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.

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.

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.

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.

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.

Health Analytics, Economics and Medicine toward a 21st Century Health Care System

After a review of recent developments in precision medicine, population health sciences and innovative clinical trial designs, and in health economics and policy, we show how innovations in health analytics can capitalize on the advances in biomedicine and health economics towards developing a data-driven and cost-effective 21st century health care system. In particular, we propose a mutually beneficial public-private partnership that combines individual responsibility with community solidarity in building this health care system.

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.

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.

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.

Chinese herbal medicine decreases incidence of hepatocellular carcinoma in diabetes mellitus patients with regular insulin management

BACKGROUND Type 2 diabetes mellitus(DM)is an independent risk factor for hepatocellular carcinoma(HCC),while insulin is a potent mitogen.Identifying a new therapeutic modality for preventing insulin users from developing HCC is a critical goal for researchers.AIM To investigate whether regular herbal medicine use can decrease HCC risk in DM patients with regular insulin control.METHODS We used data acquired from the Taiwan,Chinaese National Health Insurance research database between 2000 and 2017.We identified patients with DM who were prescribed insulin for>3 months.The herb user group was further defined as patients prescribed herbal medication for DM for>3 months per annum during RESULTS We initially enrolled 657144 DM patients with regular insulin use from 2000 to 2017.Among these,46849 patients had used a herbal treatment for DM,and 140547 patients were included as the matched control group.The baseline variables were similar between the herb users and nonusers.DM patients with regular herb use had a 12%decreased risk of HCC compared with the control group[adjusted hazard ratio(aHR)=0.88,95%CI=0.80–0.97].The cumulative incidence of HCC in the herb users was significantly lower than that of the nonusers.Patients with a herb use of>5 years cumulatively exhibited a protective effect against development of HCC(aHR=0.82,P<0.05).Of patients who developed HCC,herb users exhibited a longer survival time than nonusers(aHR=0.78,P=0.0001).Additionally,we report the top 10 herbs and formulas in prescriptions and summarize the potential pharmacological effects of the constituents.Our analysis indicated that Astragalus propinquus(Huang Qi)plus Salvia miltiorrhiza Bunge(Dan Shen),and Astragalus propinquus(Huang Qi)plus Trichosanthes kirilowii Maxim.(Tian Hua Fen)were the most frequent combination of single herbs.Meanwhile,Ji Sheng Shen Qi Wan plus Dan Shen was the most frequent combination of herbs and formulas.CONCLUSION This large-scale retrospective cohort study reveals that herbal medicine may decrease HCC risk by 12%in DM patients with regular insulin use.

Effects of insurance status on long-term survival among non-small cell lung cancer(NSCLC) patients in Beijing,China: A population-based study

Objective: To evaluate the effects of health insurance status on long-term cancer-specific survival of non-small cell lung cancer(NSCLC) in Beijing, China, using a population-based cancer registry data.Methods: Information on NSCLC patients diagnosed in 2008 was derived from the Beijing Cancer Registry.The medical records of 1,134 cases were sampled and re-surveyed to obtain information on potential risk factors.Poorly-insured status was defined as Uninsured and New Rural Cooperative Medical Insurance Scheme(NRCMS),while well-insured included Urban Employees Basic Medical Insurance(UEBMI) and Free Medical Care(FMC).To estimate survival outcomes, individuals were followed-up until December 31, 2018. Cancer-specific survival probabilities at 5 and 10 years after diagnosis were estimated using the Kaplan-Meier method. Log-rank test was used to compare long-term survival with different characteristics. Multivariable Cox proportional hazard regression model was used to examine the relative effect of insurance status on cancer-specific mortality.Results: Well-insured NSCLC patients have longer cancer-specific survival than poorly-insured individuals[hazard ratio(HR)=0.81;95% confidence interval(95% CI): 0.67-0.97), even after adjusting for age, gender, cancer stage, smoking status, family history and residential area. Older age and rural residence were associated with a higher risk of cancer-specific mortality(HR=1.03;95% CI: 1.02-1.03 and HR=1.25;95% CI: 1.07-1.46,respectively). Smoking individuals had a 41% higher long-term cancer-specific mortality risk than non-smoking ones(HR=1.41;95% CI: 1.20-1.66).Conclusions: NSCLC patients with good insurance status had better survival rates than those with poor insurance. An association was significant even after 10 years. Large population-based studies are needed to validate that high reimbursement insurance status can lead to the improvement of long-term cancer prognosis in China.

Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease

Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.

Oral Healthcare Renunciation and Socioeconomic Determinants

The unequal access to healthcare in general and oral healthcare, in particular, is a true public health concern. Thus, it is important to assess the oral healthcare renunciation and socioeconomic determinants to take appropriate measures. A cross-sectional, descriptive population-based study of 300 households was carried out between April 28, 2016, and May 28, 2016, according to WHO’s guidelines (Protocol 1997), in Senegal adapted form. Results showed that 18.23% of householders report that their household members have foregone oral healthcare. Among those who renounced care, 51.5% did so for care costs (24.2%) or remoteness of health facilities (27.3%) reasons. Therefore, dental treatment renunciation was independently associated to income level, age, sex, marital status, and types of oral healthcare coverage. This study’s analysis shows that oral healthcare renunciation depends primarily on the financial aspect and the remoteness of health structures. Still, there are other important socio-anthropological parameters that should be investigated.

Disparities in Oral Healthcare Access Due to the COVID-19 Pandemic

The U.S. has experienced very high numbers of positive COVID-19 cases, along with high unemployment rates during the COVID-19 pandemic. Similarly, on a global level, the pandemic has resulted in an increase in the unemployment rate, loss of insurance and an overall adverse social impact. In the social sector, there has been a huge gap in supply and demand;this has been especially apparent in the healthcare industry. The COVID-19 pandemic has had a significant negative impact on high-contact industries, including dentistry. Causative factors have included social distancing, shortage of healthcare professionals and loss of insurance due to unemployment. The result has been a void in preventative oral health services. Limited information on the disproportionate access to oral healthcare, due to the increase in unemployment and corresponding loss of insurance during the COVID-19 pandemic is available. This study was designed to investigate the disparities in access to oral healthcare amidst the global economic crisis and rise in unemployment.

DRG Payment System in the United States and Its Enlightenment to China

Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United States is the first country to develop and apply the DRG in the world,its research and practice of DRG are always at the forefront.Methods Literature research method was used to investigate DRG payment system,the specific steps of the payment,the setting method of relevant indicators,and the quality supervision measures.Results and Conclusion There are mainly three aspects from the experience of DRG payment system in the United States.Firstly,the government’s responsibility for health insurance is clarified.Secondly,the relevant indexes are set reasonably.Thirdly,the DRG weight and base rate are adjusted dynamically to ensure the fairness of DRG payment.Therefore,China should pay attention to the following three aspects:clarifying the main responsibility of the government in the reform of health insurance payment,establishing the quality control system of the first page of medical records,and improving the supervision mechanism for medical quality.

普惠型商业医疗保险特定高额药品保障研究

目的研究我国普惠型商业医疗保险目前特定高额药品(以下简称“特药”)保障的范围及水平,为进一步完善普惠型商业医疗保险的保障水平提供参考。方法通过官方公众号、投保小程序收集2022年普惠型商业医疗保险的保障政策,采用政策文本分析法提取和分析参保条件、筹资标准、特药的类别及保障水平等内容。结果2022年普惠型商业医疗保险所包含特药数量的均数为28种,以肿瘤药为主。54.62%的商业医疗保险方案特药起付线设定为0,报销比例的均数为74%、中位数为80%。70.54%的商业医疗保险方案封顶线在100万元及以下。58.04%的商业医疗保险方案保障既往症人群的特药费用,但保障水平在不同程度上有所降低。结论我国普惠型商业医疗保险的特药保障有助于减轻患者的经济负担,满足患者多元化用药需求,但对既往症人群的保障水平较为有限。建议进一步优化特药保障责任,明确特药目录的遴选规则。

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.

LipoCol Forte capsules reduce the risk of liver cancer:A propensity score-matched,nationwide,population-based cohort study

BACKGROUND Liver cancer is among the top five most common cancers globally. Lipid-lowering drugs such as statins can lower the risk of liver cancer, but may also cause liver damage. LipoCol Forte capsules(LFC), a red yeast rice product, have demonstrated significant antihypercholesterolemic effects and a good safety profile in clinical studies.AIM To evaluate whether LFC lowers the risk of liver cancer in adults in this propensity score-matched, nationwide, population-based cohort study.METHODS We used data from Taiwan’s National Health Insurance Research Database, which includes electronic medical records for up to 99.99% of Taiwan’s population. LFC users and LFC non-users were matched 1:1 by propensity scores between January 2010 and December 2017. All had followup data for at least 1 year. Statistical analyses compared demographic distributions including sex, age, comorbidities, and prescribed medications. Cox regression analyses estimated adjusted hazard ratios(aHRs) after adjusting for potential confounders.RESULTS We enrolled 33231 LFC users and 33231 non-LFC users(controls). No significant differences between the study cohorts were identified regarding comorbidities and medications [standardized mean difference(SMD) < 0.05]. At follow-up, the overall incidence of liver cancer was significantly lower in the LFC cohort compared with controls [aHR 0.91;95% confidence interval(CI): 0.86-0.95;P < 0.001]. The risk of liver cancer was significantly reduced in both females(aHR 0.87;95%CI: 0.8-0.94;P < 0.001) and males(aHR 0.93;95%CI: 0.87-0.98;P < 0.01) in the LFC cohort compared with their counterparts in the non-LFC cohort. The antitumor protective effects applied to patients with comorbidities(including hypertension, ischemic stroke, diabetes mellitus, hyperlipidemia, hepatitis B infection and hepatitis C infection). Those using LFC for more than 84 drug days had a 0.64-fold lower risk of liver cancer compared with controls(P < 0.001). Compared with controls, the risk of developing liver cancer in the LFC cohort progressively decreased over time;the lowest incidence of liver cancer occurred in LFC users followed-up for more than 6 years(27.44 vs 31.49 per 1,000 person-years;aHR 0.75;95%CI: 0.68-0.82;P < 0.001).CONCLUSION This retrospective cohort study indicates that LFC has a significantly protective effect on lowering the risk of liver cancer, in a dose-dependent and time-dependent manner.