Current Health Insurance System Research Articles

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.
 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:
 (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.
 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.

Influence of Narrative Strategies on Fundraising Outcome: An Exploratory Study of Online Medical Crowdfunding

Online medical crowdfunding (OMC) has attracted massive attention and participation in China. Despite its goal to lift the financial burden caused by expensive medical expenditure, little has been done to evaluate its impact on healthcare inequality. We examine the social consequences of OMC based on a large random sample extracted from one of the most widely-used OMC platforms in China. Our analysis shows that a disproportionally high percentage of fundraising campaigns are launched for patients with low socioeconomic status suffering from various illnesses, including many rare diseases. These findings suggest that OMC plays a positive role in providing an alternative channel for disadvantaged patients under the current health insurance system. We further examine whether and the extent to which the narrative style of solicitation text—fundraising campaign description—influences fundraising outcomes using natural language processing (NLP). The results show that expressions conveying optimism tend to result in a higher completion ratio, whereas descriptions engaging in moral mobilization or focusing on financial burden tend to have a negative impact on fundraising outcomes.

The Main Challenges Facing Social Policy Makers in Less Developed Countries: A Case Study of Healthcare in China

Population ageing brings additional challenges to many countries around the world. As China became the first country in the world to have more than 1 billion people aged 60 and above in 2010, this has put forward higher requirements for the amount of medical resources, quality of medical services, reliability and fairness in China. Providing a comprehensive health care system is a major challenge for policymakers. The purpose of this article is to discuss the challenges facing policymakers in less developed countries. This paper selects the Chinese healthcare system as a case study for analysis. To explore the effectiveness of the Chinese government's measures to formulate relevant basic medical security policies, reform the medical insurance system and subsidy levels, and comprehensively cover medical insurance. The study found that while health insurance levels have grown significantly, there are still challenges in coordinating programs, and many management and financing issues have arisen in the sustainable development of hospital services. Finally, it will describe how policymakers can use the current health insurance system to address these challenges. This article will discuss in detail two specific challenges facing the health care reform process, one is the discussion on the coverage and segmentation of medical insurance, and the other is the analysis on the future reform of public hospitals.

The interaction of delayed retirement initiative and the multilevel social health insurance system on physical health of older people in China.

With many social challenges posed by an ageing population, the delayed retirement initiative has received wide attention from policymakers. However, China's current multi-level social health insurance system seems not perfect and not ready for the delayed retirement initiative. The public are generally concerned that the benefits of late retirees cannot be well guaranteed. Using data from China Health and Retirement Longitudinal Study (CHARLS) and the chorological design (CHARLS-2015 and -2018 waves), this study finds that (1) late retirement could be beneficial for physical health among older adults; (2) there have disparities between the effects of different social health insurances on physical health among older adults; (3) social health insurances could weaken the benefits of late retirement to physical health among older adults. Results imply that China's current multi-level social medical insurance system may lag behind the proposed delayed retirement initiative and have policy limitations for late retirees.

Factors Affecting Dental Hygienists’ Recognition of Elderly Implant Insurance

Objectives: The purpose of this study is to assess dental hygienists’ recognition of elderly implant insurance and examine the factors affecting it. Methods: This study was conducted on 215 dental hygienists working in dental clinics with more than four years of clinical work experience, based on the time when the elderly implant insurance benefit was implemented. Data collection was conducted through a self-contained survey through direct visits and mail. The questionnaire consisted of 16 questions that covered demographic characteristics, general awareness of dental health insurance, and detailed perception of elderly implant insurance. Multiple regression analysis was performed to identify the factors affecting dental hygienists’ awareness of the coverage of elderly implant insurance. Results: The dental hygienists had a low average perception of dental health insurance. The dental hygienists’ awareness of the elderly implant insurance coverage increased when they were more interested in national health insurance (p=.002), when they highly thought that the current dental health insurance is not being implemented for national oral health (p=.000), and when they highly thought that the current dental health insurance system aims to stabilize one’s family life (p=.004). Conclusions: Through this study, dental hygienists were able to identify implant health insurance benefits and awareness. It is expected that it will contribute to the improvement of awareness and awareness of dental health insurance benefits by dental hygienists according to the changing dental health insurance benefits in the future.

Differences in injury and trauma management between migrant workers and citizens.

In Taiwan, legal migrant workers and almost all citizens are covered under the National Health Insurance program. Work-related injuries and various traumatic events constitute 2 major reasons for seeking medical care among migrant workers. Therefore, we conducted this retrospective study to delineate the clinical features of migrant workers with trauma and determine differences in trauma management between migrant workers and citizens under the current medical care and insurance system.We retrospectively reviewed the data of all patients with trauma who were discharged from adult wards between January 1, 2015 and December 31, 2016. We identified 5854 citizens and 110 migrant workers during the chart review. Data related to the prehospital period, emergency department, hospital course, and prognosis were collected and compared between migrant workers and citizens.More than half of the traumatic events among migrant workers occurred at factory, farm, or mine locations (migrant workers vs all citizens: 57.3% vs 11.5%), whereas most traumatic events among citizens occurred at street and home or dormitory locations (street: migrant workers vs all citizens: 17.3% vs 52.5%; home or dormitory: migrant workers vs all citizens: 0.9% vs 14.3%). Compared with citizens, migrant workers had lower scores in injury severity scores and new injury severity scores, but higher scores in revised trauma score and trauma and injury severity scores. The hospital course and prognosis were similar between migrant workers and citizens.Compared with citizens, migrant workers had a higher incidence of work-related injury and sustained less severe injuries. Under the coverage of the current health care and insurance system in Taiwan, migrant workers with trauma and work-related injuries receive comparable medical care and prognoses to citizens.

Outpatient Prescriptions of Kampo Formulations in Japan.

Objective Kampo is a traditional Japanese medicine using formulae of natural agents. Although Kampo is widely practiced, information regarding the current prescriptions of Kampo formulations is lacking. The aim of the study was to describe the outpatient use of Kampo formulations in the current Japanese health insurance system. Methods From the JMDC Claims Database, we identified subscribers with outpatient prescriptions of Kampo extract formulations between April 2017 and March 2018. Prescription records were summarized at the individual level to describe the pattern of each formula's use, such as the frequency of prescription and the number of days within a year that were covered by the prescriptions. We also examined whether or not Kampo formulations were prescribed in combination with other drugs. Results Of the 4.5 million subscribers, 13.5% received prescriptions of Kampo extracts within 1 year, and 54% of Kampo users were women. The most commonly prescribed Kampo formulae included kakkonto, shoseiryuto, and maoto, which were used for the short term covering a median of 5 to 7 days. There were also several formulae that were prescribed for longer periods. The median numbers of days covered by kamishoyosan and keishibukuryogan were 60 and 56, respectively. Kampo formulations were used in combination with Western drugs in 85% of prescriptions. Conclusion Kampo formulations are commonly prescribed under the Japanese insurance system and are frequently used in combination with Western drugs. The pattern of prescriptions varied across different formulae.

Life Satisfaction of Middle-Aged and Older Chinese: The Role of Health and Health Insurance

The Chinese government has launched a series of health reforms to establish universal health insurance coverage, particularly for vulnerable groups, including middle-aged and older adults. However, the current public health insurance system is highly fragmented, consisting of different programs with different levels of premiums and benefits. We analyse whether the universal health insurance system increases the life satisfaction of middle-aged and older Chinese people and to what extent the type of health insurance affects the life satisfaction of this group. Our study is based on data from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of Chinese aged 45 and above, in 2011, 2013, and 2015. We find that the life satisfaction of middle-aged and older adults does not depend on having any health insurance coverage but varies with the type of health insurance coverage, controlling for potential confounding variables such as health status, occupation, hukou status, and other demographic variables. Individuals covered by the most generous program, the Government Medical Insurance, reported a higher life satisfaction. In comparison, individuals covered by the Urban Employee Medical Insurance, the Urban Resident Medical Insurance, and the New Rural Cooperative Scheme reported a lower life satisfaction by 0.155, 0.106, and 0.112 standard deviations, respectively. Our results suggest that establishing a more equitable health insurance system should be the next step in health reforms in China.

Problems and prospect of development of health insurance system in China

This article examines the current health insurance system in China. Emphasis is made on determination of the key features and peculiarities of Chinese health insurance system, as well as its flaws and ways for overcoming them. The author believes that resolution of major issues in Chinese health insurance system requires increased state involvement thereof, since the marked-based approach that has been in effect for the past 30 years lead to inequality and deterioration of the quality of healthcare. The following recommendations are made on the improvement of health insurance system: launch the targeted financing projects that would allow the citizens with especially dangerous diseases, such as cardiovascular, oncological, digestive and nervous system, diabetes, to be paid in full by insurance and state subsidies in receiving medical services and medications; forgo the principle of “annual limit” for medical services and medications under insurance coverage; unify insurance payment systems in different regions in order to improve the quality of rendering healthcare services in poor areas. The author also offers to consider the possibility of implementation of the universal guaranteed service standards that would ensure equal level of the quality of basic services regardless the type of insurance.

Life Satisfaction of Older Chinese: The Role of Health and Health Insurance

The Chinese government has launched a series of health reforms to establish universal health insurance coverage, particularly for vulnerable groups, including older adults. However, the current public health insurance system is highly fragmented, consisting of different programs with different levels of premiums and benefits. We analyse whether the universal health insurance system increases the life satisfaction of middle-aged and older Chinese people and to what extent the type of health insurance affects the life satisfaction of this group. Our study is based on data from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of Chinese aged 45 and above, in 2011, 2013, and 2015. We find that the life satisfaction of middle-aged and older adults does not depend on having any health insurance coverage but varies with the type of health insurance coverage, controlling for potential confounding variables such as health status, occupation, hukou status, education, and other demographic variables. Individuals covered by the most generous program, the Government Medical Insurance, reported a higher life satisfaction. In comparison, individuals covered by the Urban Employee Medical Insurance, the Urban Resident Medical Insurance, and the New Rural Cooperative Scheme reported a lower life satisfaction by 0.155, 0.106, and 0.112 standard deviations, respectively. Our results suggest that establishing a more equitable health insurance system should be the next step in health reforms in China.

Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China

BackgroundReform of the health care system in China has prompted concerns about the utilization of mental health services. This study aims to compare the utilization of mental health services among inpatients in various types of health institutions in Shanghai (community health care centres, secondary general hospitals, tertiary general hospitals, and specialty hospitals).MethodsBased on electronic health record (EHR) data, we extracted all of the mental hospitalization data from various types of public health institutions in Pudong New Area, Shanghai, China, from 2013 to 2016. The distribution of mentally ill inpatients and the possible factors contributing to the observed differences in these institutions were analysed.ResultsSpecialty psychiatric hospitals in Pudong New Area, Shanghai, admitted more inpatients and treated in patients with more severe disorders (49.73%). However, those who were male (OR = 0.545), were elderly (OR = 20.133), had inferior insurance (urban social insurance for citizens: OR = 4.013; paying themselves, OR = 29.489), had a longer length of stay (OR = 1.001) and had lower costs (OR = 0.910) were more likely to choose community health centres than specialty hospitals. Those who preferred the secondary and tertiary hospitals to the specialty ones were more likely to be in the male, elderly, married, shorter length of stay and higher-cost groups. Notably, compared to those with urban social insurance for workers, those who had urban social insurance for citizens (OR = 3.136) or paid out-of-pocket (OR = 9.822) were significantly clustered in the tertiary hospitals rather than the specialty hospitals.ConclusionsInpatients who were male, were older, had inferior insurance, had a longer length of stay and had lower costs preferred the elementary health services. However, the utilization of mental health care in high-tier institutions reflected defects, especially the fact that the current health insurance system does not adequately restrict patients’ choices, and those who paid more tended to choose tertiary hospitals instead of professional specialty ones. We suggest that psychiatric services should be enhanced by instituting reforms, including public education, improved health insurance, a forceful referral system, and competency reinforcement for primary care physicians, to provide a more integrated mental health system.

Comparison of laparoscopic surgery and conventional laparotomy for surgical staging of patients with presumed low-risk endometrial cancer: The current state of Japan

ObjectiveNational health insurance coverage for the laparoscopic staging surgery for patients with stage IA endometrial cancer started from April 2014 in Japan. We conducted this retrospective study to evaluate the surgical outcomes of the laparoscopic surgery for patients with low-risk endometrial cancer compared with those of the laparotomy. Materials and methodsA total of 120 patients with presumed low-risk endometrial cancer, who were treated at Tottori University Hospital between 2005 and 2016, were eligible for this study. The laparoscopic staging surgery included only the pelvic lymphadenectomy and not the para-aortic lymphadenectomy. We evaluated the discrepancy between preoperative presumption and postoperative diagnosis of recurrent risk factors. ResultsForty patients underwent the laparoscopic surgery and 80 patients received the laparotomy. The laparoscopic surgery resulted in less intraoperative blood loss and shorter hospital stay. The operative time was significantly longer for the laparoscopic surgery compared with the laparotomy, but this difference was not seen in obese patients with a body mass index ≥30 kg/m2. The type of the surgical procedure did not affect the incidence of perioperative complications. Among 120 patients, 104 (86.6%) were diagnosed as FIGO stage IA, 118 (98.3%) with endometrioid adenocarcinoma grade 1 or 2, and 107 (89.1%) with myometrial invasion depth <50%. ConclusionThe laparoscopic staging surgery is a feasible and safe alternative to the laparotomy for patients with presumed low-risk endometrial cancer, especially for obese patients. To perform the laparoscopic surgery for patients with stage IA endometrial cancer under the current national health insurance system, it is important to limit the candidates to low-risk disease based on a precise diagnosis before the surgery.

Ethical Reflections on the Equity of the Current Basic Health Insurance System Reform in China: A Case Study in Hunan Province.

China's current basic health insurance reform aims at promoting equity in the economic accessibility of health services for all citizens, to better ensure healthcare justice. Therefore, it is important to assess equity not only from a socioeconomic perspective but also from an ethical angle. This article investigates the basic health insurance system of Hunan Province in China by focusing on insurance types as well as their classification standards, mechanisms, and utilization according to local policy documents and data. This study demonstrates the reforming achievements and the inequity of institutional design according to two interrelated dimensions: equal opportunity of access to healthcare insurance and reducing inequality in insurance benefits. The article concludes that to achieve opportunity equity and outcome fairness, the reform should focus on designing the system to promote equity with respect to procedures and rules and to be more attentive to the interests of vulnerable groups and especially to rural residents.

Improvement of the reduction in catastrophic health expenditure in China's public health insurance.

This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China’s current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China’s current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China’s health insurance system in order to reduce CHE. It’s found with China’s current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It’s concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China.

Effect of the New Health Care Reform on catastrophic health expenditure in households of patients with chronic diseases in Shaanxi Province: a before-and-after analysis

BackgroundIn 2009, China officially launched the New Health Care Reform. This study aimed to measure the occurrence of catastrophic health expenditure of households with at least one member diagnosed with chronic diseases (hereafter referred to as chronic households) in Shaanxi Province before and after the reform, and explore the influence of the New Health Care Reform on catastrophic health expenditure. MethodsThe data were from the fourth and fifth National Household Health Service Surveys of Shaanxi Province. In total, 1942 chronic households in 2008 (954 in urban areas and 988 in rural areas) and 7704 households in 2013 (2870 in urban areas and 4834 in rural areas) were selected for analysis. WHO's method was used to estimate catastrophic health expenditure, which was defined as an out-of-pocket payment for health care equal to or higher than 40% of a household's capacity to pay. A multilevel logistic regression model was used to explore the influence of the New Health Care Reform on the presence of catastrophic health expenditure. We used the concentration index to measure the income-related inequality in catastrophic health expenditure. FindingsIn rural areas, the proportion of households incurring catastrophic health expenditure dropped (288 [29%] households in 2008 vs 1142 (24%) in 2013; χ2 13·517, p=0·00024). However, in urban areas, the proportion of households suffering from catastrophic health expenditure increased (183 [19%] households in 2008 vs 716 [25%] in 2013; χ2 13.235, p=0·00027). After controlling for confounding variables (eg, commercial insurance, household size, having elderly members, having children, household economic status, and age, gender, education, marital status, and employment status of household head), the random-intercept logistic regression model showed a significant interaction term between year and geographic location, implying that the influence of the New Health Care Reform on catastrophic health expenditure differed between urban and rural areas. From 2008 to 2013, the concentration index of catastrophic health expenditure in rural areas increased from −0·4572 to −0·5499 (difference −0·0927, Z −2·22, p=0·026). InterpretationOur study suggested that the implementation of the New Health Care Reform might not have been effective in reducing catastrophic health expenditure for households of patients with chronic diseases, especially in urban areas. Additionally, the income inequality of catastrophic health expenditure was greater in 2013 than in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts to develop the current health insurance system and optimise the hierarchical health-care system are required to improve protection against catastrophic health expenditure. FundingXi'an Jiaotong University (grant number GG1K004).

Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China

ObjectiveChina has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs...

Chinese health care system and clinical epidemiology.

China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources.

The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.

Normalizing Bribes as a Solution to Romania’s Deteriorating Health System

Normalizing Bribes as a Solution to Romania’s Deteriorating Health System

Public Health Insurance in Vietnam towards Universal Coverage: Identifying the challenges, issues, and problems in its design and organisational practices

Vietnam is attempting to achieve universal health insurance coverage by 2014. Despite great progress, the country faces some challenges, issues and problems. This paper reviewed official documents, existing reports, and related literature to address: (1) grand design for achieving universal health coverage, (2) current insurance coverage, (3) health insurance premium and subsidies by the government, (4) benefit package and payment rule, and (5) organizational practices. From the review, it became apparent that the insurance system is broadly speaking complex and there are huge ambiguities, which seems hindering universal coverage of health insurance. Also, hidden distorted incentives and lack of financial stability are the main challenges in the current public health insurance system in the country.