Health Insurance Program Research Articles

Kebijakan Kesehatan di Indonesia: Tinjauan, Tantangan, dan Rekomendasi

The Indonesian government has made various efforts to overcome this health problem, such as through the National Health Insurance (JKN) program which aims to provide more equitable access to health services for the entire population. This study aims to identify and analyze key health policies in Indonesia, as well as evaluate the successes and challenges in their implementation. The research method uses the literature review method to analyze, identify and analyze key health policies in Indonesia, as well as evaluate the successes and challenges in their implementation. The research method uses the literature review method to analyze, identify and analyze key health policies in Indonesia, as well as evaluate the successes and challenges in their implementation. Literature review is an effective method for collecting, analyzing, and synthesizing information from various sources relevant to the research topic. The results of the study show that the importance of health policies in Indonesia to improve public health. Through the identification of key health policies, evaluation of their successes, and challenges in their implementation, this study provides an in-depth understanding of the political dynamics that influence health policies. In conclusion, by identifying key health policies, evaluating their success, and facing challenges in their implementation, this study provides a comprehensive understanding of the political dynamics that influence health policies.

Factors Associated with Enrollment of Household in National Health Insurance Program in Eastern Nepal

Background Health insurance is entrusted to make health services more equitable and decrease the financial burden caused by catastrophic out-of-pocket payments. This study aimed to assess the factors affecting the enrollment of households in National Health Insurance Program (NHIP) in eastern Nepal.MethodsCross-sectional data were collected from 189 households in Itahari sub-metropolitan city using a structured questionnaire. Chi-square tests was used to examine the association between NHIP enrollment and selected demographic variables derived from the data.ResultsThe findings showed that 63% of households were enrolled in NHIP and enrollment was associated with education, family type, ethnicity, socio-economic status, prior experience of illness, utilization of health facilities, and knowledge regarding NHIP.Conclusions Variables like education, family type, ethnicity, socio-economic status, prior experience of illness, utilization of health facility, knowledge regarding the annual premium amount, annual benefit ceiling, and renewal time found to be associated with NHIP enrollment.

Workshop on s-claim application system for BPJS claim officers at Grandmed Lubuk Pakam Hospital

BPJS Health is a public legal entity that is directly responsible to the President and functions to organize health insurance programs for all Indonesian residents, including foreigners who work for a minimum of six months in Indonesia. The BPJS Health claim procedure can be quite complicated and requires a lot of supporting documents. Unclearness in the guidance or instructions provided can make participants confused and not prepare the complete documents required, one of which is incomplete data files. This is a problem that slows down the claim process. This activity aims to provide health education on the application of the S-National Health Insurance (JKN) system, namely health protection program in Indonesia designed to provide basic health care and protection benefits for all Indonesian citizens. The main goal of JKN is to ensure that everyone in Indonesia has access to adequate basic health services, either through contributions paid by participants themselves or contributions paid by the government for certain groups. With the existence of JKN, it is hoped that the entire population of Indonesia can feel the benefits of equitable and quality health services, thereby improving the health status of the community as a whole. Claims to BPJS officers. The method of implementing activities is using observation sheets and questionnaires regarding the application of the S-Claim system to BPJS officers. Through this activity, it is hoped that the knowledge of BPJS claims officers can increase and change attitudes so that they can apply the BPJS E-Claim system correctly. Socialization to BPJS claims officers can be concluded that the knowledge of BPJS claims officers at Grandmed Lubuk Pakam Hospital has increased by 60% after conducting socialization using discussion, lecture and question and answer methods as well as holding quizzes or tests to evaluate participants' understanding of the S application.

ANALISIS KUALITAS LAYANAN MOBILE JKN MENGGUNAKAN METODE E-SERVICE QUALITY, CUSTOMER SATISFACTION INDEX (CSI) DAN IMPORTANCE PERFORMANCE ANALYSIS (IPA)

Mobile JKN is a non-face-to-face application that has many features and makes it easier for participants to maximize the national health insurance program organized by BPJS Kesehatan. As of June 2023, in the Surakarta area, the number of Mobile JKN registrations was 92,101 participants. Therefore, this research aims to analyze the level of quality of Mobile JKN services using e-service quality, customer satisfaction index (CSI) and importance performance analysis (IPA) methods. This research method uses quantitative methods. The object of this research was participants who came to the Surakarta branch of the BPJS Health office, totaling 100 participants. This research uses a questionnaire whose validity and reliability have been tested. The results of this research are that Mobile JKN participants are satisfied with Mobile JKN services, with an average gap value of 0.06 (positive value), and a CSI value of 81.4%, and the results of the IPA analysis have been described. There is great hope that the results of this research can become a reference for stakeholders to improve the quality of Mobile JKN services.

Socialization of The Use of BPJS for Services Inpatient Care at Pagar Jati Health Center Lubuk Pakam District

The national health insurance program is integrated into the Health Social Security Administering Body (BPJS Health). Through BPJS Health, the government is trying to ensure that all Indonesian citizens have fair and equitable access to quality health services without being constrained by costs. This program covers a variety of health services, from preventive services to treatment, with the hope of improving the welfare and health of the community as a whole. The JKN program is integrated into the Health Social Security Administering Agency (BPJS Health), a public legal entity that aims to administer the JKN program for all Indonesian people. This activity aims to provide health education about the use of BPJS for inpatient health services at the Pagar Jati Health Center. The method for carrying out activities is using observation sheets and questionnaires about the benefits of BPJS. From the results of the counseling provided, there was a significant increase in services, namely 86% compared to before the intervention was given. This indicates that the differences in the predisposing factors of BPJS patients significantly influence the utilization of inpatient services at the Pagar Jati Community Health Center. There is a significant influence on respondents' knowledge before and after being given counseling about the use of BPJS for inpatient services at the Pagar Jati Community Health Center, this can be seen from the percentage level knowledge before and after with a small percentage having insufficient knowledge. From the results of activities carried out by BPJS user patients, they were very enthusiastic about welcoming this activity. Through this activity, it is hoped that knowledge of the use of BPJS will increase so that you will no longer hesitate to use the BPJS card for inpatient health services at the Pagar Jati Community Health Center.

Burden of out-of-pocket payment for maternal healthcare and its catastrophic effects in the era of free maternal and child health policy in Ghana

BackgroundGhana introduced a free maternal healthcare policy within its national health insurance program in 2008. Despite this, there are reports of significant out-of-pocket (OOP) payments for maternal healthcare in Ghana. This study examines OOP payments for maternal healthcare services and their catastrophic effects, including the correlates of catastrophic OOP payments. MethodsCross-sectional quantitative data were collected from 414 mothers through health facility exit interviews in two regions of Ghana. Catastrophic OOP payments were computed by expressing total health expenditure as a percentage of household total expenditure and non-food expenditure at various thresholds (5 %, 10 %, 20 % and 25 %). The correlates of catastrophic OOP payments were assessed using logistic regression models. ResultsThe median OOP payments for maternal healthcare was GH₵866.5(US$109.3). The median non-medical OOP cost (GH₵479[US$ 59.9]) was higher than the median medical OOP cost (GH₵296.5[US$ 37.1]). The median OOP cost was higher for delivery (GH₵454[US$56.8]) compared to ANC (GH₵356.5[US$44.5]) and PNC (GH₵21.5[US$2.6]). Non-medical supplies comprise 58 % of the total OOP payments. About 73 % and 90 % of respondents spent more than 5 % of their annual household total and non-food expenditure on maternal healthcare, respectively. Rural areas and care at private facilities were significantly associated (AORs<1; p-values<0.05) with lower probabilities of incurring catastrophic OOP expenditure. Tertiary education was associated (AORs> 1; p-values<0.05) with a higher probability of incurring catastrophic OOP payments. ConclusionOOP payments for maternal care are still prevalent in Ghana. We call for a reform of Ghana’s free maternal healthcare policy to include non-medical supplies within its benefit package.

Association of smoking cessation patterns and untreated smoking with glaucoma, cataract, and macular degeneration: a population-based retrospective study

This study aims to assess the association between nicotine replacement therapy (NRT), varenicline, and untreated smoking with the risk of developing eye disorders. We employed a new-user design to investigate the association between NRT use and the incidence of eye disorders by the Taiwan National Health Insurance program. This study included 8416 smokers who received NRT and 8416 smokers who did not receive NRT (control group) matched using propensity scores between 2007 and 2018. After adjustment for relevant factors, a multivariable Cox regression analysis revealed that compared with untreated smokers, NRT use was associated with a significantly reduced risk of macular degeneration (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.13–0.87, P = 0.024). When stratified by dose, short-term NRT use (8–28 defined daily doses) was associated with significantly lower risk of glaucoma (HR: 0.35; 95% CI: 0.16–0.80, P = 0.012) and a trend toward reduced risk of cataract (HR: 0.60; 95% CI: 0.36–1.01, P = 0.053) compared to no treatment. However, these associations were not observed with long-term NRT use. The results of this real-world observational study indicate that NRT use, particularly short-term use, was associated with a lower risk of certain eye disorders compared to no treatment for smoking cessation. Long-term NRT use did not demonstrate the same benefits. Thus, short-term NRT may be a beneficial treatment strategy for reducing the risk of eye disorders in smokers attempting to quit. However, further evidence is required to verify these findings and determine the optimal duration of NRT use.

Unit Cost Analysis of Haemodialysis Services By Activity Based Costing Approach as a Strategy For Increasing Hospital Profits

One of the catastrophic diseases that is the focus of health insurance financing is kidney failure. Haemodialysis is a type of kidney replacement therapy for chronic kidney disease using special equipment. One method of financing haemodialysis procedures is the National Health Insurance Program. Hospitals, as health service providers for JKN participants, have an interest in the INACBG rates. Based on the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023 concerning Health Service Tariff Standards in the Implementation of the Health Insurance Program, there are changes to tariffs for haemodialysis services. With the current tariff changes, single-use and re-use services are divided into two different tariffs. The research was conducted at Siloam Hospital Bali. The data taken is secondary data originating from the Financial Division of Siloam Hospital Bali, the Medical Records Department of Siloam Hospital Bali, and the Haemodialysis Department of Siloam Hospital Bali during the period January–April 2023. The data collected and the hypothesis formulated in this research will be tested using the MANOVA (Multivariate Analysis of Variance) test method, using SPSS software. The research results show that there is a significant difference in total costs for re-use and single-use haemodialysis services; there is a significant difference in the total INACBG rates per patient for re-use and single-use haemodialysis services and there is no significant difference in the difference between INACBG rates and total costs in re-use and single-use haemodialysis services.

Health Insurance Type and Outpatient Specialist Care Among Children With Asthma

Although children with asthma are often successfully treated by primary care clinicians, outpatient specialist care is recommended for those with poorly controlled disease. Little is known about differences in specialist use for asthma among children with Medicaid vs private insurance. To examine differences among children with asthma regarding receipt of asthma specialist care by insurance type. In this cross-sectional study using data from the Massachusetts All Payer Claims Database (APCD) between 2014 to 2020, children with asthma were identified and differences in receipt of outpatient specialist care by whether their insurance was public (Medicaid and the Children's Health Insurance Program) or private were examined. Eligible participants included children with asthma in 2015 to 2020 aged 2 to 17 years. Data analysis was conducted from January 2023 to April 2024. Medicaid vs private insurance. The primary outcome was receipt of specialist care (any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician). Multivariable logistic regression models estimated differences in receipt of specialist care by insurance type accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and zip code characteristics. Additional analyses examined if the associations of specialist care with insurance type varied by asthma persistence and severity, and whether associations varied over time. Among 198 101 unique children, there were 432 455 child-year observations (186 296 female [43.1%] and 246 159 male [56.9%]; 211 269 aged 5 to 11 years [48.9%]; 82 108 [19.0%] with persistent asthma) including 286 408 (66.2%) that were Medicaid insured and 146 047 (33.8%) that were privately insured. Although persistent asthma was more common among child-year observations with Medicaid vs private insurance (57 381 [20.0%] vs 24 727 [16.9%]), children with Medicaid were less likely to receive specialist care. Overall, 64 239 child-year observations (14.9%) received specialist care, with substantially lower rates for children with Medicaid vs private insurance (34 093 child-year observations [11.9%] vs 30 146 child-year observations [20.6%]). Regression-based estimates confirmed these disparities; children with Medicaid had 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47) and a regression-adjusted 9.7 percentage point (95% CI, -10.4 percentage points to -9.1 percentage points) lower rate of receipt of specialist care. Compared with children with private insurance, there was an additional 3.2 percentage point (95% CI, 2.0 percentage points to 4.4 percentage points) deficit for children with Medicaid with persistent asthma. In this cross-sectional study, children with Medicaid were less likely to receive specialist care, with the largest gaps among those with persistent asthma. These findings suggest that closing this care gap may be one approach to addressing ongoing disparities in asthma outcomes.

Cushing's Syndrome is Associated with a Higher Risk of Cancer - A Nationwide Cohort Study.

Patients with Cushing's syndrome (CS) have higher risk of obesity and diabetes, which are important risk factors of cancers. However, if patients with CS have a higher incidence of cancer remains unknown. To investigate if endogenous CS is associated with increased cancer incidence. A nationwide cohort study. Analysis of the data retrieved from Taiwan's National Health Insurance program in 2006-2017. Between 2006-2017, 1278 patients with newly diagnosed endogenous CS were identified. Among them, 1246 patients without a history of malignancy were enrolled in this study. Endogenous CS. The age- and sex-standardized incidence rate of all-cause cancer and age-sex-calendar year standardized incidence ratio (SIR) of cancer in association with endogenous CS. The age- and sex-standardized incidences of CS decreased from 4.84 to 3.77 per million person-years between 2006-2017. The age at diagnosis of CS was 45.3 ± 14.8 years, and 80.0% of the patients were female. Cushing's disease and adrenal CS accounted for 35.4% and 64.6% of patients with CS, respectively. The incidence rate of cancer in patients with CS was 7.77 (95% Confidence Interval [CI] = 5.84-10.14) per 1000 person-years, with an SIR of 2.08 (95% CI = 1.54-2.75). The three most common cancer types were liver (27.7%), kidney (16.7%), and lung (13.0%). Patients with endogenous CS have a higher incidence of cancer.

Healthcare provider's experience and attitude towards the national health insurance program of Nepal

Healthcare provider's experience and attitude towards the national health insurance program of Nepal

Medicaid by Any Other Name? Investigating Malleability of Partisan Attitudes toward the Public Program

Context: Medicaid is the largest health insurance program by enrollment in the United States. The program varies across states and across a variety of dimensions, including what it is called; some states use state-specific naming conventions, for example, MassHealth in Massachusetts. Methods: In a preregistered online survey experiment (N = 5,807), the authors tested whether public opinion shifted in response to the use of state-specific Medicaid program names for the provision of information about program enrollment. Findings: Replacing “Medicaid” with a state-specific name resulted in a large increase in the share of respondents reporting that they “haven't heard enough to say” how they felt about the program. This corresponded to a decrease in both favorable and unfavorable attitudes toward the program. Although confusion increased among all partisan groups, there is evidence that state-specific names may also strengthen positive perceptions among Republicans. Providing enrollment information generally did not affect public opinion. Conclusions: These findings offer suggestive evidence that state-specific program names may muddle understanding of the program as a government-provided benefit. Policy makers seeking to bolster support for the program or claim credit for expanding or improving it may be better served by simply referring to it as “Medicaid.”

Characteristics of Spinal Cord Injury Presenting to Tertiary Care Center in Gandaki province of Nepal: A Descriptive Cross-sectional Study.

Spinal cord injury is one of the common injury which causes damage to the spinal cord due to trauma, diseases or degenerations leading to disability and decreasing life expectancy. The study aims to find the characteristics of spinal cord injury presenting at a tertiary care centre. A Descriptive hospital based cross-sectional study was conducted at Pokhara, Gandaki Province, from 28th March to 25th September, 2023. 139 participants were interviewed for the study. Structured interview schedule and validated questionnaires were used for data collection. Ethical approval was taken for the study (Reference number: 151/079). A total of 139 cases were observed; most common affected age group was between 25-55 years with a mean age of 48.68 years. Most (66.9%) of the spinal cord injury patients were not enrolled in health insurance program. Most 107 (77.0%) common cause for spinal cord injury was falls from height. Age, gender, occupation and duration of stay in the hospital were statistically significant with mode of treatment. Spinal cord injury mostly traumatic commonly due to fall from height affecting mainly male population residing in rural areas at their fourth decade of life who are mainly involve in manual work and agriculture. Spinal cord injury is a major health problem at global and local level causing major morbidity.

Assessing inequalities in the hypertension management under national health insurance: Evidence from Southern Central Java, Indonesia

Equal access to disease management is crucial to control the impact of hypertension on the burden of disease in Indonesia. This study aimed to assess the extent of inequalities in the use, quality, and outcomes of hypertension management for beneficiaries of the National Health Insurance (NHI) program. This cross-sectional study consecutively recruited 797 beneficiaries of National Health Insurance who participated in the hypertension management program in the Banyumas District, Indonesia, between July and October 2021. The outcomes were regular visits, standard medication, and disease control. The inequalities were measured based on educational level, employment type, type of beneficiaries, and place of residence. The rate difference, rate ratio, and multiple logistic regression were used to estimate the extent of inequality. Compared to informal workers, formal workers had more regular visits to healthcare facilities (OR 1.78; 95%CI: 1.01-3.18) and had better disease control (OR 2.36; 95%CI: 1.28-4.38). Non-subsidized participants had fewer regular visits compared to subsidized participants (OR 0.51; 95%CI: 0.30-0.84). Urban residents tended to have more regular visits compared to rural residents (OR 2.14; 95%CI: 0.90-5.05). A substantial extent of inequalities in the use and outcomes of hypertension management still exists among beneficiaries of the NHI program. The future implementation of the hypertension management program of National Health Insurance in Indonesia should consider the geographical and socio-economic background of its participants.

LEGAL PROTECTION FOR SOCIAL SECURITY ADMINISTERING BODY HEALTH PARTICIPANTS

In order to legally protect the rights of patients participating in the Social Security Administering Body (BPJS) of Health in obtaining health services, the government issued Law Number 24 of 2011, which stipulates that two state-owned enterprises, namely PT Askes (Persero) and PT Jamsostek (Persero) were transformed into public service agencies to implement five programs mandated by Law Number 40 of 2004, namely the health insurance program for BPJS Health and other programs are handed over to BPJS Employment. This study aims to analyze how to protect BPJS Health participants. This study uses a normative legal research method with field data as a complement. The results of the study Legal protection for BPJS Health participants who are hospitalized in hospitals from the regulatory aspect have protected their rights both as consumers of services, as hospital patients and as BPJS Health participants. The method of resolving BPJS Health service disputes through mediation reflects the importance of a consensual approach to dispute resolution. Mediation is chosen for several theoretical reasons, such as the dominance of a culture that prioritizes harmony and togetherness, and the balance of power between the disputing parties.

Association Between Changes in Smoking Habits and Incident Fracture After Acute Ischemic Stroke.

Survivors of stroke, particularly the older population, are at an increased risk of falls and incident fractures. Smoking is a widely recognized risk factor for fractures. However, the association between changes in smoking habits before and after an index stroke and increased risk of fracture remains unelucidated. Using the Korean National Health Insurance program, patients with ischemic stroke between 2010 and 2016 were enrolled. Individuals were classified by smoking habits: "never smoker," "former smoker," "smoking quitter," "new smoker," and "sustained smoker." The primary outcome was the composite outcome of the vertebral, hip, and any fractures. Multivariable Cox proportional hazards regression analysis was conducted, using the never-smoker group as the reference. Among 177 787 patients with health screening data within 2 years before and after ischemic stroke, 14 991 (8.43%) patients had any fractures. After multivariable adjustment, the sustained smokers had a significantly increased risk of composite primary outcomes of any, vertebral, and hip fractures (adjusted HR [aHR], 1.222 [95% CI, 1.124-1.329]; aHR, 1.27 [95% CI, 1.13-1.428]; aHR, 1.502 [95% CI, 1.218-1.853], respectively). Additionally, the new smoker group exhibited a similar or higher risk of any fractures and hip fractures (aHR, 1.218 [95% CI, 1.062-1.397]; aHR, 1.772 [95% CI, 1.291-2.431], respectively). Sustained smokers had a significantly increased risk of vertebral and hip fractures after an ischemic stroke. The risk of any hip fractures was higher in new smokers after ischemic stroke. As poststroke fractures are detrimental to the rehabilitation process of patients with stroke, physicians should actively advise patients to stop smoking.

Analysis of Real Hospital Cost on Ina-Cbgs Rates for Cesarean Section Patients

A caesarean section is an artificial birth that is carried out by making a small incision in the abdominal wall and uterine wall, but the uterus must be intact and the fetus weighs &gt;500 grams. The high cost of a cesarean section has prompted the Indonesian government to launch the National Health Insurance (JKN) program as an implementation of the National Health Insurance (JKN) which has been regulated regarding to the payment patterns to advanced health facilities by applying Indonesian Case Based Groups (INA-CBG's). This study aims to determine the difference between real hospital cost rates and INA-CBGs rates for payment of claims by JKN participants for caesarean section inpatients at Dr. Soedomo Regional Hospital Trenggalek. The research method is analytical observation with a cross sectional approach which refers to the hospital's perspective by comparing the direct medical costs of BPJS’s (Social Security Agency on Health) participant patients and the INA-CBG's rates. The populations of this study were BPJS recipients of class I, II, III inpatients who received mild category of caesarean section at Dr. Soedomo Regional Hospital Trenggalek in 2020. The sample used in this study was medical record documents that met the inclusion and exclusion criteria. Purposive sampling method was used. In treatment of I, II, III classes, a significant difference was found between the average total direct medical costs of mild category of caesarean section patients (O-6-10-I) compared to the INA-CBGs rates. The treatment of class I had a difference of IDR 886,582. (p&lt;0.05). The treatment of class II had a difference of IDR 754,881. (p&lt;0.05) and the treatment of Class III, the difference obtained was IDR 1,109,368. (p&lt;0.05).

DETERMINANTS OF POOR HOUSEHOLDS IN SOUTH SUMATRA USING A MULTILEVEL LOGISTIC MODEL

Poverty is still one of the problems experienced by all countries, including Indonesia. According to BPS, in March 2021, the poverty rate in Indonesia was 10.14 percent. South Sumatra is a province with a poverty rate, which is the tenth-highest nationwide and the third-highest on Sumatra Island. This poverty rate is accompanied by a contraction in economic growth in 2021 by 3.58 percent. This condition indicates a contradiction and suggests that poverty still needs to be resolved. Moreover, the disparity in social and economic aspects across regions could potentially make the poverty rate high. This research aims to see the individual and regional or contextual factors affecting poor households. To simultaneously capture the effects of individual and regional level, we perform a Multilevel Logistic model using hierarchical structured poverty data from SUSENAS. The result shows that 4 (four) variables at individual level, which are the number of household members, the status of residence building, health insurance, and saving ownership, had a significant effect on the poor household. The region with high unemployment rate tend to have a high percentage of poor households. This result indicates that local government need to have policies that can affect poor households directly, such as socializing more about health insurance program and family planning program, as well as supervision in social aid distribution. Moreover, they need to create a program that can employ more people in order to decrease the percentage of poor households in such regions.

Association between sodium–glucose cotransporter-2 (SGLT2) inhibitors and macular degeneration in patients with diabetes: a nationwide population-based study in Taiwan

AimsEvidence showed that SGLT2 inhibitors have greater protective effects against retinal diseases compared to other hypoglycemic agents. Thus, we explore the association between SGLT2 inhibitor usage and macular degeneration (MD) in Taiwanese patients with diabetes.MethodsThe National Health Insurance (NHI) program's claim data are released as the National Health Insurance Research Database (NHIRD). This database covers more than 99% of the residents in Taiwan. We included data on patients who were newly diagnosed with type 2 diabetes mellitus (ICD-9-CM: 250, exclude 250.1x; ICD-10-CM: E11), with an age at diagnosis of over 20 years as our study population. Patients who received (sodium-glucose cotransporter 2 inhibitor) SGLT2i (ATC code: A10BK) over 90 days in 2016–2019 were defined as the SGLT2i cohort. Conversely, patients who did never received SGLT2i were defined as the non-SGLT2i cohort. The exclusion criteria were having MD before the index date, receiving SGLT2i within 1–89 days, and missing data on sex, age, or days of SGLT2i usage. Two cohorts were matched by 1:1 propensity score matching, which was based on age, sex, payroll bracket grade, urbanization, comorbidities, and medications.ResultsCompared to non-SGLT2i cohort, patients who received SGLT2i had a significantly lower risk of MD (adjusted hazard ratio = 0.70, 95%CI = 0.66–0.75).ConclusionsWe found that SGLT2is has a strong protective effect against MD in patients with diabetes. SGLT2is may have benefits beyond glycemic control in patients with DR. However, additional clinical and experimental studies are required.

User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal.

The Government of Nepal initiated a family-based National Health Insurance Program (NHIP) in April 2016, aiming to ensure universal health coverage (UHC) by enhancing access to and utilization of quality health services. However, NHIP, in its initial years of implementation, encountered challenges such as low population coverage, a high dropout rate, and concerns among the insured regarding the quality of healthcare services. There is a dearth of information regarding user satisfaction with the NHIP in Nepal. This study aimed to assess user satisfaction with NHIP at the household level in Nepal. We conducted a cross-sectional study among 347 households in the Ilam district using a multi-stage random sampling method. Face-to-face interviews were conducted with household heads enrolled in NHIP. A semi-structured questionnaire was used to collect the data. The multivariable logistic regression analysis was done to identify the predictors of satisfaction level. Overall, 53.6% of the insured were satisfied with the NHIP, while 31.1% had comprehensive knowledge about the NHIP. Factors such as gender (AOR: 1.80, 95% CI: 1.08-3.00), distance to the first point of contact (AOR: 2.15, 95% CI: 1.24-3.74), waiting time (AOR: 2.02, 95% CI: 1.20-3.42), availability of diagnostic services (AOR: 1.90, 95% CI: 1.05-3.45), availability of prescribed medicine (AOR: 3.90, 95% CI: 1.97-7.69), perceived service quality (AOR: 2.20, 95% CI: 1.15-4.20), and the behavior of service providers (AOR: 3.48, 95% CI: 1.04-11.63) were significantly associated with user satisfaction. The satisfaction level among NHIP users was deemed moderate. This study highlighted several factors, such as gender, distance to the first point of contact, waiting time, availability of diagnostic services and prescribed medicine, perceived service quality, and the behavior of service providers, as key determinants impacting user satisfaction. Recognizing the pivotal role of user satisfaction, health insurance stakeholders must prioritize it to ensure higher retention rates and coverage within NHIP.