Prevalence and Infant Mortality of Major Congenital Malformations Stratified by Birthweight

<b><i>Background:</i></b> Low birthweight and major congenital malformations (MCMs) are key causes of infant mortality. <b><i>Objectives:</i></b> The aim of this study was to explore the prevalence of MCMs in infants with low and very low birthweight and analyze the impact of MCMs and birthweight on infant mortality. <b><i>Methods:</i></b> We determined prevalence and infant mortality of 28 life-threatening MCMs in very-low-birthweight (&#x3c;1,500 g, VLBW), low-birthweight (1,500–2,499 g, LBW), or normal-birthweight (≥2,500 g, NBW) infants in a cohort of 2,727,002 infants born in Germany in 2006–2017, using de-identified administrative data of the largest statutory public health insurance system in Germany. <b><i>Results:</i></b> The rates of VLBW, LBW, and NBW infants studied were 1.3% (34,401), 4.0% (109,558), and 94.7% (2,583,043). MCMs affected 0.5% (13,563) infants, of whom &#x3e;75% (10,316) had severe congenital heart disease. The prevalence (per 10,000) of any/cardiac MCM was increased in VLBW (286/176) and LBW (244/143), as compared to NBW infants (38/32). Infant mortality rates were significantly higher in infants with an MCM, as opposed to infants without an MCM, in each birthweight group (VLBW 28.5% vs. 11.5%, LBW 16.7% vs. 0.9%, and NBW 8.6% vs. 0.1%). For most MCMs, observed survival rates in VLBW and LBW infants were lower than expected, as calculated from survival rates of VLBW or LBW infants without an MCM, and NBW infants with an MCM. <b><i>Conclusions:</i></b> Infants with an MCM are more often born with LBW or VLBW, as opposed to infants without an MCM. Many MCMs carry significant excess mortality when occurring in VLBW or LBW infants.

NRCMS and Rural Household Credit Availability in China: Evidence From CFPS

Background: The Chinese government has, in seeking to enable farmers to obtain and use safe and affordable formal financial services, implemented Inclusive Finance. But disease burden, poor health and other factors have made it difficult for farmers to obtain formal credit servicesMethods: This paper draws on 2010 China family survey (CFPS) data to explore how the New Rural Cooperative Medical Scheme (NRCMS) affected rural households’ credit availability. Results:The results show that, as a public health insurance system sustained by the participation of government investment participation, the NRCMS provides good ‘collateral’ and significantly enhances farmers’ credit availability level. Conclusions: Our study suggests the positive impacts is mainly reflected in the economic effect of the NRCMS. This raises the question of how to make better use of the NRCMS’ mortgage function, promote inclusive finance and provide more financial services for farmers that will promote their income. This serves to confirm and underline the importance of relevant policies.JEL Classifications: I18; G50; O16

Condiții privind recunoașterea statutului civil al persoanelor transsexuale și transgender în sistemul român de drept

Under the Romanian legal system there are no specific regulations concerning transsexualism, nor are clear medical, administrative or judicial procedures configured. However, without any doubt, the medical transition to the gender with which a trans person identifies him/herself is allowed, as well as the legal recognition of the new sexual identity. If a trans person obtained a favourable judicial decision, based on which the necessary changes have been made in the civil status acts, being issued a new identity card, then, in principle that person can prevail him/herself of the legal consequences of his/her new identity, in all areas of social life. Regarding the coverage by the public health insurance system of treatments and operations for gender reattribution, there is no convergent point of view of competent institutions.

Determinan Pemanfaatan Kartu Jaminan Kesehatan Nasional (JKN) di Wilayah Kerja Puskesmas Manutapen Kecamatan Alak Kota Kupang

To achieve Universal Health Coverage (UHC) for the entire population, the Indonesian government took the initiative to establish a public health insurance system through JKN for individual health. The JKN program managed by BPJS, intended to provide health protection for participants to obtain health care benefits and protection to meet the basic health needs. However, the use of JKN cards in community health centers (Puskesmas) remains low. This study was to investigate the determinants of JKN card utilization in Puskesmas Manutapen in 2019. The research is was quantitative study using a cross-sectional design. The sample consisted of 85 people obtained by a purposive sampling technique. Data analysis employed using univariate and bivariate methods with the chi-square test. The results showed that factors related to JKN card utilization were knowledge (ρ =0.023), income (ρ = 0.037), the availability of facilities and infrastructure (ρ = 0.043), and disease complaints (ρ = 0.041), while unrelated factor was family support (ρ= 0.662). The community should maximize the use of JKN card to obtain comprehensive health services, not only for treatment, but also for prevention to improve their health status. To achieve Universal Health Coverage (UHC) for the entire population, the Indonesian government took the initiative to establish a public health insurance system through JKN for individual health. The JKN program managed by BPJS, intended to provide health protection for participants to obtain health care benefits and protection to meet the basic health needs. However, the use of JKN cards in community health centers (Puskesmas) remains low. This study was to investigate the determinants of JKN card utilization in Puskesmas Manutapen in 2019. The research is was quantitative study using a cross-sectional design. The sample consisted of 85 people obtained by a purposive sampling technique. Data analysis employed using univariate and bivariate methods with the chi-square test. The results showed that factors related to JKN card utilization were knowledge (ρ =0.023), income (ρ = 0.037), the availability of facilities and infrastructure (ρ = 0.043), and disease complaints (ρ = 0.041), while unrelated factor was family support (ρ= 0.662). The community should maximize the use of JKN card to obtain comprehensive health services, not only for treatment, but also for prevention to improve their health status.

HAS REFORM OF THE SYSTEM OF PUBLIC HEALTH INSURANCE FOR THE POOR IN INDONESIA INCREASED HEALTH INEQUALITY? CONSIDERING DIFFERENT ACCESSIBILITY OF PUSKESMAS

Though the Indonesian government reformed its public health insurance system for the poor in 2008, the country still faces challenges with the disparity of accessibility to primary healthcare centres (puskesmas). This study examines whether the 2008 healthcare system reforms increased health inequality of the poor. Using data from the RAND Indonesian Family Life Survey (IFLS) and The Village Potential Statistics (PODES), this study found an indication that, in the aftermath of the reforms, the gap widened in the tendency for the poor to make insurance claims depending on their level of access to healthcare centres. Therefore, to protect the poor from catastrophic out-of-pocket expenditure, besides the provision of public health insurance, the government needs to be concerned about the accessibility of public health care, which includes not only the provision of direct healthcare infrastructure, but also improving road access conditions.

Implementasi Jaminan Kesehatan Nasional (JKN) dalam Konteks Perlindungan Sosial dan Keamanan Nasional: Tinjauan Kritis Dimensi Keamanan Non Tradisional

This paper argues that concept of national security is not only consists of traditional dimension, but also its encompasses of non-traditional dimension such as social, economic, and all significant forms that are free from fear, worry, danger and threat. One of the important aspect of national security is health and social security in the form of policy tracking and its implementation of state policies that undertake a major transformation in the public health insurance system which well known as the JKN, whose form in the community is known as BPJS Kesehatan.

Improving migrants’ access to the public health insurance system in China: A conceptual classification framework

Although the Chinese government has established a public health insurance system covering both rural and urban areas, the rural–urban migrants seem to have been neglected. To have a clear sense of the current status of migrants in the public health insurance system and to find ways to increase their enrollment to medical insurance, this paper attempts to construct a conceptual classification framework of China’s health insurance system. This was done by reviewing the development of China’s health insurance system and identifying barriers to entry for migrants. The finding suggests that migrants’ limited access to health insurance owes more to their reluctance than to system exclusions. The job and residential stability of migrants are critical factors to building the classification framework to account for supply and demand factors in the formulation of China’s health insurance policy.