Comprehensive Health Insurance Research Articles

Belief in Religion or Participation in Insurance? The Impact of Religious Beliefs on the Decision to Participate in Social Health Insurance in China

Investigating the factors that influence individual decisions to participate in social health insurance is an essential component of constructing a multi-tiered, comprehensive social health insurance system, and religious beliefs may constitute an important potential factor. Utilising data from the China General Social Survey (CGSS), this study has developed a comprehensive explanatory framework encompassing both macro- and micro-level analyses to ascertain the impact of religious beliefs on individual decisions to participate in social health insurance through quantitative methods. The findings indicate that religious beliefs significantly diminish the likelihood of individuals participating in social health insurance, and the influence varies among different types of religions; endogeneity and robustness tests offer robust support for these conclusions. With respect to heterogeneity, the influence of religious beliefs on the decision to participate in social health insurance exhibits differentiation across dimensions such as educational attainment, social trust levels, income levels, and self-rated health statuses. Furthermore, the social interaction effect and the employment opportunity effect are identified as potential mechanisms driving this influence.

Proposed Feature Selection Technique for Pattern Detection in Patients with Pneumonia Records

Pneumonia in Peru is a very serious problem. Its impact in recent years has been aggravated due to the Covid-19 pandemic, generating an increase in infections and deaths without distinguishing the age range, which placed this country on the mortality list due to the pandemic. That is why this research seeks the causes of this problem and evaluates what patterns were detected between the years 2019–2022 in patients with pneumonia in Peru from data set from the Comprehensive Health Insurance (SIS). The data presented values related to age, gender, medication and other significant values to understand the disease. The results of the research were achieved by using the PCA technique where the dimensionality of the data was reduced from 28 to 4 main features (Patient’s year of health care, Age, BMI, Department). Finally, with this processed data set, the K-Means algorithm was used, where it was determined that patients in the 60 to 85 years range are the most affected by J189 pneumonia. In addition, an environmental pattern was found in J189 pneumonia. J128, resulting in a focus on patients on the Peruvian coast in places like Lima or La Libertad.

Health Care Facilities for Unorganised Sectors - Beedi, Cine, and Non-Coal Mine Workers: A Comprehensive Sociological Overview

This paper provides an in-depth review of healthcare facilities for unorganized sector workers in general and particularly in India. It also looks into the systemic lapse ealier in all governments across the globe and a serious and administrative, logistical support now being provided to the unorganised workers in India, particularly focusing on beedi workers, cine industry employees, and non-coal mine workers. Based on a systematic review of existing literature and analysis of dispensary-wise patient data from February 2024, sourced from the Directorate General of Labour Welfare, the study illuminates the disparities in healthcare access and quality across different states. The data includes a detailed breakdown of patient visits across 206 dispensaries, highlighting the heavier reliance on static (on-site) healthcare services compared to mobile services, with notable variations among states such as Karnataka and Madhya Pradesh. This quantitative analysis is graphically represented through charts that depict the distribution of healthcare services and the socio-economic factors influencing healthcare utilization in these sectors. Through critical evaluation of literature the review explores the necessity for more inclusive health insurance schemes and enhanced private sector involvement to mitigate the healthcare challenges faced by these workers. The findings suggest a significant gap in the provision and utilization of healthcare, influenced by logistical, financial, and informational barriers. Recommendations include the implementation of targeted health interventions, expansion of mobile health units, and the development of comprehensive health insurance models that cater specifically to the needs of the unorganized sectors. The study contributes to the broader goal of achieving health equity and improving socio-economic outcomes for these essential yet vulnerable segments of the workforce. Keywords: Unorganized sectors, healthcare accessibility, data analysis, health disparities, beedi workers, cine workers, non-coal mine workers, India, health policy, empirical research.

The effects of state and federal mental health parity laws on working time in the US

This paper provides new empirical evidence on the impacts of state and federal mental health parity laws on related labor market outcomes, particularly working time. The mandated benefits for mental health in the US drive up the costs of providing health insurance substantially. In response, employers may avoid hiring more full-time workers, whose compensation includes health insurance, by increasing working time per worker and reliance on part-time employment; employees may also have an incentive to increase their labor supply to qualify for the benefits. Using individual-level data from the Current Population Survey 1992–2010 and exploiting policy variation by state and year, we find state parity laws increase average weeks worked by 1.4 percent (47.56 weeks as the baseline). Since self-insured firms are exempted from state regulations, parity is estimated to have nearly twice as large an effect on small firms as it does on large firms. Moreover, we study two federal parity laws and find the more comprehensive one is associated with 1.7 percent more weeks worked (47.62 weeks as the baseline). These results indicate that both of employers and employees may response to the increasing costs of providing more comprehensive health insurance by extending their working time.

An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India.

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017-2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI -0.10; outpatient CI -0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India.

Impact of the COVID-19 pandemic on the services provided by the Peruvian health system: an analysis of people with chronic diseases

During the pandemic, many individuals with chronic or infectious diseases other than COVID-19 were unable to receive the care they needed due to the high demand for respiratory care. Our study aims to assess the impact of the COVID-19 pandemic on services provided to people with chronic diseases in Peru from 2016 to 2022. We performed a secondary database analysis of data registered by the comprehensive health insurance (SIS), the intangible solidarity health fund (FISSAL), and private healthcare institutions (EPS), using interrupted time series analysis. Our study identified 21,281,128 individual users who received care. The pooled analysis revealed an average decrease of 1,782,446 in the number of users receiving care in the first month of the pandemic compared with the expected values for that month based on pre-pandemic measurements. In addition, during the pandemic months, there was an average increase of 57,911 in the number of new additional single users who received care per month compared with the previous month. According to the time-series analysis of users receiving care per month based on each chronic disease group, the most significant decreases included people with diabetes without complications and chronic lung disease.

New migrants' access to primary healthcare services in Aotearoa New Zealand.

To explore new migrants' access to primary healthcare services in the first 10 years after arrival in Aotearoa New Zealand. Data come from three New Zealand Health Surveys (2014/2015, 2015/2016 and 2016/2017), which each sampled around 13,500 people, aged 15+ years, who were usual residents of Aotearoa New Zealand. Respondents who said they were born overseas were asked the first year they had come to Aotearoa New Zealand. Those who had arrived in the 10 years before their survey was completed were considered new migrants. The survey data were pooled and around 3,700 respondents were estimated to fit this category. Log-linear models, with adjustments for age, sex, ethnicity and New Zealand Deprivation Index, were used to look at last year use of primary healthcare. Overall, new migrants used primary healthcare similarly to other New Zealanders. They were more likely to have comprehensive health insurance and paid more for GP visits upon arrival but acted similarly to other New Zealanders after 4 years. Generally, new migrants-after adjusting for covariates-appear to be accessing primary healthcare services in a similar manner to other New Zealanders, on average, soon after arrival.

Planned behavior theory: Exploring health risk, insurance literacy, and infrastructure effects

ABSTRACT This study aimed to create a comprehensive health insurance coverage model, integrating key factors like health insurance literacy, health illness, and healthcare infrastructure availability, using the Theory of Planned Behavior (TPB) as its theoretical foundation. In Gujarat, India, a cross-sectional survey involving 1005 respondents was conducted. The survey measured the effects of health insurance literacy, health illness, and healthcare infrastructure availability on health insurance coverage. Data analysis was performed using Hayes's process macros model, considering socio-demographic factors to understand their influence on health insurance coverage. Unexpectedly, healthcare infrastructure and health insurance literacy didn't significantly affect health insurance coverage. However, attitude emerged as a key factor, influencing the intention to purchase health insurance alongside all independent variables. The study's model, incorporating health insurance literacy, health illness, healthcare infrastructure, and the TPB, provided detailed insights into the factors affecting health insurance coverage. The study highlights the critical role of attitude as a mediating factor in health insurance coverage, while demonstrating the minimal impact of healthcare infrastructure and health insurance literacy. It offers a novel model integrating TPB variables, providing valuable perspectives for policymakers, insurers, and healthcare providers.

Inequality in the distribution of resources and health care in the poverty quintiles: Evidence from Peruvian comprehensive health insurance 2018-2019

<b>Introduction: </b>In many regions of the world, healthcare is inequitable and limited, affecting poor populations who need greater health opportunities. Given that Peru’s comprehensive health insurance (SIS) seeks to enhance its coverage for the entire population, it is important to know if its coverage benefits the poorest populations.<br /> <b>Objectives: </b>To determine the allocation of SIS resources and care to the poorest quintile during 2018 and 2019 in Peru.<br /> <b>Methods:</b> We conducted a secondary analysis of data from five Peruvian technical institutions. In 39,8207 Peruvian households, we analyzed the per capita budget assigned to the population affiliated with SIS in microregions of quintile 1 and quintile 2 (poor), and quintile 4 and quintile 5 (non-poor), health coverage, and the level of poverty considering the human development index (HDI) and the regional competitiveness index (RCI).<br /> <b>Results:</b> The poorest regions are inversely correlated with HDI and RCI and have an average service of 25.0% affiliates. In poor areas, the allocated budget was lower (approximately $303,000 to $2.2 million), but the proportion of members requiring care was higher (>70.0%). The budget allocated to health was unfair (p<0.05) between poor areas (maximum resources from $96.28 to $108.14) and non-poor areas (maximum resources from $150.00 to $172.43). Low budget allocations and low household per capita income contributed to poverty in quintile 1 and quintile 2 (p<0.01).<br /> <b>Conclusions:</b> the poorest regions have greater inequity and the majority of affiliates do not use or do not have access to SIS services, but they have a greater need for health care. In addition, poor regions have a high amount of population without SIS coverage, and low allocated budgets, which affects competitiveness and regional development.

Financial burden of tuberculosis diagnosis and treatment for patients in Ethiopia: a systematic review and meta-analysis

BackgroundDespite the diagnosis and treatment of tuberculosis (TB) given free of charge in many high-burden countries, the costs that patients face in the cascade of care remain a major concern. Here, we aimed to investigate the financial burden of TB diagnosis and treatment for people with TB in Ethiopia.MethodFor this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, and Cochrane Center for Clinical Trials from December 1 2022 to 31 June 2023 for articles reporting the cost of diagnosis and treatment for patients regardless of their age with all forms of TB in Ethiopia. Major study outcomes were catastrophic costs, direct (out-of-pocket) pre-diagnosis, medical cost, and post-diagnosis costs, indirect (income loss) costs, coping costs, and total costs. We have used a threshold of 20% to define catastrophic costs. We used random-effects meta-analyses to calculate summary estimates of costs. R-studio software was used for analysis. The study is registered with PROSPERO: CRD42023387687.ResultTwelve studies, with a total of 4792 patients with TB, were included in our analysis. At the 20% threshold of total expenses, 51% of patients (2301 participants from 5 studies, 95% CI: 36-65%, I2 = 97%) faced catastrophic costs due to bacteriologically confirmed drug-sensitive pulmonary TB. Private facility diagnosis, drug-resistance TB, TB-HIV co-infection, hospitalization, and occupation were found to be associated with catastrophic costs. Reduction in the total cost spent by the patients was associated with digital adherence interventions, community-based direct observed therapy, short-course MDR-TB treatment regimens, and active case-finding. Pre-diagnosis costs had a positive correlation with diagnosis delays and the number of facilities visited until diagnosis. Post-diagnosis costs had a positive correlation with rural residence and inpatient treatments.ConclusionIrrespective of a national policy of free TB service, more than half of TB patients are suffering catastrophic costs due to drug-sensitive pulmonary TB in Ethiopia and most of the patients spend a lot of money during the pre-diagnosis period and intensive phase, but declined drastically over time. Active case-finding, digital adherence interventions, community-based treatment, and comprehensive health insurance coverage have the potential to minimize the financial burden of TB diagnosis and treatment.

Risk factors of reattempt among suicide attempters in South Korea: A nationwide retrospective cohort study.

This study aimed to identify underlying demographic and clinical characteristics among individuals who had previously attempted suicide, utilizing the comprehensive Health Insurance Review and Assessment Service (HIRA) database. Data of patients aged 18 and above who had attempted suicide between January 1 and December 31, 2014, recorded in HIRA, were extracted. The index date was identified when a suicide attempt was made within the year 2014. The medical history of the three years before the index date and seven years of follow-up data after the index date were analyzed. Kaplan-Meier estimate was used to infer reattempt of the suicide attempters, and Cox-proportional hazard analysis was used to investigate risk factors associated with suicide reattempts. A total of 17,026 suicide attempters were identified, of which 1,853 (10.9%) reattempted suicide; 4,925 (28.9%) patients had been diagnosed with depressive disorder. Of the reattempters, 391 (21.1%) demonstrated a history of suicide attempts in the three years before the index date, and the mean number of prior attempts was higher compared to that of the non-reattempters (1.7 vs.1.3, p-value < 0.01). Prior psychiatric medication, polypharmacy, and an increase in the number of psychotropics were associated with suicide reattempt in overall suicide attempters. (Hazard ratio (HR) = 3.20, 95% confidence interval [CI] = 2.56-4.00; HR = 2.42, 95% CI = 1.87-3.14; HR = 19.66, 95% CI = 15.22-25.39 respectively). The risk of reattempt decreased in individuals receiving antidepressant prescriptions compared to those unmedicated, showing a reduction of 78% when prescribed by non-psychiatrists and 89% when prescribed by psychiatrists. Similar risk factors for suicide reattempts were observed in the depressive disorder subgroup, but the median time to reattempt was shorter (556.5 days) for this group compared to that for the overall attempters (578 days). Various risk factors including demographics, clinical characteristics, and medications should be considered to prevent suicide reattempts among suicide attempters, and patients with depressive disorder should be monitored more closely.

A SYSTEMATIC REVIEW ON AGING IN THE COMMUNITY AND CULTURE AMONG CHINESE OLDER ADULTS

Abstract Chinese older adults face many barriers to healthy aging in community, such as increased financial burden, threatened place security, limited accessibility to medical services, language and transportation difficulties, daily housework and repairs challenges, etc. This systematic review aimed to examine and report the results current scholars have published in journal articles in the last decade (2010-present) on the influence of culture on Chinese older adults aging in community. Combination terms of “aging in community or aging in place,” “Chinese,” and “culture or cultural or ethnicity or identity or values” were used when searching in the four databases: CINAHL Complete; ERIC; MEDLINE; and PsycInfo. Researcher examined abstracts of all journal articles retrieved using the above criteria and further determined their relevance for inclusion. A total of 38 journal articles were included. Findings suggest that aging in community reflects a changing policy tendency from institution-based to community-centered care which better responds to the needs of the growing Chinese senior population. Family care remains older adults’ preferences. However, individual, community, and larger contextual factors can be influenced, such as the number of adult children in the household, education level, residential area, accessibility to healthcare facilities, perceived cultural values of filial piety, state-owned enterprise reformation, and the one-child policy in China. Policymakers are encouraged to promote older adults’ personalized care plans; comprehensive health insurance coverage; constructive social/community environments (e.g. community parks or community open spaces for age-friendly activities); home care support, or smart home technologies for regular health monitoring.

Magnitude of health expenditure induced removable poverty in India: Some reflections of Ayushman Bharat

The authors have measured the health expenditure-induced removable poverty in India using nationally representative consumer expenditure surveys of three quinquennial rounds conducted by the National Sample Survey Organization (NSSO). This study has also focused on the reflections of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the world's largest Government-funded health insurance scheme, on these poverty rates in the country. The study has used headcount, payment gap, and concentration index to measure the economic burden and impoverishment impact of out-of-pocket (OOP) health expenditure. The analysis shows that the incidence and depth of poverty are substantially understated because of overlooking OOP health expenditure in the country's standard poverty measure. Outpatient care contributes almost four times more than inpatient care to health expenditure-induced impoverishment in India, though this care has not been covered in the AB-PMJAY. Muslims, among all religious groups, Scheduled Castes among social groups, and casual labourers among different household types are more vulnerable to OOP health expenditure-induced removable poverty in the country. Poverty, in general, has dropped significantly, but the share of health expenditure-induced poverty in general poverty has increased substantially. It has risen considerably in rural areas and among India's most vulnerable sections of society in the past 20 years. We emphasised that universal health insurance coverage is needed in India. Implementing comprehensive health insurance schemes that cover both inpatient and outpatient care can help alleviate the financial burden of healthcare expenses on households and contribute to reducing poverty rates.

Cancer care and economic burden-A narrative review.

Cancer care poses a significant economic burden in India, where noncommunicable diseases contribute to a large number of deaths and disability-adjusted life-years. Despite economic growth, equitable wealth distribution remains a challenge, leading to inequalities in healthcare access. India's healthcare system is primarily privatized, financed through out-of-pocket expenditure (OOPE), and lacks coverage for a majority of the population. As a result, individuals without financial means face catastrophic health consequences when seeking necessary healthcare. OOPE in India's healthcare system is a major concern, with medicines accounting for a significant portion of expenses, followed by diagnostic tests and consultation fees. Nonmedical expenses also contribute to the financial burden. Cancer care specifically faces substantial financial challenges, with high treatment costs, reduced workforce participation, and the need for distress financing. Cancer-related OOPE is predominantly borne by patients and their families, leading to significant financial strain. The lack of comprehensive health insurance coverage and limited access to publicly funded healthcare services exacerbate the problem. Catastrophic health expenditure (CHE) in cancer care is prevalent, pushing households into financial distress and potentially impoverishment. Efforts have been made to address this issue, such as increasing public spending on healthcare and implementing health insurance schemes. However, challenges remain in ensuring their effectiveness and reach. The role of family care physicians is crucial in supporting patients and their families during catastrophic health expenditures related to cancer-related palliative care. They coordinate care, provide advocacy, emotional support, symptom management, and facilitate end-of-life discussions. Comprehensive measures are needed to strengthen healthcare infrastructure, improve access to affordable cancer care, enhance health insurance coverage, and implement supportive measures for cancer patients. Additionally, promoting preventive measures and early detection can help reduce the need for expensive treatments and decrease the risk of catastrophic health expenditures.

Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey

BackgroundThe government-subsidized health insurance scheme Seguro Integral de Salud (“SIS”) was introduced in Peru initially to provide coverage to uninsured and poor pregnant women and children under five years old and was later extended to cover all uninsured members of the population following the Peruvian Plan Esencial de Aseguramiento Universal – “PEAS” (Essential UHC Package). Our study aimed to analyze the extent to which the introduction of SIS has increased equity in access and quality by comparing the utilization of maternal healthcare services among women with different insurance coverages.MethodsRelying on the 2021 round of the nationally-representative survey “ENDES” (Encuesta Nacional Demográfica y de Salud Familiar), we analyzed data for 19,181 women aged 15–49 with a history of pregnancy in the five years preceding the survey date. We used a series of logistic regressions to explore the association between health insurance coverage (defined as No Insurance, SIS, or Standard Insurance) and a series of outcome variables measuring access to and quality of all services along the available maternal healthcare continuum.ResultsOnly 46.5% of women across all insurance schemes reported having accessed effective ANC prevention. Findings from the adjusted logistic regression confirmed that insured women were more likely to have accessed ANC services compared with uninsured women. Our findings indicate that women in the “SIS” group were more likely to have accessed six ANC visits (aOR = 1.40; 95% CI 1.14–1.73) as well as effective ANC prevention (aOR = 1.32; 95% CI 1.17–1.48), ANC education (aOR = 1.59; 95% CI 1.41–1.80) and ANC screening (aOR = 1.46; 95% CI 1.27–1.69) during pregnancy, compared with women in the “Standard Insurance” group [aOR = 1.35 (95% CI 1.13–1.62), 1.22 (95% CI 1.04–1.42), 1.34 (95% CI 1.18–1.51) and 1.31(95% CI 1.15–1.49)] respectively. In addition, women in the “Standard Insurance” group were more likely to have received skilled attendance at birth (aOR = 2.17, 95% CI 1.33–3.55) compared with the women in the “SIS” insurance group (aOR = 2.12; 95% CI 1.41–3.17).ConclusionsOur findings indicate the persistence of inequities in access to maternal healthcare services that manifest themselves not only in the reduced utilization among the uninsured, but also in the lower quality of service coverage that uninsured women received compared with women insured under “Standard Insurance” or “SIS”. Further policy reforms are needed both to expand insurance coverage and to ensure that all women receive the same access to care irrespective of their specific insurance coverage.

An Analytical Data Model to Improve Benefits of the Comprehensive Health Insurance System By Data Mining Techniques

Health insurance represents a crucial safeguard against the myriad risks associated with individual health conditions, covering expenses related to examinations, diagnosis and treatment, as well as providing psychological and physical support. Until mid-2019, Egypt implemented a social health insurance system, and then moved to a renewed framework known as the comprehensive health insurance system in the latter half of 2019. The research at hand focuses on exploring a new mechanism through develop a new model, it can be help the General Authority for Health Insurance to attainment of maximum benefits, whether in terms of individuals medical services or the enhancement of the nation's overall income return.&#x0D; The researcher depends on using the data mining technique to conduct specialized analyzes of big data for the new model, to offer the numerous advantages, including empowering decision-makers to make accurate decisions based on reliable information and proficient data analysis, Based on the new model for the health insurance system that was prepared and implemented using the Weka program, version 3.8.6, through the classifier scheme (classifiers.trees.J48 algorithm), the applied pattern was used:&#x0D; (Scheme:weka.classifiers.misc.InputMappedClassifier -I -trim -Wweka.classifiers.trees.J48 -- -C 0.25 -M 2), Through the Weka program, a new model was designed that contains two parts. The first part is to classify the insured into insurance categories according to their monthly salaries, and the second part is to predict the classification and distribution of employees among insurance packages according to the new health insurance model. The model was prepared using Weka.classifiers.trees.J48. software to analysis the dataset of 2781 employees.&#x0D; One of the significant outcomes that the researcher emphasizes from implementing the new model is the attainment of maximum benefits, whether in terms of individual medical services or the enhancement of the nation's overall income return. Under the existing health insurance law in Egypt, the monthly subscription fee is a flat 1% for all employees, without accounting for other factors. The results of applying the new model showed the effectiveness of the model through a comparison between the current subscription fees and the new health insurance model, developed using the same dataset of 2781 employees, reveals that the total monthly subscription fees under the current health insurance system amount to 153057.97 Egyptian Pounds (L.E.), whereas the total subscription fees under the new health insurance system model reach 365998.91 L.E., The financial benefits realized from the new model amount to 212940.94 L.E., representing a percentage increase of up to 139.12%. This demonstrates a considerable improvement in financial outcomes, and the potential advantages of transitioning to the new health insurance model.

Peranan Program Jaminan Kesehatan Nasional (JKN) Dalam Mendorong Sustainable Development Goals (SDGs) di Indonesia

The National Health Insurance has received great attention in the Sustainable Development Goals, where one of the main targets is to guarantee a healthy life and promote welfare for all people at all ages or later called Universal Health Coverage (UHC). The National Health Insurance is a social security program based on Law Number 40 of 2004 which aims to provide comprehensive health insurance coverage for every Indonesian so that Indonesians can live healthy, productive and prosperous lives. Whereas Universal Health Coverage is a health system that ensures that every citizen in the population has equitable access to quality promotive, preventive, curative and rehabilitative health services at affordable costs. In this study, in its implementation, there was an increase in the Community Health Development Index which was marked by an increase in health service efforts with cross-sector, central and regional synergy towards achieving Universal Health Coverage. The problem found in this study is that there are still many problems found regarding mothers, babies and toddlers. The nutritional status of the people who have a double burden, as well as problems regarding the quality and access to basic and referral health services which include fulfilling the conditions and facilities for basic and referral health services, fulfilling the availability of facilities and infrastructure for health service facilities both medical and non-medical, and not yet covering guarantee services national health as a whole. The purpose of this study was to find out the planning for the implementation of the National Health Insurance (JKN) program in Encouraging Sustainable Development Goals (SDGs) in Indonesia, especially in Medan City. This research is a descriptive qualitative research. The process of monitoring and evaluating the implementation of activities is carried out according to their duties and functions and in accordance with the procedures and provisions of the 1945 Constitution, Law Number 40 of 2004 concerning the National Social Security System&#x0D; Keywords: Role, National Health Insurance, SDGs

Creating and Implementing a Community Engagement Strategy for the 2022-2027 Illinois Comprehensive Cancer Control Plan Through an Academic-State Public Health Department Partnership.

Comprehensive cancer control (CCC) plans are state-level blueprints that identify regional cancer priorities and health equity strategies. Coalitions are encouraged to engage with community members, advocacy groups, people representing multiple sectors, and working partners throughout the development process. We describe the community and legislative engagement strategy developed and implemented during 2020-2022 for the 2022-2027 Illinois CCC plan. The engagement strategies were grounded in theory and evidence-based tools and resources. It was developed and implemented by coalition members representing the state health department and an academic partner, with feedback from the larger coalition. The strategy included a statewide town hall, 8 focus groups, and raising awareness of the plan among state policy makers. A total of 112 people participated in the town hall and focus groups, including 40 (36%) cancer survivors, 31 (28%) cancer caregivers, and 18 (16%) Latino and 26 (23%) African American residents. Fourteen of 53 (26%) focus group participants identified as rural. Participants identified drivers of cancer disparities (eg, lack of a comprehensive health insurance system, discrimination, transportation access) and funding and policy priorities. Illinois House Resolution 0675, the Illinois Cancer Control Plan, was passed in March 2022. The expertise and voices of community members affected by cancer can be documented and reflected in CCC plans. CCC plans can be brought to the attention of policy makers. Other coalitions working on state plans may consider replicating our strategy. Ultimately, CCC plans should reflect health equity principles and prioritize eliminating cancer disparities.

Out-of-Pocket Health Expenditures Associated with Chronic Health Conditions and Disability in China.

The objective of this study is to estimate the extra costs of living associated with chronic health conditions and disabilities in China. Leveraging the 2018 China Health and Retirement Longitudinal Study involving 13,530 respondents aged 50 and over, we apply both an ordinary least squares linear regression model and a logistic model to analyze the correlation between medical out-of-pocket expenditures (OOPEs) and chronic health conditions, as well as disabilities measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations. This paper bridges the gap in the literature on OOPEs and their association with disabilities and chronic health conditions, respectively. We find that ADL limitations, IADL limitations, and chronic health conditions are consistently associated with higher OOPEs. The odds that older persons with disabilities and chronic health conditions incur OOPEs are two to three times higher than for persons without disabilities and chronic health conditions, respectively. Persons with disabilities and chronic health conditions have the highest OOPEs. The findings suggest that more policy and research attention is necessary to improve the financial protection of those with chronic health conditions and disabilities, including through access to comprehensive health insurance coverage.

Examining the &amp;ldquo;Medicare Effect&amp;rdquo; on Distant-Stage Cancer Diagnoses by Site, Gender, and Rurality

Background: Compared to cancers detected early, distant stage cancers are associated with lower survival, diminished quality of life, and higher costs. Evidence suggests that greater access to comprehensive health insurance (i.e., Medicare) improved early detection. Yet, few studies have evaluated the effect of Medicare coverage across cancers or factors influencing healthcare use. Methods: This study analyzed 35 years of population-based cancer registry data from the Surveillance Epidemiology and End Results program for eight common cancers: Oral, Digestive, Respiratory, Skin, Genital, Urinary, Endocrine, and Breast. Leveraging the subjective threshold determining Medicare’s eligibility at age 65, Medicare’s effect on the probability of a distant diagnosis was estimated using Robust Non-Parametric Regression Discontinuity models. Results: Medicare was associated with reduced proportion of distant diagnoses for five common cancers. The proportion of distant cancers declined by 1.7-percentage points for digestive cancers (p &lt; 0.01), 1.6-percentage points for respiratory cancers (p &lt; 0.01), 0.5-percentage points for genital cancers (p &lt; 0.05), 1.4-percentage points for urinary cancers (p &lt; 0.01), and 0.8-percentage points for female breast cancers (p &lt; 0.01). The relative difference from average distant stage rates for these significant estimates range from 3% (Respiratory) to 15% (Genital). Most estimates were consistent across gender, but Medicare was only associated with declined distant-stage diagnoses for patients in urban and metro regions. Conclusions: This study reaffirms that Medicare coverage is associated with earlier diagnoses for patients in urban and metro regions for digestive, respiratory, genital, urinary, and female breast cancers. These results stress the importance of healthcare insurance, but also reveal the limitations of insurance expansion policies for patients in rural areas and for cancers without standard screening protocols.