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.

Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Incidence and in-hospital mortality of acute aortic dissection in China： analysis of China Health Insurance Research （CHIRA） Data 2011

Objective Acute aortic dissection （AAD） is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in China's Mainland is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. Methods We used the China Health Insurance Research Data （the CHIRA Data） 2011 which comprises all inpatient hospital records （300,886） during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries （1,718,500 men and 1,616,500 women） from 25 cities and counties in different economic-geographic regions of China's Mainland. Patients with acute aortic dissection were identified according to International Classification of Disease 10m Revision （ICD-10） of I71.0, The estimated incidence of AAD was calculated using the equation： estimated incidence = 2.0 × （40% × hospital admission rate） ＋ 60% × hospital admission rate. Results The hospital admission rate was 2.0/100,000 （65/3,325,000, 95% CI： 1.2-2.8）. The estimated annual incidence of AAD was 2.8/100,000 （95% CI： 1.9-3.6） and was higher in male than in female （3.7 vs. 1.5, P 〈 0.001）. The mean age was 58.9 ± 13.4 years. During the mean hospital stay of 23 ±6 days, the overall in-hospital mortality was 13.9% （9/65）. Conclusions Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.

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.

Determinants of self-rated private health insurance coverage in Jamaica

The purpose of the current study was to model the health insurance coverage of Jamaicans;and to identify the determinants, strength and predictive power of the model in order to aid clinicians and other health practitioners in understanding those who have health insurance coverage. This study utilized secondary data taken from the dataset of the Jamaica Survey of Living Conditions which was collected between July and October 2002. It was a nationally representative stratified random sample survey of 25,018 respondents, with 50.7% females and 49.3% males. The data was collected by way of a self-administered questionnaire. The non-response rate for the survey was 29.7% with 20.5% not responding to particular questions, 9.0% not participating in the survey and another 0.2% being rejected due to data cleaning. The current research extracted 16,118 people 15 years and older from the survey sample of 25,018 respondents in order to model the determinants of private health insurance coverage in Jamaica. Data were stored, retrieved and analyzed using SPSS for Windows 15.0. A p-value of less than 0.05 was used to establish statistical significance. Descriptive analysis was used to provide baseline information on the sample, and cross-tabulations were used to examine some non-metric variables. Logistic regression was used to identify, determine and establish those factors that influence private health insurance coverage in Jamaica. This study found that approximately 12% of Jamaicans had private health insurance coverage, of which the least health insurance was owned by rural residents (7.5%). Using logistic regression, the findings revealed that twelve variables emerged as statistically significant determinants of health insurance coverage in this sample. These variables are social standing (two weal- thiest quintile: OR = 1.68, 95% CI = 1.23 – 2.30), income (OR = 1.00, 95%CI = 1.00 – 1.00), durable goods (OR = 1.16, 95% CI = 1.12 – 1.19), marital status (married: OR = 1.97, 95% CI = 1.61 – 2.42), area of residence (Peri-urban: OR = 1.45, 95% CI = 1.199 – 1.75;urban: OR = 1.83, 95% CI = 1.40 – 2.40), education (secondary: OR = 1.57, 95% CI = 1.20 – 2.06;tertiary: OR = 9.03, 95% CI = 6.47 – 12.59), social support (OR = 0.64, 95% CI = 0.53 – 0.76), crowding (OR = 1.14, 95% CI = 1.02 – 1.28), psychological conditions (negative affective: OR = 0.97, 95% CI = 0.94 – 1.00;positive affective: OR = 1.11, 95% CI = 1.06 – 1.16), number of males in household (OR = 0.85, 95% CI = 0.77 – 0.93), living arrangements (OR = 0.62, 95% CI = 0.41 – 0.92) and retirement benefits (OR = 1.55, 95% CI = 1.03 – 2.35). This study highlighted the need to address preventative care for the wealthiest, rural residents and the fact that social support is crucial to health care, as well as the fact that medical care costs are borne by the extended family and other social groups in which the individual is (or was) a member, which explains the low demand for health insurance in Jamaica. Private health care in Jamaica is substantially determined by affordability and education rather than illness, and it is a poor measure of the health care- seeking behaviour of Jamaicans.

Hospice and Palliative Care Services in South Korea Supported by the National Health Insurance (NHI) Program

Previous main body of research on end-life-care in South Korea has focused on developing services quality in hospital settings or service payment system in National Health Insurance Program. The delivery system of hospice and palliative care services has evolved in diverse ways but there is little research on reviewing the past history of development and whole picture of them so far. So, the aim of this study is to review the old hospice and palliative care system and also to introduce the current one supported by the National Health Insurance Program in South Korea. The palliative care or hospice services in South Korea have been available in diverse settings and provided by different organizations (i.e. catholic hospitals or charity organizations). Finally, it was set up in 2004 that the hospice team or official Palliative Care Units (PCUs) was established in hospitals, in order to meet the end-of-life care for the patients with terminal cancer under the Cancer Control Act. The current hospice and palliative care services such as pain management, bereavement services, and counselling can be reimbursed by National Health Insurance program since 2008. Nevertheless hospice and palliative care services are available to dying patients, yet the utilization rate of hospice and palliative care services or the length of stay in the palliative care unit (PCU) is still relatively short compared to other country systems. South Korea is undergoing several efforts to expand the services in PCU along with the development of quality indicators for PCU. Hospice and palliative care services are still new in the health care system and unfamiliar to the public so it requires raising awareness for medical professionals and the public as well as further research.

Building Long-Term Care Insurance System in China

The objective is to explore the foundation of the elderly long-term care insurance system in China, which is to face the problem resulted from aging of the population. Adopting the contrastive analysis to introduce briefly the long-term care insurance system in German, Japan and America for our learning. Therefore, China＇s long-term care insurance system could not totally indiscriminately imitate the mandatory long-term care insurance system in German and Japan, it also could not copy the business model of nursing insurance system in America. The conclusion is that long-term care insurance system in China should use the experience of developed countries based on the basic national conditions, doing some relative works, such as establishing policies and regulations, strengthening personnel training, and improving the market specification.

A Model to Estimate the Impact of Thresholds and Caps on Coverage Levels in Community-Based Health Insurance Schemes in Low-Income Countries

Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.

Community Based Health Insurance in India: Prospects and Challenges

The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.

Health insurance and switching behavior: Evidence from the Netherlands

Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health insurance system aimed to create a more competitive market in which consumers would switch health plans, thereby stimulating insurers to price competition and quality improvement. This article evaluates the switching behavior of Dutch consumers and evaluates whether this behavior is advantageous to the goals of the reform. Methods: Three surveys were conducted: from 2005-2006 (n = 478), 2008-2009 (n = 389), and 2010-2011 (n = 191). Results: In 2005-2006, almost 20 percent of the Dutch consumers switched their insurance company. In between 2006 and 2012, however, the percentage of switchers decreased to less than four percent. The main cause of this decrease is that consumers no longer perceive sufficient differences between insurance companies in terms of premium and service. In addition, consumers have difficulties finding the proper information making the right decision and believe they may not be accepted for the supplementary insurance. Consequently, insurance companies only perceive limited incentives to create a more competitive market. Conclusion: Clear and unambiguous information, combined with an obligatory acceptance for the supplementary insurance might help to improve the potential mobility of Dutch consumers.

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 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.

The Acceptance Intention of Consumers for a Dynamic Payment Mechanism for Health Insurance Coverage

Currently, a consumer＇s monthly premium payment amount remitted to the National Health Insurance is based on the ＂monthly real wages,＂ while commercial health insurance uses ＂consumer age＂ as the basis for the premium amount charged. In reality, health, salary, and age have no visible connection. Therefore, the insurance premium scheme using salary and age as standards should be improved and adjusted upon. This study uses the Decomposed Theory of Planned Behavior as the research basis, and through the designed questionnaire, investigates the health data gathered from wearable devices and uses big data to process the constructed health assessment indicators. These indicators will be used to analyze whether consumers are willing to contribute to their health insurance using the dynamic payment mechanism. Subsequently, empirical research was performed using hypothesis architecture and structural equation.

Community-Based Health Insurance： An Evolutionary Approach to Achieving Universal Coverage in Low-Income Countries

The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.

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.

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.

An Overview Study of Health Insurance in India

Health insurance is a mechanism by which a person protects himself from financial loss caused due to accident and/or disability.The chairman of Insurance Regulatory and Development Authority(IRDA)has mentioned that low consumer awareness and insufficient healthcare infrastructure are the major hindrances to widen the reach of healthcare insurance in India.Healthcare costs have witnessed a phenomenal rise in the current times.This has led the customers to insure not only themselves but their family members for any future medical expenses and other related requirements.The need to insure assumes is more importance for older generations who are either retired or will be retired in near future.Given high health cost,it is important for us to get covered for health risks.With this,a good insurance policy is needed to cover doctor's visit,laboratory tests,hospital stays and diagnostic tests.There are quite a few companies covering health risks with good insurance policies.Health insurance(popularly known as Mediclaim)offers protection in case of unexpected medical emergencies.In case of a sudden illness or accident,the health insurance policy takes care of the hospitalization,medical and other costs incurred.Thus,health insurance to be introduced to all consumers in India to protect them from financial loss caused by unfortunate incidents.

Research on the development mode of long-term nursing insurance ——taking Qingdao as an example

With the gradual development of society, scientific and technological progress, aging gradually aggravated, has become a hot topic of society. People to old age, self-care ability than in the past, not only suffer from disease, life has become difficult, coupled with the large number of empty nest family, the cost of care is also very high, whether it is to receive home care or professional institutions of care have great difficulties. Therefore, the community should be a large number of people with long-term care needs of the appropriate economic compensation, in this context, long-term care insurance is born. As a leading city in Shandong Province, Qingdao has introduced long-term care insurance and achieved good results. This paper analyzes the practical problems faced by Qingdao, that is, the development background of Qingdao long-term nursing insurance model, obtains the deficiency of Qingdao long-term nursing insurance, and then puts forward the corresponding countermeasures, and then ponders how to choose the long-term nursing insurance model of our country＇s future development.

Analysis of the necessity of Shanghai＇s long-term care insurance

The aging population of Shanghai is China one of the most serious city, is also one of the cities of the aging problem is prominent. As a result, the city＇s endowment pressure also with aging and aging aggravate gradually increased, especially the old man nursing problems become the main problem in society. Study abroad to establish a long term care insurance comprehensive factors, considering the feasibility of the long-term care insurance in Shanghai, alleviate the pressure of the pension, the construction of a harmonious society.

Research on the institutional design of the long-term care insurance in Shanghai

Shanghai went into the ranks of the aging society in 1979, as the first area which entered into the aging society in China. Along with the arrival of the ageing, the nursing problems of the old man and disabled elderly become the important factors which affect social development. The establishment of the legal system, System integration to realize resource optimal allocation, Division of multilevel optimization services provide new pattern can make it happen.