Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

Assessing the Impact of Health Insurance on Household Financial Protection in Togo

Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their dependents. In addition, other voluntary and community mechanisms have been developed. After several years of implementation, the level of catastrophic health expenditures among insured individuals shows that there is still a considerable level of financial risk associated with health care. This study aims to assess the impact of health insurance in Togo on insured populations. Methodology: The data used in this study come from the harmonized survey on household living conditions carried out in 2018 by the National Institute of Statistics, Economic and Demographic Studies. The propensity score matching method was used according to the following steps: estimation of propensity scores, verification of the conditional independence hypothesis (balancing property) and estimation of the average treatment effect on treated. Stata V14.2 software was used. Findings: The average effect of health insurance on household financial protection is −0.012 for the nearest neighbor method, −0.013 for the matching radius method, −0.015 for the Kernel and −0.016 for the stratification method. Results showed that health insurance contributes to reducing catastrophic health expenditures, but their effect remains very limited. This could be explained by the level of care package covered and the cost covered. Conclusion: Health insurance contributes to the reduction of catastrophic health expenses for households. However, it is important to widen the range of care covered and the cost covered. In addition, measures to extend this coverage to a larger proportion of the population will make it possible to have a greater impact.

Impact of Dialysis Coverage on the Provision of Universal Health Insurance in the Republic of the Congo

Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim of this study is to assess the impact of including dialysis in the health insurance package in Congo. Methodology: This is a descriptive cross-sectional study with an evaluative aim, analyzing the impact of dialysis on the financing capacity of health insurance and health facilities to provide this type of care. Results: The results show that including dialysis in the universal health insurance package will require an additional financial effort of 6.20% of the current total financing capacity of the care basket. Most dialysis sessions are provided by the private health sector (87.5%), whose health facilities are unevenly distributed across the country, and concentrated in the country’s two major cities. This problem is the dual consequence of the very high cost of a dialysis session (average cost 140,234,375 FCFA or 229 US Dollars) and the number of patients under care, which will increase in the absence of effective and ongoing prevention efforts against chronic diseases in general and end-stage renal failure in particular. Conclusion: Dialysis is a high-impact public health intervention. The impact of its inclusion in the universal health insurance care package is difficult to bear financially. For dialysis to be covered by universal health insurance, additional funding and improved technical facilities are needed.

Household Perceptions, Willingness to Pay, Benefit Package Preferences, Health System Readiness for National Health Insurance Scheme in Southern Nigeria

Introduction: Several Nigerians are completely denied access to adequate health care because of cultural, temporal and financial factors with inequity. Objectives: To ascertain the household perceptions, willingness to pay, benefit package preferences, and health systems readiness for Insurance Scheme. Methods: A cross-sectional study of 400 heads of households and 43 health workers in Enugu, Southern Nigeria. Results: Awareness of NHIS among the heads of household was 56.8%, while it was 86% among the health workers. Awareness of NHIS among heads of households was significantly associated to both educational level (X2 = 16.083, P = 0.001), and occupation (X2 = 5.694, P = 0.017). More males (61.6%) had correct perceptions of NHIS compared to females (58.6%), but not statistically significant (X2 = 0.336, P = 0.562). Majority of households respondents 89% are willing to pay for NHIS. Willingness to pay was significantly associated to occupation (X2 = 5.169, df = 1, P = 0.023), but willingness to pay mandatory 5% premium was not significantly associated to occupation (X2 = 0.884, P = 347). Only 11.6% of the health facilities are enlisted as providers in the scheme. Conclusion: Willingness to pay was high, but majority are not ready to pay 5% premium of their earnings. Awareness creation programmes should be improved for the public, and more health facilities enlisted for wider coverage.

Assessing Drug Use Indicators in Health Insurance Facilities, Gezira State, Sudan, 2017-2018

Background: Inappropriate use of medicines is a global concern with serious consequences related to prescribing, dispensing, and use. WHO estimated that 50% of medicines are not used correctly on their journey from the facility to home. Objective: To assess medicines use using WHO drug core indicators regarding prescribing, patient, and facilities. Setting: Outpatients, Health centers in Wadmadani locality (Urban area) in Gezira State, Sudan. Method: A cross-sectional, prospective, analytical study was conducted in 30 health centers and 60 patients from each center were selected using a simple random sampling technique. WHO indicators form was used to collect data containing different variables. T-test at a level of confidence of 95% was used to test differences between indicators. Statistical Package for Social Science (SPSS) was used for data analysis. Results: The main prescribing indicators were 2.5 ± 0.6 for drugs per encounter, 44.1% ± 14.2%. Generic 54 ± 18.0 antibiotics, 12.0% ± 9.3% injectable, and 95.2% ± 11.5% of drugs were prescribed according to the NHIF-EML. The main patient’s indicators were, 2.9 ± 0.8 minutes for consultation time, 99.5 ± 36.8 seconds for dispensing time, and 72.5% ± 16.0% for medicines actually dispensed, 49.0% ± 18.0% for medicines adequately labeled, and 22.5% ± 7.3% of the patient’s knowledge about the correct dose. The Facility specific indicators were 66.7% for the availability of a copy of EML, while the percentage of key drugs in the stock was 75.3% ± 11.6%. No statistically significant differences were found between direct and indirect facilities except in generic prescribing. Main Outcome Measure: • Interventions to improve Generic and antibiotics prescribing indicators. • The patient-to-physician ratio should be revised to optimize consultation time. • The availability of key drugs should be improved to make sure effective treatment. • The pharmacy cadre should be oriented and trained to improve patients’ compliance. Conclusion: The study concluded that there was irrational use of medicines when investigated by WHO drug core indicators. So, the study recommended interventions to improve the rationale prescribing, dispensing, and use of medicines.

Study of the Impact of the COVID-19 Pandemic on Health Insurance Fund of Hubei Province in 2020

Objective To provide a reference for future budget of health insurance fund for the COVID-19 pandemic in other parts of China or other major public health events.Meanwhile,it also offers a reference for the government to introduce and adjust the policy of health insurance funds after the pandemic.Methods Models of the income,expenditure and cumulative balance of health insurance fund in Hubei Province in 2020 were established and compared.The former was mainly established and tested using SPSS 26.0 and Excel,while the latter was obtained by inferential analysis.Results and Conclusion The COVID-19 pandemic reduced the income and increased expenditure of the health insurance fund in Hubei Province in 2020,resulting in a deficit.The COVID-19 outbreak has caused a deficit in health insurance fund of Hubei Province in the short term,but in the long term,the outbreak will not have a major impact on the health insurance fund.

Health Insurance:Better Safe than Sorry!

If your employer is sending you to China, chances are you will enjoy the status of an expatriate and all the benefits that come with it, including health insurance. However, if you＇re not that lucky, you＇ll have to deal with this painfully expensive matter on your own, unless, of course, you decide not to purchase health insurance. But in a country where serious or even fatal accidents and health emergencies can and do happen, you would literally be taking your life into your own hands.

Design and Selection of Pharmaceutical Innovation Incentive Policies:Subsidy or Inclusion in Health Insurance Plan

A critical problem plaguing regulators in promoting pharmaceutical innovation is to design and select efficient incentive policies. In this study, we develop a stylized model comprising a regulator and two representative drug producers to evaluate the effects of three incentive policies: Innovation subsides, inclusion new drugs in the health insurance plan, and the combination of the above two policies(also called hybrid policy). Our analysis shows that innovation subsidies and inclusion of new drugs in the health insurance plan can both promote pharmaceutical innovation, but their incentive effects vary in different policy objectives. Specifically, if the regulator aims to improve patient welfare, he should incorporate new drugs into the health insurance plan to expand the accessibility of new drug when the copayment level is low. However, if the regulator aims to improve social welfare, he should choose innovation subsidies when the copayment level is high, and the hybrid policy when the copayment level is low. In particular, with a sufficiently low copayment level, the hybrid policy allows the new drug producer, patients and the regulator to achieve Pareto improvement due to a lower regulator’s innovation subsidy expenditure, higher profits of the new drug producer and consumer surplus.

Enlightenment of German social health insurance system reform on China

According to the latest Chinese Healthcare Reform .Plan, the medical insurance system is one ofthe four components of the healthcare sector. The Healthcare financing and payment in China are mainly based on medical insurance. So it is important to learn the experiences of the developed countries. This paper examines the key issues of the German Healthcare system and reforms, with a particular emphasis on basic social medical insurance, which has the broadest coverage in Germany. It reviews the evolution of the background of the German social medical insurance system, describes how the system functions, and analyzes the existing and emerging problems with the system which push the Germany government to adapt a series of reforms.

A survey on the attitudes of doctors towards health insurance payment in the medical consortium

Background Medical consortium is a specific vertical integration model of regional medical resources.To improve medical resources utilization and control the health insurance costs by fee-for-service plans （FFS）,capitation fee and diagnosis-related groups （DRGs）,it is important to explore the attitudes of doctors towards the different health insurance payment in the medical consortium in Shanghai.Methods A questionnaire survey was carried out randomly on 50 doctors respectively in 3 different levels medical institutes.Results The statistical results showed that 90% of doctors in tertiary hospitals had the tendency towards FFS,whereas 78% in secondary hospitals towards DRGs and 84% in community health centers towards capitation fee.Conclusions There are some obvious differences on doctors＇ attitudes towards health insurance payment in 3 different levels hospitals.Thus,it is feasible that health insurance payment should be supposed to the doctors＇ attitudes using the bundled payments along with the third-party payment as a supervisor within consortium.

Coverage and utilization of the health insurance among migrant workers in Shanghai, China

Background According to the regulations of the Chinese and Shanghai governments, migrant workers employed in Shanghai should all be entitled to Shanghai Migrant Worker Hospitalization Insurance （SMWHI） without premium and the vast majority should also have the New Rural Cooperative Medical System （NRCMS）. This study aimed to examine the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai. Methods Quantitative and qualitative research methods were employed in the study. A survey of 1020 migrant workers employed in Shanghai was conducted in 2010 with a structured questionnaire. Focus group discussions were held with respondents who were unable to maintain health insurance coverage through NRCMS or SMWHI. In-depth interviews were held with village heads and employers of the migrant workers, migrant workers who were hospitalized within the last year, and various individuals employed by the insurance agencies. Results The study found that 72.9% and 36.5% of migrant workers were covered by NRCMS or SMWHI, respectively, while 16.7% of them had no health insurance. The coverage by NRCMS among migrant workers correlated significantly with education level and workplace, while the coverage by SMWHI correlated significantly with the length of employment in Shanghai and workplace. The qualitative results confirmed that migrant workers were the main group who were not covered by NRCMS, and the coverage by SMWHI was completely dependent upon the employers of the migrant worker. The results also showed that health insurance utilization among migrant workers was strongly limited by hospital location. Conclusions We observed that the status of health insurance among migrant workers was not accordant with theory, and that Chinese health insurance policy should be further reformed in order to realize full coverage and equal utilization of health insurance among migrant workers in China.

Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China

Background:Health inequity is an important issue all around the world.The Chinese basic medical security system comprises three major insurance schemes,namely the Urban Employee Basic Medical Insurance(UEBMI),the Urban Resident Basic Medical Insurance(URBMI),and the New Cooperative Medical Scheme(NCMS).Little research has been conducted to look into the disparity in payments among the health insurance schemes in China.In this study,we aimed to evaluate the disparity in reimbursements for tuberculosis(TB)care among the abovementioned health insurance schemes.Methods:This study uses a World Health Organization(WHO)framework to analyze the disparities and equity relating to the three dimensions of health insurance:population coverage,the range of services covered,and the extent to which costs are covered.Each of the health insurance scheme’s policies were categorized and analyzed.An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city(YC),which included 1506 discharges,was conducted to identify the differences in reimbursement rates and out-of-pocket(OOP)expenses among the health insurance schemes.Results:Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by(TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI,who have less inpatient expenses than those covered by the UEBMI).We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups.In terms of financial inequity,TB patients who earned less paid more.The NCMS provides modest financial protection,based on income.Overall,TB patients from lower socioeconomic groups were the most vulnerable.Conclusion:There are large disparities in reimbursement for TB care among the three health insurance schemes and this,in turn,hampers TB control.Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control.Achieving equity through integrated policies that avoid discrimination is likely to be effective.

Efficiency of resource allocation in the hospital sector after global budgeting under National Health Insurance

Background Taiwan has implemented a National Health Insurance （NHI） program to provide uniform comprehensive coverage since 1995. Forced by the severe financial deficit, global budgeting is introduced to replace the original payment system in Taiwan＇s NHI. Under global budgeting system, the total budget is distributed to six geographical regions in Taiwan. There is no pre-determined budget for each hospital. In order to investigate the longitudinal trend of how global budgeting influences health care resource, it is essential to estimate the efficiency of resource allocation in Taiwan＇s NHI. Methods Data Envelopment Analysis （DEA） and Malmquist index （MI） are used to investigate the 8-year panel data of 23 cities and counties which was collected from the annual report from the Department of Health, Taiwan, China. A value of MI greater than 1 indicates that total factor productivity progress has occurred, while a value of MI less than 1 indicates productivity loss. Results As a result, 37 of the 184 DMUs in the analysis were found to be relatively efficient during the period, in which 14 of 23 DMUs are efficient in 2002 right after adopting globe budgeting. A trend of MI declines between 2002 and 2009 implies the volume of health care services decrease after adopting global budgeting system. Production efficiency has been improved after global budgeting implies that behaviors of health providers control cost and avoid wasting resource at macro level. Conclusions The regressive MI indicates the hospitals redistribute health care resource to eliminate unnecessary treatment and to control the growth of service volume under global budgeting system. Hence, a trend of declining MI focuses on health care resource redistribution rather than efficiency improvement in this study.

Precautionary Saving and Health Insurance： A Portfolio Choice Perspective

This paper analyzes the impact of health insurance on household portfolio choice. Using the U.S. Survey of Consumer Finance and Health Retirement Survey databases, it finds that insured households are more likely to own stocks and invest a larger proportion of financial assets in stocks than uninsured households do. The results remain strong even after controlling for household characteristics and reverse causality. Furthel, the results are robust across different survey years and data sources. It suggests that a precautionary motive is strong in household portfolio choice decisions.

Does Health Insurance Coverage Influence Household Financial Portfolios？ A Case Study in Urban China

Health insurance lowers the medical financial burden of the insured through a risk-sharing mechanism, and more importantly, reduces the motivation for precautionary saving. This paper explores the relationship between health insurance coverage and household financial portfolios. We choose 2002 urban China as a case study when the health insurance system had a problem of limited adverse selection. Using data from the 2002 Chinese Household Income Project Survey, we find that health insurance coverage influences households＇ preference for financial assets, especially for the risky financial assets. These effects become more pronounced as the coverage rate of health insurance in the family increases. Our results are consistent with precautionary saving theory which suggests that future expenditure risk could affect household asset portfolios. Therefore, development of social security or a health insurance system could effectively promote the development of financial markets, especially riskier aspects of financial markets.

Challenges to the Chinese Health Insurance System： Users＇ and Service Providers＇ Perspectives

To achieve universal health insurance coverage,China has launched three phases of health care system reforms.The first round of reforms was embarked on in the mid-1980s with the introduction of market incentives.The second round began in 1997 with the introduction of the Urban Employee Basic Medical Insurance （UEBMI） scheme which provided health insurance coverage to all urban workers in addition to a long-term/historical scheme for government workers.

Measuring health care efficiency with a tripartite configuration under the ＂National＂ Health Insurance system

Background The ＂National＂ Health Insurance （NHI） in Taiwan, China is a single-payer system that was introduced in 1995 to provide universal health care. It is worth noting that three stakeholders are involved in Taiwan＇s NHI, which can be seen as a triangular governance regime between the Bureau of ＂National＂ Health Insurance （BNHI）, the insured and providers. Accordingly, this study intended to assess the efficiency of various different production processes that occur among these stakeholders in Taiwan＇s NHI system. Methods A two-stage relational Data Envelopment Analysis （DEA） model is adopted to investigate the sub-process efficiencies of the health care resources held by 23 cities and counties through stages I or II, where the outputs of the first stage serve the inputs of the second. The dataset was collected from the annual reports published by the Department of Health, Taiwan, China. Results Under the proposed framework, the efficiency of the whole process can be obtained from the product of productivity and allocative efficiency. Ten DMUs are efficient either in stages I or II, with only two DMUs being efficient with regard to both sub-processes. Conclusion The relational DEA model not only demonstrates the physical relationship between the whole process and the sub-process components, but also produces reliable outcomes in efficiency measurement among different stakeholders in Taiwan＇s NHI system.

Health insurance and household income associated with mammography utilization among American women, 2000-2008

Background National Breast and Cervical Cancer Early Detection Program （NBCCEDP） has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States （US） since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women. Methods Data were from the database of Behavioral Risk Factor Surveillance System （BRFSS） of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year. Results From 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006. Conclusions Health insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.

Public Health Insurance and Farm Labor Supply:Evidence from China's Rural Health Insurance Reform

This study examines the impact of China’s public health insurance program on the farm employment decisions of the rural population.Using a difference-in-differences(DID)model,this study indicates that the public health insurance reform led to reallocation of the rural labor force out of the farm sector by reducing the farm employment and increasing the likelihood of rural residents working in both the farm and nonfarm sectors.This research finds that rural female residents who are of a younger age and in better health were more likely to leave farm employment when covered by public health insurance.Suggestive evidence also finds that such public health insurance reform increased the individual income of the farm population.

Public satisfaction with the quality of First Health Facility Services in Indonesia: Does sociodemographic matter?

Objective:To investigate individual characteristics related to satisfaction with the quality of First Health Facility Services(FHFS)in Indonesia.Methods:This cross-sectional study analyzes national representation data.Meanwhile,the study involved 9846 representative respondents in 2019.Respondent’s satisfaction with FHFS based on the five dimensions of service quality(SERVQUAL)is a dependent variable.Independent variables consist of sex,marital status,age,education,employment,insurance ownership,and economics.The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality.Results:77.3%Respondents were satisfied with FHFS,with the highest order of satisfaction dimensions being assurance(59.4%),empathy(57.3%),reliability(53.6%),responsiveness(52.7%),and then tangibility(49.1%).Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied(95%CI 1.17-1.87).Employees were 0.77 less likely than the unemployed to get satisfied(95%CI 0.70-0.86).Respondents with higher education was 0.82 less likely than those with primary education to be satisfied(95%CI 0.67-0.99).Meanwhile,respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied(95%CI 1.42-1.80).Moreover,the rich were 0.82 less likely than the poor to get satisfied(95%CI 0.73-0.92).Conclusions:Community satisfaction with FHFS is generally high,though some areas could be improved.Demographic factors are still strongly related to satisfaction ratings.The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society,ensuring that service satisfaction is rated as good by all groups.