Health Insurance Reform Research Articles

Operation strategies of the supplier, demander, and third party under the DRG/DIP reform

In this study, we analyze the operation strategies of the supplier, demander, and third party involved in the current process of China’s health insurance reform. Specifically, we summarize the relevant literature on the reform of healthcare insurance both in China and abroad, explore the current changes in healthcare policy, and identify the main problems in the current diagnosis-related group/diagnosis-intervention packet (DRG/DIP) payment method reform. Based on our analysis, we propose strategies that can satisfy the needs of the supplier, demand side, and third parties and offer valuable suggestions to enhance the healthcare security system and promote the DRG/DIP payment method reform.

4.D. Scientific session: From policy to implementation: Learnings around health system reforms and Universal Health Coverage

Abstract In this session, the authors and audience have the opportunity to engage in discussions around health policy integrity and reform implementation. Introducing and implementing health system reform has been a perennial issue for countries around the world over the past number of decades. Recently, the introduction and implementation of Universal Health Coverage (UHC) has been of particular focus, with 193 countries committed to introducing UHC by 2030. At the same time, European countries that previously established national health systems are introducing new reforms in the hope of making their health systems more efficient and equitable. However, there are a number of challenges along the path of policy development and implementation with which all countries must grapple, and how individual countries go about reforming their health systems depends on their social, political, cultural and economic contexts. Learnings from around the world have highlighted that reforms can be challenged or stalled in both the design and implementation phases. This workshop, which conceptualises implementation as the “acid test” of a policy, thus explores, through three case studies, the factors that facilitate or challenge the implementation of reforms. At the same time, we discuss policy integrity, exploring reasons for why policies pivot away from original design and intent. Furthermore, we discuss the implications of health reform on equity, cognisant that the primary objective of this collective reform work is to reduce the financial burden of healthcare on households and improve access. The first presentation will provide the framework for audience discussions, outlining international lessons in relation to UHC reforms and equity. The second presentation will provide a snapshot of the Finnish experience of introducing a “big bang” structural reform. The third presentation highlights lessons from the Portuguese experience of primary healthcare reforms, the opportunity these offer for creating patient-centred care and the integral role that politics and governance play in the reform process. Finally, the Irish case study highlights the experiences of a High Income County attempting to introduce UHC much later than its European counterparts, and negotiations between the public and private sectors. Through this, we hope to hold the tensions and stimulate debate about policy robustness and resilience, and reform implementation. Each presenter will be given a strict deadline of 10 minutes each by the chair and then the audience will be invited to debate the problems identified and strategies proposed to discuss: (i) what are the facilitators and barriers to reform implementation, (ii) what are the factors that encourage policy integrity and change and (iii) whether greater cooperation across Europe regarding health reforms can be more effective in supporting robust health systems. Key messages • For reforms to be facilitated, there must be cohesion and commitment across the political, social, economic and cultural systems, and no fragmentation across health system functions. • As policy implementation is attempted, there is a tension between remaining true to key values and adapting to new circumstances.

1.X.1. Achieving universal health coverage: international lessons from Irish policy implementation

Abstract Health systems all over the world are struggling to meet population health needs and provide timely access to universal healthcare in the context of the COVID-19 pandemic. COVID-19 occurred in Ireland in the early years of implementation of a national plan for universal healthcare, called Sláintecare. While many health systems are experiencing a retrenchment on universalism in the context of COVID-19, in Ireland despite tediously slow Sláintecare implementation, the pandemic provided a boost to reform implementation and universalism. The reason for this workshop is to draw on a publicly funded Health Research Board Applied Partnership Award, entitled ‘Foundations’, harnessing lessons from the Irish COVID-19 health system response to inform Sláintecare’s implementation https://hrbopenresearch.org/articles/3-70/v1 The objectives of the workshop are to 1) provide academic research evidence from the Irish experience of universal health system reform during and since COVID-19; 2) to give participants space to reflect on the implications of the Irish universal health system reform on international health systems and policy; 3) to actively involve workshop participants in an engaged discussion on implementing universal health coverage in the context of COVID-19. The added value of the workshop is to share learnings from an academic research programme, which is coproducing evidence in partnership with the Irish health system, in a worldwide context, providing relevant and thought-provoking discussion and analysis for an international audience. Four separate inter-related presentations will draw on aspects of the Foundations’ research project. Presentation 1, Prof Sara Burke will outline recent academic literature on universalism and the politics of reform implementation in the context of COVID-19 and present a timeline of universal healthcare reform implementation since 2018 when Sláintecare was adopted by the Irish government (14 mins). Presentation 2, Dr Sarah Parker will detail a specific study which set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation (10 mins). Presentation 3, Dr Katharine Schulmann and Carlos Bruen will present findings on the governance of reform implementation and implications for all health systems (10 mins). Presentation 4, Dr Philip Crowley, Health Service Executive (HSE) National Director of Strategy and Research and Chair of the Foundations’ research steering group will reflect how research findings can inform implementing reform and their implications for all health systems (6 mins). There will be four presentations totalling 40 mins, followed by questions and discussion chaired by an international expert/academic on universal health systems. Key messages • COVID-10 has highlighted how universal health coverage is more important than ever, however the pandemic has resulted in some retrenchment on universalism. • While data and research drove health system decision making during the pandemic, embedding research evidence into health system and policy reform remains challenging and can be politically opposed.

University student suicides in Türkiye: Insights from two decades of media reports

University student suicides have emerged as a significant societal concern, reflecting challenges inherent in the transition to adulthood and academic pressures. This study aims to analyze two decades of national media coverage on university student suicides in Türkiye, examining demographic trends, suicide methods, and social factors implicated in these tragic incidents. A comprehensive scan of Turkish national media archives from January 1, 2004, to December 31, 2023, identified 213 unique reports of university student suicides. Data extracted included age, sex, year of incident, prior suicide attempts, geographic distribution, housing status, academic major, psychiatric history, social background, suicide method, and presence of suicide notes or social media posts. Statistical analyses utilized Fisher's Exact Test and Pearson's Chi-square to examine categorical data. Male students accounted for 61.6% (n=125) of reported suicides, with a mean age of 22.2 years (SD=3.05). The most common suicide method was jumping from height, differing by sex, with hanging prevalent among males and jumping more frequent among females. Mobbing emerged as a predominant social stressor implicated in suicide incidents, surpassing other factors reported in the literature. The findings highlight an alarming increase in media-reported university student suicides, predominantly affecting males and characterized by distinct suicide methods. The pervasive impact of mobbing underscores the urgent need for targeted interventions addressing social stressors, alongside comprehensive medical, psychological, social, and economic support systems within academic settings. Efforts should prioritize proactive mental health initiatives, policy reforms, and community-based interventions to mitigate suicide risks among university students.

Annual Family Premiums for Employer Coverage Rise 7% in 2024 After Also Rising 7% Last Year

Family premiums for employer-sponsored health insurance rose 7% this year to reach an average of $25,572 annually, KFF’s 2024 benchmark Employer Health Survey finds. On average, workers contribute $6,296 annually to the cost of family coverage. This marks the second year in a row that premiums are up 7%. Comparatively, there was an increase of 4.5% in workers’ wages and inflation of 3.2%

Welfare effects of health insurance reform: The role of elastic medical demand

Some medical demand is inelastic to price fluctuations, but not all. This paper examines the role of the price elasticity of medical demand on the welfare effects of public health insurance reform. I develop a computational general equilibrium life-cycle model for heterogeneous agents with varying income, wealth, and health that allows for endogenous medical spending. I calibrate the model for the Japanese economy. If medical spending is totally price-inelastic, increasing copayments will improve the welfare of future generations, but harm all current generations, particularly older people with low income or poor health. In contrast, the welfare gain for newborns is significantly greater in the empirically observed situation where medical spending includes some price-elastic components. Moreover, the reform reduces welfare losses for current individuals and may benefit younger generations.

Measuring the Impact of Medical Cannabis Law Adoption on Employer-Sponsored Health Insurance Costs: A Difference-in-Difference Analysis, 2003-2022.

Recent studies suggest that medical cannabis laws may contribute to arelative reduction in health insurance costs within the individual health insurance markets at the state level. We investigated the effects of adopting a medical cannabis law on the cost of employer-sponsored health insurance in the United States. We analyzed state-level data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) Private Sector spanning from 2003 to 2022. The outcomes included log-transformed average total premiumcosts per employee for single, employee-plus-one, and family coverage plans. We utilized the Sun and Abraham (J Econometr 225(2):175-199, 2021) difference-in-difference (DiD) method, looking at the overall DiD and event-study DiD. Models were adjusted for various state-level demographics and dichotomous policy variables, including whether a state later adopted recreational cannabis, as well as time and unit fixed effects and population weights. For states that adopted a medical cannabis law, there was a significant decrease in the log average total premium per employee for single (-0.034, standard error [SE] 0.009(-$238)) and employee-plus-one (-0.025, SE 0.009(-$348)) coverage plans per yearconsidering the first 10 years of policy change compared with states without such laws. Looking at the last 5years of policy change, we saw increases in effect size and statistical significance. In-time placebo testing suggested model robustness.Under a hypothetical scenario where all 50 states adopted medical cannabis in 2022, we estimated that employers and employees could collectively save billions on healthcare coverage, potentially reducing healthcare expenditure's contribution to GDP by 0.65% in 2022. Adoption of a medical cannabis law may contribute to decreases in healthcare costs. This phenomenon is likely a secondary effect and suggests positive externalities outside of medical cannabis patients.

Health Policy Reforms and Their Effect on Healthcare Delivery: Utilizing Natural Language Processing (NLP) to Analyze Public Sentiment and Policy Feedback

For health policy reforms, they've a profound impact on the healthcare transport structures, shaping how services are given and obtained. For lawmakers to make knowledgeable decisions that cope with the concerns and wishes of the society, they need to be able to apprehend what the public senses and says about the ones changes. The effectiveness and acceptability of health policy reforms can be better understood by the use of Natural Language Processing (NLP), which has advanced strategies for analyzing huge quantities of public discourse. Decoding diverse and unstructured records resources along with open forums, social media posts as well as news tales is one out of several troubles this assignment tackles. Natural Language Processing-Based Integrated Sentiment Analysis (NLP-ISA) is a new approach to evaluating how healthcare delivery has been converted by using changes in health policy. To process big data sets consisting of public speeches, NLP-ISA combines sentiment evaluation with present day herbal language processing algorithms. This technique analyzes public temper to show worries approximately the change in guidelines, gratification, and potential challenges that want interest when it comes to it. This paper helps policymakers to improve carrier conveyance by demonstrating real-time outcomes that their regulations create. It could screen public response in the direction of new hints while ascertaining trends in opinion among contributors of the public. The efficiency will confirm if NLP-ISA is effective or now not through simulation analysis.This process includes comparing previous polls on health care deliveries with the results from previous polls concerning past improvements made on health policies. By simulating the effect of public opinion on policy outcomes, this simulation will show how well NLP-ISA can formulate evidence-based suggestions for policy changes.

Challenges and Opportunities in Accessing Surgery for Glioblastoma in Low-Middle Income Countries: A Narrative Review.

Glioblastoma: a highly aggressive brain tumor, presents substantial challenges in treatment and management, with surgical intervention playing a pivotal role in improving patient outcomes. Disparities in access to brain tumor surgery arise from a multitude of factors, including socioeconomic status, geographical location, and healthcare resource allocation. Low- and middle-income countries (LMICs) often face significant barriers to accessing surgical services, such as shortages of specialized neurosurgical expertise, limited healthcare infrastructure, and financial constraints. Consequently, glioblastoma patients in LMICs experience delays in diagnosis, suboptimal treatment, and poorer clinical outcomes compared to patients in high-income countries (HICs). The clinical impact of these disparities is profound. Patients in LMICs are more likely to be diagnosed at advanced disease stages, receive less effective treatment, and have lower survival rates than their counterparts in HICs. Additionally, disparities in access to surgical care exacerbate economic and societal burdens, emphasizing the urgent need for targeted interventions and health policy reforms to address healthcare inequities. This review highlights the importance of addressing global disparities in access to brain tumor surgery for glioblastoma through collaborative efforts, policy advocacy, and resource allocation, aiming to improve outcomes and promote equity in surgical care delivery for all glioblastoma patients worldwide.

Exploring the Landscape of Adult Acute Poisoning in Saudi Arabia: A Comprehensive Narrative Review.

This narrative review meticulously examines the intricate landscape of poisoning incidents within Saudi Arabia, delineating the prevalence and characteristics across three main categories: pharmaceutical, illicit, and chemical substances. Pharmaceutical agents, particularly analgesics and antipsychotics, are identified as leading causes of acute adult poisoning, highlighting the paramount role of their widespread accessibility and the potential risks associated with over-the-counter availability. The review underscores the alarming prevalence of over-the-counter analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), as the most frequent culprits in poisoning cases, with a significant correlation observed between analgesic poisoning and gender, notably affecting the female population. Additionally, the study delves into the burgeoning issue of illicit drug use, with opioids and amphetamines emerging as substantial contributors to the poisoning landscape, reflecting a broader global trend of increasing substance misuse and its associated health risks. Chemical poisoning, encompassing a range of substances from household cleaners to industrial chemicals, presents another critical area of concern, with specific emphasis on the dangers posed by antiseptics, detergents, and organophosphates. The review identifies a pressing need for targeted public health interventions and policy reforms aimed at mitigating the risks associated with these diverse types of poisoning. By offering a comprehensive overview of the poisoning epidemiology in Saudi Arabia, the study contributes valuable insights into the multifaceted nature of this public health challenge, advocating for enhanced regulatory measures, public awareness campaigns, and improved access to mental health services to address the underlying factors contributing to poisoning incidents.

A Proposed Condition-Based Risk Adjustment System for the Colombian Health Insurance Program

This article explores the development of a condition-based risk adjustment system for healthcare financing in Colombia, where the current age-, sex-, and geographic-based system faces significant challenges. These shortcomings, including inadequate compensation for high-risk members, necessitate workarounds that compromise efficiency. We propose a condition-based system that provides more accurate and equitable compensation, eliminating the need for special payments. This research discusses the existing issues in the current system, details the construction process of the condition-based risk adjustment system, and assesses its accuracy. This study not only offers an alternative to the current compensation system but also contributes to the broader discourse on health insurance reform.

Health insurance and transportation barriers impact access to epilepsy care in the United States

PurposeInconsistent access to healthcare for people with epilepsy results in reduced adherence to antiseizure medications, increased seizure frequency, and fewer appropriate referrals for epilepsy surgery. Identifying and addressing factors that impede access to care should consequently improve patient outcomes. We hypothesized that health insurance and transportation affect access to outpatient neurology care for adults living with epilepsy in the United States (US). MethodsWe conducted a retrospective cross-sectional study of US adults with active epilepsy surveyed via the National Health Interview Survey (NHIS) in 2015 and 2017. We established whether patients reported seeing a neurologist in the past year and used multiple logistic regression to determine whether health insurance status and transportation access were associated with this outcome. ResultsWe identified 735 respondents from 2015 and 2017, representing an estimated 2.98 million US adults with active epilepsy. After adjusting for socioeconomic and seizure-related co-variates, we found that a lack of health insurance coverage was associated with no epilepsy care in the past year (adjusted odds ratio [aOR] 0.22; 95 % confidence interval [CI]: 0.09 – 0.54). Delayed care due to inadequate transportation (aOR 0.42; 95 % CI: 0.19 – 0.93) also resulted in reduced patient access to a neurologist. ConclusionDue to the inherent nature of their condition, people with epilepsy are less likely to have employer-sponsored health insurance or consistent driving privileges. Yet, these factors also impact patient access to neurological care. We must address transportation and insurance barriers through long-term investment and partnership between community, healthcare, and government stakeholders.

“No room for error”: a qualitative interview study of experiences with health insurance coverage loss and COVID-19 pandemic relief policies among people with asthma

Objectives The COVID-19 pandemic led to unemployment and associated health insurance loss, prompting an unprecedented adoption of emergency policies, including economic relief efforts and health insurance coverage expansion. We sought to understand pandemic-related challenges for people with asthma and how emergency policies served families facing both chronic disease management and health insurance loss. Study design Qualitative interview study. Methods In 2021, we conducted semi-structured telephone interviews with 21 adults who had asthma and lost employment and employer-sponsored health insurance coverage during the COVID-19 pandemic. We used thematic analysis to assess how health and economic policies affected participants’ ability to access care and manage their asthma. Results Participants reported reduced access to care, as well as worry about heightened susceptibility to COVID-19 due to their asthma. While insurance loss exacerbated these challenges, participants indicated that economic relief efforts, including direct stimulus payments, helped them afford needed asthma care. Participants were more critical of enhancements to existing coverage policies such as the Affordable Care Act (ACA) Marketplace and Consolidated Omnibus Budget Reconciliation Act (COBRA) due to difficulty understanding, accessing, and affording such coverage. Conclusions Our findings underscore that people affected by asthma and health insurance loss benefit from policies that provide flexible and easy-to-use assistance, such as direct payments, for meeting the diverse challenges posed by living with a chronic disease. Although policies that expand health insurance coverage are critical, more attention is needed to help people with chronic conditions access these programs in a timely way.

Evaluating the effect of health insurance reform on health equity and financial protection for elderly in low- and middle-income countries: evidences from China

BackgroundTo achieve Universal Health Coverage (UHC), China have implemented health system reform to expend health coverage and improve health equity. Scholars have explored the implementing effect of this health reform, but gaps remained in health care received by elderly. This study aims to assess the effect of implementing health insurance payment reform on health care received by elderly, as well as to evaluate its effect on cost sharing to identify whether improve financial protection of elderly under this reform.MethodsWe identified hospitalization of 46,714 elderly with cerebral infarction from 2013 to 2023. To examine the determinant role played by DRGs payment reform in healthcare for elderly and their financial protection, this study employs the OLS linear regression model for analysis. In the robustness checks, we validated the baseline results through several methods, including excluding the data from the initial implementation of the reform (2021), reducing the impact of the pandemic, and exploring the group effects of different demographic characteristics.ResultsThe findings proposed that implementing DRGs payment reduces drug expenses but increases treatment expense of chronic disease for elderly in China. This exacerbates healthcare costs for elderly patients and seems to be contrary to the original purpose of health care reform. Additionally, the implementation of DRGs payment reduced the spending of medical insurance fund, while increased the out-of-pocket of patients, revealing a shift in health care expenses from health insurance fund to out-of-pocket.ConclusionsThis study shares the lessons from China’s health reform and provides enlightenment on how to effective implement health reform to improve health equity and achieve UHC in such low- and middle-income countries facing challenges in health financing.

Labor market pathways to job quality mobility in the service sector: Evidence from the “Great Resignation”

Since the mid-1970s, there has been a sharp rise in the prevalence of “bad jobs” in the U.S. labor market, characterized by stagnant wages, unstable work schedules, and limited fringe benefits. Scholarly, policy, and public debate persists, however, about whether these jobs can serve as steppingstones to intra-generational job quality mobility or are instead “poverty traps.” While scholarship increasingly recognizes the multi-dimensional nature of job quality, prior research on intra-generational job mobility overwhelmingly estimates only wage mobility and generally focuses on estimating the degree of mobility, to the exclusion of the contexts and mechanisms that foster such mobility. We draw on new panel data collected from 8600 hourly service sector workers between 2017 and 2022 to estimate short-run mobility into good jobs, defined as paying at least $15/hour, having a stable work schedule, and offering paid sick leave, employer-sponsored health insurance, and retirement benefits. Overall, we find that mobility into such “good jobs” is low. However, we show that the rate of transition into “good jobs” is strongly conditioned by local labor market conditions: during the “Great Resignation” and in low state-month unemployment periods, nearly twice the share of workers transitioned to “good jobs” as in less favorable contexts, particularly workers who changed sector as opposed to staying at the same firm or taking new jobs in the service sector. Notably, during periods of labor market tightness, workers who stayed at the same employer had similar rates of mobility into “good jobs” as those who changed employers within the sector.

The doctor vote: Interactions between political ideological preferences and healthcare reform strategies among U.S. physicians

IntroImproving the American healthcare system has consistently predominated the domestic policy agenda in the United States for decades. However, physicians have traditionally played a small role in the U.S. legislative process despite their direct observations of the obstacles that cost, access, and quality can have on their patients and their care. The goal of this study was to examine the relationship between physician political ideological preferences and health policy reform options. MethodsWe conducted a cross-sectional survey of 3,001 currently practicing U.S. physicians to predict how self-identification as liberal, moderate, or conservative impacted a physician’s policy preferences under the domains of cost, access, and quality. ResultsA total of 536 (18.8%) out of 3,001 physicians responded to the survey. Overall, 32% of physicians identified as liberal, 43% as moderate, and 22% as conservative. ConclusionLiberal-identifying physicians favored traditionally liberal reform ideas (a national health plan or public option), while conservative physicians preferred conservative policies (free market optimization). However, variation within political groups and domains of healthcare suggest that no single reform policy will be unanimously supported by every physician within a political group. Nonetheless, physicians are unanimously dissatisfied with the state of our current system, and physician-supported healthcare reform should be a national priority.

Annual trends in pain management modalities in patients with newly diagnosed autoimmune rheumatic diseases in the USA from 2007 to 2021: an administrative claims-based study

Autoimmune rheumatic diseases have distinct pathogenic mechanisms and are causes of disability and increased mortality worldwide. In this study, we aimed to examine annual trends in pain management modalities among patients with autoimmune rheumatic diseases. We identified newly diagnosed patients with ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren's syndrome, systemic sclerosis, or systemic lupus erythematosus (SLE) in the Merative Marketscan Research Databases from 2007 to 2021. The database includes deidentified inpatient and outpatient health encounters with employment-sponsored health insurance claims in the USA. We found minimal occurrences of multiple overlapping conditions and included only the initial recorded diagnosis for each patient. We determined the annual incidence of patients treated with opioids, anticonvulsants, antidepressants, skeletal muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, and physical therapy in the year following diagnosis. Logistic regression was used to estimate the association between calendar year and outcomes, adjusted for age, sex, and region. We included 141 962 patients: 10 927 with ankylosing spondylitis, 21 438 with psoriatic arthritis, 71 393 with rheumatoid arthritis, 16 718 with Sjögren's syndrome, 18 018 with SLE, and 3468 with systemic sclerosis. 107 475 (75·7%) were women and 34 487 (24·3%) were men. Overall, the incidence of opioid use increased annually until 2014 by 4% (adjusted odds ratio [aOR] 1·04 [95% CI 1·03-1·04]) and decreased annually by 15% after 2014 (0·85 [0·84-0·86]). The incidence of physical therapy use increased annually by 5% until 2014 (aOR 1·05 [95% CI 1·04-1·06]), with a slight decrease annually by 1% after 2014 (0·99 [0·98-1·00]). The incidence of anticonvulsant use increased annually by 7% until 2014 (aOR 1·07 [95% CI 1·07-1·08]) and did not significantly change after 2014 (1·00 [0·99-1·00]). Before 2014, the incidence of NSAIDs use increased by 2% annually (aOR 1·02 [95% CI 1·02-1·03]); however, after 2014, the incidence decreased annually by 5% (0·95 [0·95-0·96]). These trends did not differ by sex except for NSAID use before 2014 (pinteraction=0·02) and topical analgesic use after 2014 (pinteraction=0·0100). Since 2014, the use of non-opioid pain management modalities has increased or stabilised, whereas opioid and NSAID use has declined. Future studies are needed to evaluate the effectiveness of these changes, and the effects they have had on outcomes such as quality of life, disability, and function. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

WHAT IS THE ROLE OF JOURNALISM IN THE POLITICAL ADVOCACY OF HEALTH POLICY IN INDONESIA?

In this short commentary article, the complex association between journalism, health policy, and political campaigning in Indonesia is explained, in need of more scholarly expansion. Within those limitations, the paper does alert to the necessary function journalism serves intrinsic to the public discourse that drives health policy recommendations, as well as noting how this has been perverted by misinformation and dwindling faith in the media. The article examines how journalism (including digital and social media) has shaped health policy advocacy and public opinion and highlights the role of the media in health communication campaigns and policy reform. Through scrutiny of its role in health policy advocacy, with a broader look at how journalism roles have shifted over time. In this article, the author demonstrated that journalism is a bridge between health policy experts and the public, enabling a more informed democratic engagement with health policy. These conclusions highlight the need to build a nexus between democratic journalism and health policy advocacy for public health priorities in Indonesia. Keywords: health policy, journalism, political campaign

What explains the provision of health insurance by Indonesian employers? A trend analysis of the National Labour Force Survey 2018-2022.

Indonesian laws mandate that every employer should provide health insurance and work accident insurance to their employees. Nevertheless, there is a significant gap in the coverage of employer-sponsored insurance among Indonesian workers. This study examines the coverage of employer-sponsored insurance and work accident insurance and analyses the characteristics of the uninsured working population in Indonesia. We analysed nationally representative cross-sectional data from the National Labour Force Survey (NLFS) conducted between 2018 and 2022. The primary dependent variable was the provision of health insurance and work accident insurance by employers. The independent variables included having any physical disabilities, number of working hours, duration of employment, labour union membership, earning at least the provincial minimum wage, having a written contract and working in high risk jobs. Logistic regression was employed using the R statistical software. The findings indicate that coverage of employer-sponsored health insurance is low in Indonesia-ranging from 36.1% in 2018 to 38.4% in 2022. Workers with a written contract, earning at least the provincial minimum wage, were members of a labour union, employed for at least 5 years and working more than 40 hours a week were more likely to be insured. By contrast, workers who had physical disabilities or were employed in high-risk jobs were less likely to be insured. Our study concludes that having a written employment contract is the single most influential factor that explains the provision of employer-sponsored health insurance in Indonesia. The country's labour laws should therefore formalize the provision of written employment contracts for all workers regardless of the type and nature of work. The existing laws on health insurance and work accident insurance should be enforced to ensure that employers meet their constitutionally mandated obligation of providing these types of insurance to their workers, particularly those engaged in high risk jobs.

Childcare needs as a barrier to healthcare among women in a safety-net health system

BackgroundChildcare needs are an understudied social determinant of health. The effect of childcare needs on access to healthcare must be understood to inform health system interventions and policy reform. This study sought to characterize childcare needs, access to childcare, and prior experience with navigating childcare needs in healthcare settings among women in a safety-net population.MethodsWe conducted a cross-sectional study of patient-reported survey data collected in-person between April and October 2019. Surveys were administered in waiting rooms of ambulatory services in a large, urban safety-net health system in Dallas, Texas. Survey respondents were derived from a random convenience sample of women waiting for outpatient appointments. Participants were screened for having children under the age of 13 and/or childcare responsibilities for inclusion in the sample. Outcomes of interest included self-reported delayed or missed care, reasons for delayed or missed care, perceived difficulty in accessing childcare, prior methods for managing childcare during healthcare appointments, and prior experience with childcare centers.ResultsAmong the 336 respondents (96.7% response rate), 121 (36.0%) reported delaying or missing a mean 3.7 appointments/year. Among women with delayed or missed care, 54.5% reported childcare barriers as the primary reason for deferral of care, greater than transportation (33%) or insurance (25%) barriers. Respondents rated childcare access as more difficult than healthcare access. Delayed or missed care due to childcare was more common among White (68.8%) and Black (55.0%) women compared to Hispanic women (34.3%). Common methods of navigating childcare needs during scheduled appointments included bringing children to appointments (69.1%) and re-scheduling or missing the scheduled appointment (43.0%). 40.6% of patients reported leaving an appointment before completion due to childcare needs.ConclusionsChildcare needs are a leading barrier to healthcare among women accessing care in safety-net settings. Unmet childcare needs result in deferral of care, which may impact health outcomes. Childcare access is perceived as more challenging than healthcare access itself. Health system and policy interventions are needed to address childcare as a social determinant of health.