Basic Healthcare Insurance Research Articles

18 years old: choose wisely! Provision of information about changing health insurance status

From the age of 18, dental care is no longer covered by basic healthcare insurance [in the Netherlands]. Individuals can voluntarily take out additional insurance however. The aim of this study was to map out what information those nearly 18 years old receive about the changes in coverage of dental care (Part A) and what their preferences were concerning information on this topic (Part B). Part A consisted of desk research on the websites of 4 health insurers and government agencies, complemented with interviews with portfolio holders. Part B consisted of a questionnaire survey among 18-year-old secondary school pupils training for university and vocational students (n = 106).The websites of health insurers and government agencies contained some information, 2 health insurers sent information by post about dental insurance and 1 also got in touch by phone. The level of knowledge about the insurance system among 18-year-olds was low, information often did not seem to have been received and they did not look for information themselves. Secondary school pupils training for university preferred to receive written information, vocational students preferred to receive it orally. Conclusion: Information about the changing health insurance status is available but does not reach those nearly 18 years old effectively. Cooperation and clarity on the responsibilities regarding the provision of information is recommended.

Continuous Glucose Monitoring as a Matter of Justice

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D.

PNS78 COMPARISON AND ENLIGHTMENT OF THE CURRENT CRITICAL ILLNESS INSURANCE SYSTEMS OF DIFFERENT REGIONS IN CHINA

To provide suggestions for the improvement and reformation of Healthcare Insurance in China by comparing and analyzing Critical Illness Insurance Systems of different regions in China. Provinces or municipalities representing different developing levels were chosen based on the per capita disposable income provided by the Office for National Statistics. A review was conducted in regional Healthcare Security Administrations (HSA) and CNKI database for relative policies where differences in administration, funding resources, insured population, list of diseases and level of insurance were compared. Critical Illness Insurance (CII) policies in 9 of the total 34 provinces or municipalities (Shanghai, Beijing, Zhejiang, Hunan, Anhui, Jiangxi, Gansu, Guizhou, Yunnan) were compared. CII was undertaken by commercial insurance companies and supervised by provincial or municipal HSAs in all of the regions unlike Basic Healthcare Insurance (BHI) organized all by HSA. Most of the CII funds were assigned from provincial or municipal BHI funds and half of regions would receive supports from local governments. The CII was developed mainly for residents without stable income as supplement of BHI, however, 2 regions covered all citizens. Most regions had specific lists to define the range which covered more than 20 kinds of critical illness while rest of them only set certain deductibles and limit lines. Deductibles were decided based on the regional per capita income last year and reimbursement rates were no less than 60% according to the policies. Generally, the CII policies has improved the healthcare levels for residents. However, deductibles were relatively high and insured residents still faced certain burden under the current policies. It is suggested that CII systems should be better improved to benefit the public.

Study protocol of a prospective multicenter study comparing (cost-)effectiveness of a tailored interdisciplinary head and neck rehabilitation program to usual supportive care for patients treated with concomitant chemo- or bioradiotherapy

BackgroundSince 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients’ functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients’ individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.MethodsThis multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.DiscussionThis prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.Trial registrationThe study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 (NTR7140).

The organisation and financing of curative care

In the Netherlands, market incentives are increasingly used in the organisation of curative healthcare. This use of a free-market system is not an end in itself but rather a way of achieving better care at appropriate prices. Considering the special characteristics of healthcare, this is, however, not self-evident. As a result, the government is still significantly involved. This is also very clear in the financing of healthcare. In the case of curative care, the choice has been made for basic healthcare insurance compulsory for everyone. Medically necessary care pertaining to this coverage, including some oral care, is nearly fully financed collectively in the form of compulsory premiums. Every increase in the cost of care results, consequently, in difficult (political) dilemmas. Within the 'regulated' free-market system of the basic healthcare insurance package as well as the supplementary packages particularly important to oral care, it is essential that healthcare providers and insurers find common ground as contracting parties to a greater and greater degree.

Are college students health literate?

Objective: To examine the health literacy of college students. Participants: A convenience sample of 245 graduate and undergraduate college students. Methods: During February–April of 2018 participants completed the Short Test of Functional Health Literacy which assessed literacy on two passages describing a thyroid scan, and basic healthcare insurance information. Results: Most college students displayed adequate health literacy (99.2%). The ANOVA analyses revealed college classification was the most significant predictor, followed by ethnicity, sex, and primary language. Age was significantly related to health literacy, when holding college classification constant. Interestingly, college major, healthcare work experience, or having health care credentials were not predictors of health literacy. Conclusion: This group of college students had adequate health literacy skills. However, the results of this study revealed demographic disparities that suggest further study.

Endodontic re-treatment or apical surgery, is an evidence-based choice possible?

Treatment of a recurrence after an initial endodontic treatment can consist of endodontic re-treatment or apical surgery. The literature reports comparable success rates for these two options. However, randomised controlled trials that are truly comparable to each other are unavailable as a result of which comparison and an informed choice are not really possible. In addition to the treatment outcome, consideration also has to be given to cost-effectiveness and other patient-related factors, such as pain, swelling and medication. Regarding these considerations, too, little reliable information can be found in the literature. Moreover, factors relating to insurance play an important role in the Netherlands, where only apical surgery is covered by the basic healthcare insurance. In conclusion, all of these factors should be carefully considered before proceeding to an individual treatment strategy.

Diabetes, HIV and other health determinants associated with absenteeism among formal sector workers in Namibia

BackgroundAs countries in sub-Saharan Africa develop their economies, it is important to understand the health of employees and its impact on productivity and absenteeism. While previous studies have assessed the impact of single conditions on absenteeism, the current study evaluates multiple health factors associated with absenteeism in a large worker population across several sectors in Namibia.MethodsFrom March 2009 to June 2010, PharmAccess Namibia conducted a series of cross-sectional surveys of 7,666 employees in 7 sectors of industry in Namibia. These included a self-reported health questionnaire and biomedical screenings for certain infectious diseases and non-communicable disease (NCD) risk factors. Data were collected on demographics, absenteeism over a 90-day period, smoking behavior, alcohol use, hemoglobin, blood pressure, blood glucose, cholesterol, waist circumference, body mass index (BMI), HIV status, and presence of hepatitis B antigens and syphilis antibodies. The associations of these factors to absenteeism were ascertained using negative binomial regression.ResultsControlling for demographic and job-related factors, high blood glucose and diabetes had the largest effect on absenteeism (IRR: 3.67, 95%CI: 2.06-6.55). This was followed by anemia (IRR: 1.59, 95%CI: 1.17-2.18) and being HIV positive (IRR: 1.47; 95%CI: 1.12-1.95). In addition, working in the fishing or services sectors was associated with an increased incidence of sick days (IRR: 1.53, 95%CI: 1.23-1.90; and IRR: 1.70, 95%CI: 1.32-2.20 respectively). The highest prevalence of diabetes was in the services sector (3.6%, 95%CI:-2.5-4.7). The highest prevalence of HIV was found in the fishing sector (14.3%, 95%CI: 10.1-18.5).ConclusionBoth NCD risk factors and infectious diseases are associated with increased rates of short-term absenteeism of formal sector employees in Namibia. Programs to manage these conditions could help employers avoid costs associated with absenteeism. These programs could include basic health care insurance including regular wellness screenings.

Willingness to Pay for Adverse Drug Event Regulatory Actions

Regulatory requirements for the pharmaceutical industry have become increasingly demanding with respect to the safety and effectiveness of drugs. The objective of this study was to determine the willingness to pay (WTP), of both the Dutch general public and dialysis patients, for regulatory requirements related to reducing the risk of pure red cell aplasia (PRCA) associated with epoetin alpha use. A survey was carried out in April 2009. The Dutch general public (n = 422) was approached through a survey sampling agency. Patients (n = 112) were included through several Dutch dialysis clinics because they are often treated with epoetin alpha and therefore were expected to have a higher WTP than the general public. The survey aimed to determine the WTP for reducing the risk of PRCA in epoetin alpha users from 4.5 to 0 per 10 000 patients per year, based on regulatory actions that have been taken by the European Medicines Agency (EMA). WTP was determined via a payment scale and an open-ended follow-up question. Patients were asked how much extra per year they would be willing to pay for their basic healthcare insurance. We used two censored regression models to test the association between WTP and a set of independent variables: a Tobit model with the stated WTP as the dependent variable and an interval regression model with the interval between the lower and upper bounds of the payment scale as the dependent variable. The patients' mean WTP was significantly higher (€46.52) than that of the general public (€24.40). The Tobit model showed significant associations (α = 0.05) with WTP for dialysis patients, risk perception and respondents' opinions on costs of healthcare. The interval regression model showed significant associations with WTP for the same variables as the Tobit model and for one additional variable (risk aversion). Income did not significantly affect WTP. A scenario with a 10-fold larger risk reduction did not increase WTP significantly. This study is, as far as we know, one of the first attempts to analyse the WTP for drug regulation and should in future be used in studies of the societal costs of drug regulation for epoetin alpha use. Our results indicate that the Dutch general public, especially Dutch dialysis patients, are willing to pay limited amounts to reduce the risk of serious adverse events associated with drug use.

Dynamics of social health insurance development: Examining the determinants of Chinese basic health insurance coverage with panel data

Social health insurance (SHI) is gaining popularity in many developing countries, but there are few systematic empirical studies on the dynamics of SHI development. This study investigates the determinants of coverage of the Basic Healthcare Insurance for Urban Employees (BHI) in China. Using a panel database ranging from 1999 to 2007, the study finds that: (1) economic development plays a valuable role in BHI development; (2) strong financial capacity and administrative capacity in the government contributes to BHI progress; (3) higher trade union density is closely related to more rapid BHI expansion; and (4) taxation agencies are better at collecting SHI premiums. These findings provide evidence-based lessons for new and ongoing SHI programs. In addition, this article aims to make a more general contribution to the study of social policy development by expanding the scope of current theories on social policy development.

Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers

Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system – the chain-DTC – is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system. The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs). The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between caregivers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs.

Interpretation of primary care physicians’ attitude regarding rotavirus immunisation using diffusion of innovation theories

To evaluate primary care physicians’ attitude towards implementation of rotavirus (RV) immunisation into the Swiss immunisation schedule, an eight-question internet-based questionnaire was sent to the 3799 subscribers of InfoVac, a nationwide web-based expert network on immunisation issues, which reaches >95% of paediatricians and smaller proportions of other primary care physicians. Five demographic variables were also inquired. Descriptive statistics and multivariate analyses for the main outcome “acceptance of routine RV immunisation” and other variables were performed. Diffusion of innovation theory was used for data assessment. Nine-hundred seventy-seven questionnaires were returned (26%). Fifty percent of participants were paediatricians. Routine RV immunisation was supported by 146 participants (15%; so called early adopters), dismissed by 620 (64%), leaving 211 (21%) undecided. However, when asked whether they would recommend RV vaccination to parents if it were officially recommended by the federal authorities and reimbursed, 467 (48.5%; so called early majority) agreed to recommend RV immunisation. Multivariate analysis revealed that physicians who would immunise their own child (OR: 5.1; 95% CI: 4.1–6.3), hospital-based physicians (OR: 1.6; 95% CI: 1.1–2.3) and physicians from the French (OR: 1.6; 95% CI: 1.2–2.3) and Italian speaking areas of Switzerland (OR: 2.5; 95% CI: 1.1–5.8) were more likely to support RV immunisation. Diffusion of innovation theory predicts a >80% implementation if approximately 50% of a given population support an innovation. Introduction of RV immunisation in Switzerland is likely to be successful, if (i) the federal authorities issue an official recommendation and (ii) costs are covered by basic health care insurance.

中國農村貧困地區衛生保健問題及對策

LANGUAGE NOTE | Document text in Chinese; abstract also in English.中國農村貧困地區衛生保健面臨籌資與組織等方面的問題，尤其是貧困地區經濟發展滯後，嚴重影響了衛生保健需求的購買力，因而形成了因病致貧和因貧致病的惡性循環，嚴重阻礙着生產力的發展。儘管貧困地區的政府對衛生保健的投資力度不大，但衛生資源的利用極不充分，表現為人力過剩，業務量不足，設備閑置。調查中發現，貧困地區農民在煙酒、求神拜佛、請客送禮等方面的開支甚大，故仍存在保健籌資的潛力。在保健制度方面，合作醫療比例不大，婦幼保償制和免疫保償制覆蓋面低，病人流向在不同保健制度之間差別較大。調查中發現，經濟與保健有着雙向互制作用。衛生保健應與經濟發展同步。政府應承擔發展保健事業的主要責任，加大對保健的投入，引導農民調整消費結構，改善籌資環境，普及健康教育，同時採取分步到位的辦法，逐步建立合作性質的保健制度，並建立相應的法規。Approximately sixty million Chinese people live in China's poverty-stricken rural areas (annual income per capita is lower than 400 Chinese yuan, or US $50). Most people in these areas do not have any level of health insurance. About 72.6% of the individuals who need to visit physicians are not unable to do so because of financial difficulties. The death rate of newborns is as high as 10%. Many households are caught up in a vicious circle: they contract disease because of poverty, and they become poor because of disease.It is vitally important to establish a basic level of health care insurance for these people. According to our investigation and calculation, it requires about 18 hundred million Chinese yuan per year in total (based on medical prices in 1993) to provide a minimum amount of health care for these people, including four prenatal care visits and delivery service, vaccine shots for children (thirteen times total for every child before the age of 13), and basic medical care (including three clinic visits and half a day hospitalization per capita per year). In our investigation, most people in these areas support such a plan for basic health care insurance and express their willingness to pay part of premium.Currently, the average health care spending per capita per year in these areas is 17.40 yuan, or 3.75% of the annual income per capita. Accordingly, there should be no serious difficulty for everyone to pay 2.50% of their annual income for health insurance, except for those whose annual income is lower than 200 yuan. In addition, our investigation found that about 28% of the average household expenditures in these areas are spent for tobacco and liquor. Individuals can be encouraged to save this type of spending for their medical care. Currently, from individual premiums (2.50% of annual income), particular funds from villages and towns, and special government financial subsidies, the total amount of funding can reach about 10 hundred million yuan yearly. In order to obtain 18 hundred million yuan as required, about 8 hundred million yuan a year needs to be raised.China used to attempt to provide basic medical care for people by way of providing financial support to health care providers, i.e., hospitals and clinics, so that they could offer cheap medical care for patients. This has not turned out to be a good strategy. The government should, instead, directly provide financial support to health care recipients, especially those living in poverty-stricken rural areas, so that they will financially be able to set up basic health care insurance for themselves. In contemporary times, it is vitally important to help them establish a basic amount of health care insurance.DOWNLOAD HISTORY | This article has been downloaded 14 times in Digital Commons before migrating into this platform.