Health Insurance Participants Research Articles

The impact of digital finance on young People's health insurance participation decisions in China.

The digital finance era has reshaped young people's lifestyles, risk perceptions and insurance participation decisions. Modern youth have to constantly seek for rational social security support and construct individual protection barriers to adapt to new lifestyles and social structures. China's multi-tiered, universal health insurance system is urgently needed to satisfy young people's flexible needs and rational decision-making. Based on the micro data from 2011 ~ 2021 Chinese General Social Survey (CGSS), this paper uses macro data from Digital Inclusive Finance Index (DIFI) matching to construct probit and m-logit model to assess the impact of the development of digital finance on Chinese youth whether or not to participate in health insurance, and how they choose the concrete type of health insurance. (1) Baseline regression results shows that digital finance has a significant positive effect on Chinese youth's health insurance participation decisions, and has different effects on choices within health insurance types. Strong support for the conclusions is provided by endogeneity and robustness tests. (2) The results of the heterogeneity analysis reveal that the marginal effect of digital finance on young people's health insurance decisions shows urban-rural differences, divergence in levels of self-rated health. (3) The mechanism analysis results suggest that there are two mechanism paths of digital finance on youth health insurance decisions: the household income effect and the subjective well-being effect, and two moderating effects: employment type and family structure. Highlighting the positive value that digital finance brings to the perception of youth insurance participation and the construction of social security systems, it needs to pay close attention to the dynamic changes in employment security and family structure through data, and explore the socio-psychological fluctuation and demand for social security among modern youth. To provide a way forward to achieve the integration of the health insurance system in China and solve the current problem of health insurance equity.

The Role of Online Queues as a Moderator Between Service Quality and Patient Satisfaction for National Health Insurance's Participants

The Role of Online Queues as a Moderator Between Service Quality and Patient Satisfaction for National Health Insurance's Participants

The impact of the implementation of hierarchical medical system on population health: evidence from China

IntroductionThe implementation of a hierarchical medical system holds significant practical importance in advancing the Healthy China strategy and elevating the overall health status of the population of China.MethodsThis article empirically examines the influence of the implementation of a hierarchical medical system on the health of the population using the latest 2020 China Family Panel Studies database. Furthermore, it investigates the variability of this impact across distinct health insurance participation statuses and literacy groups.ResultsThe findings of the study demonstrate that the implementation of the hierarchical medical system substantially enhances the health of the population, not only in terms of self-assessed health but also through a notable positive effect on alleviating chronic diseases. These results maintain their validity even after conducting robustness tests utilizing a replacement estimation model. Heterogeneity analysis reveals that the impact of the hierarchical medical system on the population’s health status exhibits significant variation concerning health insurance participation and literacy. Specifically, regarding health insurance participation, the hierarchical medical system effectively improves both self-assessed health and chronic disease status among the insured population. However, for those not enrolled in health insurance, the hierarchical medical system only demonstrates improvement in chronic disease status, with insignificant results observed in enhancing self-assessed health status. Moreover, propensity score matching (PSM) was also used to address endogeneity problems resulting from sample selectivity bias. The findings demonstrate that endogeneity issues can be suitably addressed by the PSM model. Additionally, they point out that an overestimation of the impact of the hierarchical medical system on the population’s self-assessed health state would result from failing to take sample selectivity bias into account. On the other hand, it will lead to the underestimation of the effect of the hierarchical medical system on the status of chronic diseases.DiscussionMoving forward, steadfast efforts should be directed toward further enhancing the implementation of the hierarchical medical system. This includes the comprehensive promotion and using the pivotal role of the hierarchical medical system in improving the health of the population.

The Influence of National Health Insurance Participant Satisfaction in Mediating the Relationship of Service Quality and Brand Image Towards Participant Loyalty at RSU Balimed Denpasar

The irregularity of participants in paying National Health Insurance contributions shows that participants lack loyalty in paying contributions which are their routine obligations as participants in the National Health Insurance program. The aim of this research is to reveal the mediating impact of satisfaction on service quality and brand image on loyalty. This research is quantitative research conducted using a survey, using data samples from National Health Insurance participants with active membership and receiving services at the Bali Med Denpasar General Hospital, totaling 82 people with PLS-based SEM analysis. The research results showed that service quality had a positive and significant effect on satisfaction, brand image had no significant effect on satisfaction, service quality and brand image had a positive and significant effect on loyalty, and patient satisfaction was able to mediate the effect of service quality and brand image on patient loyalty. It is hoped that the results of the research can provide advice to related parties to improve the quality of health services, such as how to respond to existing complaints and communicate well with patients and this is expected to have a positive impact on the quality of services

Does health insurance participation matter in shaping African immigrants' physical health in Guangzhou, China? The role of mental health

AbstractChina is a burgeoning immigrant‐receiving country, and policies on immigration are just beginning to be developed. While African immigration to China was uncommon 30 years ago, China has gradually become a major destination for African immigrants due to its robust economy, welcoming universities, and low cost of living. Currently, there are increasing numbers of African students and professionals who are migrating to China to study or work. The health status of African migrants in China shapes their wellbeing, which plays a key role in strengthening long‐term cooperative relations between China and African countries. Although previous literature has examined the socioeconomic status of these African immigrants, the role of health insurance participation in shaping the health status of African immigrants remains obscure in China. Using data from the 2019 questionnaire‐survey in Guangzhou, China, this paper investigates the underlying mechanism driving African immigrants' health insurance participation as critical to their physical and mental health. Our results demonstrate that health insurance participation is a pivotal factor in the overall health of African immigrants; specifically, purchasing health insurance and one's mental and physical health can be characterised as a feedback loop. Purchasing health insurance can positively impact mental health, and consequently, better mental health can improve physical health. Good physical health also tends to bolster mental health. Therefore, policies aimed at improving African immigrants' mental and physical health are expected to encourage them to purchase health insurance above their present low level of insurance participation. The proposal here is that health policymaking for immigrants should include the interaction mechanism between physical and mental health rather than focus only on physical health conditions.

Impact Of The Covid-19 Pandemic On Glycemic Control In Childhood Type 1 DM Patients

There has been an increase in cases of diabetic ketoacidosis in children aged 1-14 years from 73% in 2019 to 83% in 2020 during the COVID-19 pandemic. An increase in acute complications of type-1 DM can occur due to lack of compliance with glycemic control and activity restrictions which have the impact of reducing the level of glycemic control in children with type-1 DM. Based on these findings, researchers wanted to know the impact of restrictions on community activities during pandemic on the glycemic control of children with type 1 DM. The aims of this study is to determine the impact of the COVID-19 pandemic on glycemic control through HbA1c parameters in children with type 1 DM. Methods of this research is a cross sectional study with a sample size of 26 patients. Results are The average age of respondents was 15.58 years. More than half of respondents were female (73.1%). The average duration of suffering from type 1 DM was 4.77 years. More than half of the respondents had a history of diabetic ketoacidosis, 53.8%, and all respondents were Health Insurance (BPJS) participants (100%). There was a decrease in HbA1c levels during the pandemic compared to before the pandemic, namely 12.17 ± 2.60 to 10.32 ± 2.21. Statistically, this decrease means that there is an impact of the COVID-19 pandemic on glycemic control through the HbA1c parameter in children with type 1 DM (p<0.05). There was a decrease in HbA1c levels during the pandemic compared to before the pandemic.

Risk preference and relative poverty: An analysis based on the data of China Family Panel Studies

It is posited that solving the problem of relative poverty (RP) first requires the identification of its cause. We use data from China Family Panel Studies to examine the impact of risk preference on RP of urban and rural families in China and the underlying mechanism. This paper contributes to the existing body of evidence on the determinants of RP. The results show that a high degree of risk preference is conducive to alleviating families' RP. The effect is still significant after dealing with potential endogeneity through instrumental variables. Furthermore, the effect is more obvious among health insurance participation families, endowment insurance participation families, families with low life satisfaction, non-poor families, especially middle-income families, urban families, male-headed families and families in the West in China. Further analysis suggests that risk preference affects RP by promoting entrepreneurship and credit in urban and rural families. Families with a higher risk preference are more likely to engage in entrepreneurship and utilize credit, which in turn helps alleviate their RP. Overall, this paper provides new empirical evidence for understanding the mechanism of risk preference influencing RP.

The impact of basic health insurance participation characteristics on the health of mobile populations: the mediating role of health service utilization behavior.

It is a pivotal element of China's health system reform to improve the health security of health insurance for the mobile population. Achieving this objective is integral to the success of the reform. The aim of this study was to analyze the impact of different enrollment characteristics of basic health insurance on the health of the mobile population and to investigate the mediating role of health service utilization behavior. This cross-sectional study included 135,372 migrants who participated in the 2018 China Migrants Dynamic Survey (CMDS). Two indicators were employed in this study to assess the characteristics of the mobile population's involvement in basic health insurance-namely, whether or not they participated in local health insurance and the type of health insurance in which they participated. The health status of the mobile population was measured using self-assessed health. Health service utilization behavior was divided into public health service utilization and medical service utilization. Multivariate ordered logistic regression was employed to examine the effect of health insurance on the health of the mobile population. Subsequently, the Bootstrap method was applied to analyze the mediating effect of health service utilization behavior in the relationship between health insurance and the health of the mobile population. Health insurance had a positive impact on health, public health services, and health service utilization among the mobile population. However, enrollment in local health insurance (OR = 1.088, 95% CI = 1.043-1.134) and enrollment in Basic Medical Insurance for Urban Employees (OR = 1.178, 95% CI = 1.090-1.273) were more likely to be associated with higher levels of health and a greater likelihood of receiving health service utilization. The results of the mediating mechanism analysis indicated that health education, health records, family doctor contracting, receiving inpatient services, and being hospitalized locally all played a partially mediating role in the impact of the place of enrollment on health. Regarding the effect of the type of enrollment on health, three types of services-namely, health education, health records, and contracting with a family doctor-played a partially mediating role, while receiving inpatient services and being hospitalized locally did not exhibit a mediating effect. The effect of the type of participation on health is partially mediated. Based on the impact of the different enrolment characteristics of basic health insurance on the health of the mobile population and the mediating role of health service utilization in this impact, furthermore, improvement of health insurance coverage for the mobile population should focus on improving the accessibility of health services, increasing the level of health insurance coverage, mitigating differences in treatment between the different insurance systems, and simplifying the process of transferring the health insurance relationships.

Sustaining Universal Health Coverage in Vietnam: Expanding Health Coverage for Informal Economy Workers

As of 2022, Vietnam's health insurance coverage has reached approximately 91% of the population. However, over 5.4 million informal workers have not participated in health insurance due to limited access to health services, insufficient information about health insurance, loose labor contracts, and low income. This article presents solutions to expand health insurance coverage for informal workers and achieve the goal of maintaining universal health coverage. The proposed solution groups: Solution groups for access to medical services, include: Increasing access to high-quality medical examinations and treatments; Enhancing access through investment and upgrading of grassroots healthcare; and reforming payment methods for medical costs. State management solution group, including: Strengthening law enforcement in signing labor contracts; Strengthening propaganda work; Encouraging participation in health insurance by households; Strengthening inspection and supervision of health insurance participation in salaried groups and individual production and business households. Solution group strengthens public policy and supports vocational training, including: Strengthening linkage policies in local economic development; Strengthening training to improve skills for informal workers; and strengthening public policies to increase income for informal workers.

Determinants of Behavioral Compliance in Coronary Heart Disease Therapy Among Patients at Bandung Heart Clinic

Background: Coronary heart disease (CHD) ranks seventh among non-communicable diseases (NCDs) in Indonesia, with a projected increase in mortality by 2030 to approximately 23,6 million. The rehabilitation of CHD, which constitutes long-term treatment, significantly depends on patient adherence. Objective: This study aims to investigate the determinants of patient adherence behavior at the Bandung Heart Clinic. Methods: It employed a cross-sectional research design, gathering data from 471 CHD patients with a history of atherosclerosis at the clinic between January and October 2022. The minimum sample size of 80 respondents, calculated using the Lemeshow formula, was increased to 150 to mitigate potential dropouts. The research instrument used was a questionnaire that had been validated and deemed reliable, except for one question regarding family support. Sampling was conducted using accidental sampling and involved interview data collection. Results: Bivariate data analysis, using the chi-square test, indicated significant associations between gender (p=0.09), employment status (p=0.01), health insurance participation (p=0.012), healthcare accessibility (p=0.022), family support (p=0.006), and treatment motivation (p=0.22) with patient adherence behavior. Additionally, female patients (OR=3,316) patients who are members of a health insurance (OR=2,617), patients with high treatment motivation (OR=1,983), patients who receive support from their families (OR=2,476) are more likely to exhibit adherence behavior compared to those who are not. Conclusion: In summary, it can be concluded that gender, employment status, health insurance participation, family support, and treatment motivation have significant correlations with patient adherence behavior in the context of CHD at the Bandung Heart Clinic.

Private health insurance incentives and passive adverse selection: is Lifetime Health Cover responsible for the excess ageing of Australia's hospital cover risk pool?

Objective Lifetime Health Cover (LHC) was introduced in mid-2000 to increase participation in private health insurance that includes hospital cover (PHI-HC) and improve the risk profile of PHI-HC participants. It initially achieved both objectives, but since 2001 the PHI-HC population has aged faster than the general population. The aim of this study was to determine if the excess ageing of the PHI-HC risk pool has been due to passive age-based adverse selection, an inherent risk of LHC. This study has potential implications for the retention of LHC. Methods A descriptive population-level analysis of publicly available administrative datasets was performed. Data relating to PHI-HC were obtained from the Australian Prudential Regulatory Authority. National population data were obtained from the Australian Bureau of Statistics. Trends in demography, PHI-HC participation rates and LHC loading payments were analysed. Results By 2021, age-based adverse selection had returned to the pre-LHC level. Based on the available data, this was due to passive age-based adverse selection not active age-based adverse selection. Specifically, it reflected the combination of an avoidable unintended consequence of the introduction of LHC (the over-representation, in 2001, of individuals aged 45-59) and one of LHC's intended effects (incentivisation of insured individuals to retain PHI-HC). Conclusions This study supports the retention of LHC. Nonetheless, it highlights the risk of passive age-based adverse selection created by incentivising insured individuals to retain PHI-HC in the presence of distortions in the age distribution of the PHI-HC risk pool. Early targeted interventions are required when such distortions arise.

Factors Related to The Level of Compliance to Pay Contributions of National Health Insurance Participants Non-Wage Earners

Introduction: Nationally, in 2022 there are 15,679,006 participants of Non-Wage Earners in arrears of contributions, while in the working area of BPJS Kesehatan Kambi Branch there are 228,181 participants of Non-Wage Earner Workers in arrears with contributions. The number of participants who are delinquent due to non-compliance of Non-Wage Earner Workers participants in paying contributions. Objective: To measure the relationship between knowledge, number of family members and payment methods with the level of compliance to pay contributions for participants of the National Health Insurance Non-Wage Earner Workers in Jambi City in 2023. Method: This study is a descriptive study with a cross sectional design. Questionnaire research instruments, then univariate and bivariate analysis with chi-square test. Results and Discussion: The results of this study show that there is a significant relationship between knowledge (p-value = 0.000), number of family members (p-value = 0.000) and payment method (p-value = 0.018) with the level of compliance to pay contributions of national health insurance participants non-wage earners workers in Jambi City. Conclusion: there is a relationship between knowledge, number of family members and payment methods with the level of compliance to pay contributions of national health insurance participants non-wage earners workers in Jambi City.

Perception and Usage of Telemedicine Among National Health Insurance Participants in Padang City

Perception and Usage of Telemedicine Among National Health Insurance Participants in Padang City

Perception and Usage of Telemedicine Among National Health Insurance Participants in Padang City

The existence of a policy on the use of telemedicine in health facilities is applied almost all over the world. In Indonesia, Padang is one city of the achievements in that the use of telemedicine services remains low, even after the implementation of regulations on telemedicine services. This study aimed to determine the perceived convenience and benefits of using telemedicine services among National Health Insurance participants through the Technology Acceptance Model (TAM). This study was a cross-sectional survey. The sample of this study consisted of 100 National Health Insurance respondents registered at a first-level healthcare facility. The samples were collected using consecutive sampling and online questionnaire sheets carried out for three months in 2021. The analysis includes univariate, bivariate, and multivariate analysis. The results showed that 55% of respondents had a high level of accessibility in getting health services by using telemedicine, 54% of respondents had a good experience related to telemedicine officer services, 94% of respondents had perceptions of illness exist positive, 89% of respondents said that they had a perception of ease in using telemedicine services, and 80% of respondents had a perceived the benefits of telemedicine services. The utilization of telemedicine was affected by accessibility (p=0.000), staff service (p=0.000), perceived ease of use (p=0.022), and perceived benefit (p=0.001). The multivariate analysis indicated that the officer service was the most influencing the use of telemedicine services (OR=3.669). Healthcare facilities should improve their service quality and apply a more accessible and more valuable service for patients as end users.

Labour code, location, and migration

AbstractThe introduction of the 2012 Labour Code is considered ‘groundbreaking’ in industrial relations in Vietnam. However, knowledge about the effects of this law is still minimal. This study provides the first evidence of the impacts of the law on worker outcomes, disaggregated by location and migration status. The Vietnam Labour Force Survey is used as the primary dataset. Both difference-in-differences and fixed-effect models are applied in the investigation. The estimated results show a relationship between the introduction of the law and the labour supply of contracted workers in urban areas, especially long-term migrant workers. Furthermore, income for these long-term migrant contract workers was affected significantly by the introduction of the law. A link between the law and health insurance participation was also found among non-migrant contracted workers in urban areas. We also perform estimations using a short panel sample and find notable results. The study likewise reveals disadvantages of rural workers compared to urban workers in terms of earnings, and of short-term migrants compared to other workers, in terms of labour supply.

Reasons for switching the primary health providers among national health insurance participants in Klungkung District, Bali Province, Indonesia

Background and purpose: National Health Insurance Provider (BPJS Kesehatan) facilitates the distribution of National Health Insurance (NHI) participants. High number of 1,947 NHI participants were switched primary health providers in Klungkung, Bali between July to December 2021.This study aims to explore the reasons for the switching of providers among NHI participants and the health providers’ efforts to minimize it. Methods: A qualitative descriptive study guided by an access theory was conducted in Klungkung District between December 2022 to March 2023. A total of 18 informants were purposively recruited, consisting of NHI participants (12 people), health service providers (4 people), BPJS Kesehatan (1 person) and staff of the district health office (1 person). Data was collected through in-depth interviews guided by interview guidelines. Data were analyzed using a thematic approach and presented in a descriptive narrative. Results: NHI participants in Klungkung District switched provider due to spatial and non-spatial reasons. Spatial reason was the distance and time to the health provider. Non-spatial reasons included (1) conflict in social relations due to service and negative attitudes of health workers, (2) economic considerations in the health system which are difficult to reach, and (3) external encouragement. Strategies that have been or can be implemented to minimize the switching of PHCs were adjusting operational hours, improving the infrastructures, administration through fulfilling accreditation, service quality and training for human resources. Conclusion: The dominant reason for switching of PHCs is associated with negative social interaction experiences related to human resources and service facilities at PHCs. PHCs are expected to be able to improve the quality of services through improving human resources and service delivery facilities.

Analisis Cost of Illness pada Pasien Diabetes Mellitus Dengan Terapi Glimepiride-Metformin Rawat Jalan Peserta BPJS di Puskesmas Ketapang II Kota Sampit

Diabetes mellitus is a chronic disease that affects the costs incurred by patients during illness. The financingissuedfor the treatment of diabetes mellitus diseases can be measured using Cost of Illness analysis. Research objectivestofind out the total cost of treatment of diabetes mellitus patients BPJS participants with Glymepiride-Metformintherapy for one year. The method this study used a non-probability sampling technique with an accidental sampling method. This research conducted at Ketapang II Health Center with sample total 45 people. The instrument usedastructured interview which was previously tested for validity. Data were analyzed using Microsoft Excel. Result andconclusion, the estimate total cost of treatment of diabetes mellitus with outpatient glimepiride-metformin therapyofIndonesia Health Insurance participants at Ketapang II Health Center in Sampit city for one year is Rp.623.760-Rp.4.475.520. The direct medical cost per patient is Rp.143.760 - Rp.2.787.120. Non-medical direct cost is Rp.0-Rp.188.400. Indirect cost is Rp.480.000 - Rp.1.500.000. High cost are more expensive but the frequencyof visitsand patient compliance are orderly so that the therapeutic effect achieved is good, while the lowcost is cheaper butthe frequency of patient visits and patient compliance are not orderly so that the therapeutic effect achievedislessgood and not maximal.

A Study for Hanoi on How Perceived Value and Service Quality Affect Customer Satisfaction in Healthcare Insurance

Healthcare insurance is currently attracting special attention in low- and middle-income countries. Theory and practice have proven that healthcare insurance is a means to improve access to healthcare services for all people, especially those with low incomes, helping to prevent financial risks during illness, especially the risk of financial disaster due to direct payment methods. The empirical literature on health insurance participation is limited despite the importance of insurance participation. This research was conducted through interviews and surveys of customers of insurance businesses in Hanoi, with 242 feedback forms received. The authors process the collected data through SPSS software. Research results show a positive relationship between customer-perceived value and service quality and satisfaction. Service quality also positively impacts customers' perceived value. The research results are the basis for the authors' proposal of policy suggestions for insurance businesses to develop healthcare insurance operations in Vietnam's current insurance market.

Construction of BPJS National Health Insurance Membership Regulations in Indonesia

The issuance of the BPJS National Health Insurance Law was a government effort to enhance the welfare of citizens by making it mandatory for them to become BPJS health insurance participants, with a deadline set for January 2019. However, as of May 2022, around 13.79% (according to Worldometer) or 12.26% (according to the Home Ministry) of citizens have not yet joined, due to various factors, including issues related to the BPJS health insurance membership regulations. This paper aims to provide clarity on the construction of health insurance membership regulations as outlined in Law Number 24 of 2011 concerning the Social Security Agency connected to the National Social Security System. The research utilized a descriptive analysis with a statutory approach, along with secondary data obtained through a library study to collect data, and systematic and teleological analysis to analyze the data. The results of the study indicate that the construction of BPJS health insurance membership regulations follows the Stufen theory, which is in accordance with the hierarchy of occupying concrete norms (Hans Kelsen) or formalgezets (Hans Nawiasky).
 Keywords: construction, national health insurance, national social security system regulation

Anti-corruption publicity and internal migrants in China

ABSTRACT This study uses the conditional logit model to explore the impact of anti-corruption publicity on the probability of choosing a specific city among internal migrants in China. By leveraging China’s Corruption Investigations Dataset and China Migrants Dynamic Survey, we find that anti-corruption publicity significantly decreases the probability of migrants choosing the city. The effects are driven by the mechanism whereby anti-corruption publicity increases the individuals’ perceptions of corruption and reduces their trust in local government officials. The negative effects remain after the migrants move to the city. Exposure to anti-corruption publicity is associated with decreased settlement intention and social health insurance participation. Our findings strongly indicate the necessity for the government to reconsider its communication strategies concerning anti-corruption efforts.