 at P=.05 level of significance. Results: A total of 11,156 medical cases were recorded after attrition, 9,525 (85.38%) primary cases and 1,632 (14.62%) secondary cases. Malaria (41.23%) and Respiratory Tract Infection (11.98%) led the primary case table while Hypertension (3.83%) Urology related cases (2.49%) and Diabetes (0.79%) were among the leading secondary cases. Female enrollees had slightly more cases and therefore higher tendencies to seek medical treatment than their male counterpart even though there was no significant relation between gender and type of case. Conclusion: The study concludes that the awareness and utilization of healthcare services are gradually growing among enrollees under the Private Health Insurance Programme (PHIP). In ensuring that there is an improvement in the health sector of Nigeria and achieving universal health coverage, focus should be on the primary healthcare services with high consideration for research, proper data management and periodic sharing of trends, observations and outcome of researches with the growing health community.

Adoption of crop insurance in Ghana: an application of the complementary log-log truncated Poisson double-hurdle model

PurposeThe aim of this paper is to identify the factors that influence rice farmers' decisions to adopt crop insurance and premium payments (willingness to pay [WTP] amounts). The paper also demonstrates the usefulness of the complementary log-log (cloglog) truncated Poisson double-hurdle model as an alternative hurdle model.Design/methodology/approachThe study first investigated the nature of the dependent variable, which had non-normal residuals and was overdispersed. The probit truncated normal regression double-hurdle model was tried but it failed the normality and homoscedasticity tests; hence, the cloglog truncated Poisson double-hurdle model was employed in the study.FindingsAn estimated 61% of respondents would purchase crop insurance, despite farmers not having prior experience with this product. Amongst others, the factors that influence insurance adoption amongst rice farmers are the share of rice in total income, reliability perception of crop insurance schemes and the probability of failure to achieve target yields. The latter helps the authors to address adverse selection, a central issue to the viability of such an insurance programme. The determinants of farmers' WTP are also identified.Research limitations/implicationsSampling was limited to farmers using irrigation and living in one region of Ghana, which may limit the study’s wider applicability.Originality/valueAs far as the authors are aware, this study is the first to select the appropriate hurdle model based on established properties of the dependent variable on this topic – crop insurance decisions.

Impact of the ‘Seguro Médico Siglo XXI’ medical insurance programme on neonatal and infant mortality in Mexico, 2006–14: an ecological approach to estimation

The ‘Seguro Médico Siglo XXI’ (SMSXXI), a universal coverage medical insurance programme for children under 5 years of age, started in 2006 to help avoid catastrophic health expenditures in poor families without social security in Mexico. The study used information from the National Health Information System for the 2006–14 period. An ecological approach was followed with a panel of the 2457 municipalities of Mexico as the units of analysis. The outcome variables were the municipality-level neonatal mortality and infant mortality rates in population without access to social security. The programme variable was the coverage of the SMSXXI programme at the municipality level, expressed as a proportion. Demographic and economic variables defined at the municipality level were included as covariates. Impact was estimated by fitting a fixed-effects negative binomial regression model. Results reveal that the SMSXXI significantly reduced both infant and neonatSal mortality in the target population, although in a non-linear fashion, with minimum mortality levels found around the 70% coverage range. The effect is mostly given by the transition from the first quintile to the fourth quintile of coverage (&lt;13% vs 70.5–93.7% coverage), and it is attenuated significantly at coverage levels very close to or at 100%. The observed risk reduction amounted to an estimated total of 11 358 infant deaths being avoided due to the SMSXXI during the 2006–14 period, of which 48% were neonatal. In conclusion, we found a significant impact of the SMSXXI programme on both infant mortality and neonatal mortality. An attenuation of the effect of the insurance on mortality rates at levels close to 100% coverage may reflect the saturation of health units in detriment of the quality of care.