Health Insurance Scheme Research Articles

Is the criminalization of informal payment a good idea? The role of the free choice of physician in the elimination of the phenomenon

In Hungary, the new act on the employment status of health workers aims at the elimination of informal payments by the strict separation of public and private care, by a significant increase of the salary of medical doctors and with the criminalization of giving and accepting informal payments. In this study, which is based on our former research, an analysis of the Hungarian judicial practice and an internet research focused on obstetrics, we examine whether the chosen tools are appropriate to achieve this goal, and if not, how the provisions of law should be modified. Both the theoretical considerations and the empirical evidence suggest that the approach the act took is wrong, because the majority of patients are not paying to compensate the doctors for their low salary. Patients pay because they think that they will not get the necessary care without it. This fee-for-service type informal payment is not corruption and it originates from health system shortages, which is not addressed by the act. On the contrary, the full implementation of the provisions of the act might even increase these shortages, which paradoxically can lead to the amplification of the phenomenon. According to the international experiences, long-term measures aiming at the easing of shortages, in themselves, are not sufficient to roll back this undesirable phenomenon, if they are not coupled with a short-term quick fix intervention, which creates a formal substitution mechanism allowing patients to buy the services associated with informal payments legally. The free choice of doctor is perceived to be an additional service to be paid for by the majority of patients and doctors, despite that, according to the current regulations, it is part of the public benefit package and should be available free of charge. Hence, informal payments could be formalized in the frame of the free choice of doctor and health care provider by making it a chargeable service. Such an approach is not unfamiliar in the Hungarian health policy, judicial practice, and even private obstetric care. Moreover, there is a government-supported obstetric model program in the public system in Hungary, where an explicit goal is to replace informal payments with formal fees to be paid by the patients for the free choice of the obstetrician who attends the delivery. All of these seem to be realistic starting points to introduce a technically and politically feasible pilot project, but the detailed regulations should be designed so that the involved health workers have no financial interest to discriminate against non-paying patients. To achieve this, we recommend that the attending physicians are also paid a fee even if they care for a patient, who did not choose them and pay them out of pocket, but live in the catchment area of the health service delivery organization, which is obliged to care for the local residents. Obviously, the source of this fee, which is eventually a performance-based component of the income of physicians, in this case, has to be the social health insurance scheme.

Government Insurance and Out-of-Pocket Healthcare Expenditure in Ghana

The relationship between membership in Ghana’s national health insurance scheme and out-of-pocket healthcare expenditure (OOPHE) was quantified using data from two rounds of the Ghana Living Standards Survey for 2013 and 2017. Censored quantile regressions were evaluated with and without instrumental variables. The results show that going from having no insured household member to all insured predicted less OOPHE (by 19% at the median). We find statistically significant differences between the 2013 and 2017 estimates. Insurance reduced OOPHE in 2013 but had a statistically insignificant effect in 2017. The effect on spending on outpatient care was greater than that related to medicine and medical supplies. There was no statistically significant relationship with hospitalisation fees. Falling government health spending and growing reliance on private healthcare financing have been observed. The insurance scheme has become less generous, and it was therefore less effective in 2017.

The effect of the price of time on healthcare provider choice in Ghana

The existing literature confirms that the cost of treatment affects the choice of a particular healthcare provider. The Ghana National Health Insurance Scheme was established in 2003 to reduce the cost of healthcare provision and increase access to healthcare. However, we find that that even when the price is assumed to be “zero”, there remain some economic costs for choosing a particular healthcare provider over the other. This is called the price of time or opportunity cost. The study uses data from the seventh round of the Ghana Living Standards Survey (GLSS 7) conducted in 2016/2017 and employs multinomial probit regression as the technique for the analysis. The study finds that travel time and waiting time have significant effects on the choice of healthcare provider. If travel time and waiting time increase by 1 h, it will decrease the probability of seeking healthcare by 12% and 17%, respectively. Travel cost was not found to have a significant effect. The recommendations are that policymakers should make the effort to decrease travel time and waiting time at the health facilities in the country to improve healthcare delivery.

A Cross-Sectional Study of Price and Affordability of Drugs for Rare Diseases in Shandong Province, China.

Objective: The affordability of rare disease drugs has become a social issue that cannot be ignored. This study aims to evaluate the current price and affordability of rare disease drugs in China, with evidence from Shandong province. Methods: Data on prices and affordability of 50 drugs for 22 rare diseases were collected from secondary and tertiary public hospitals in Shandong Province, using an adaptation of the World Health Organization/Health Action International (WHO/HAI) methodology. Prices were measured as Median Price Ratios (MPRs). Affordability was measured as days of daily per capita disposable income required for the cost of one month’s treatment. Results: Out of the 50 rare disease drugs, 11 drugs had MSH reference prices and 34 had PBS reference prices. Median prices of 11 drugs were higher than MSH reference prices (median 1.33), and median prices of 34 drugs were higher that Australian PBS prices (median 1.97). Thirty-six (72.00%) and forty-four (88.00%) drugs were unaffordable for urban and rural residents, respectively. Thirty-four (68.00%) and thirty-eight (76.00%) drugs were unaffordable for urban and rural residents even after reimbursement by the health insurance schemes of China, respectively. Conclusions: The affordability of some rare disease drugs remained poor with their relatively high prices in Shandong Province. Sustainable mechanisms are needed to reduce the price of rare disease drugs and to improve the affordability of rare disease patients.

Long-Term Impact of COVID-19 on Hospital Visits of Rural Residents in Guangdong, China: A Controlled Interrupted Time Series Study.

To date, there is a lack of comprehensive understanding regarding the effect of coronavirus disease 2019 (COVID-19) on the healthcare-seeking behavior and utilization of health services in rural areas where healthcare resources are scarce. We aimed to quantify the long-term impact of COVID-19 on hospital visits of rural residents in China. We collected data on the hospitalization of all residents covered by national health insurance schemes in a county in southern China from April 2017 to March 2021. We analyzed changes in residents’ hospitalization visits in different areas, i.e., within-county, out-of-county but within-city, and out-of-city, via a controlled interrupted time series approach. Subgroup analyses based on gender, age, hospital levels, and ICD-10 classifications for hospital visits were examined. After experiencing a significant decline in hospitalization cases after the COVID-19 outbreak in early 2020, the pattern of rural residents’ hospitalization utilization differed markedly by disease classification. Notably, we found that the overall demand for hospitalization utilization of mental and neurological illness among rural residents in China has been suppressed during the pandemic, while the utilization of inpatient services for other common chronic diseases was redistributed across regions. Our findings suggest that in resource-poor areas, focused strategies are urgently needed to ensure that people have access to adequate healthcare services, particularly mental and neurological healthcare, during the COVID-19 pandemic.

Baseline Assessment Towards the Implementation of Formal Sector Health Insurance Scheme for Civil Servants in Ogun State of Nigeria

The healthcare financing mechanism of a nation generally determines the access of her people to the needed qualitative and affordable health care services without undergoing any financial hardship, This study is therefore set to determine among other things the preferred mode of service payment for healthcare, as a measure of demand for health insurance, among civil servants in Ogun State of Nigeria. The study adopted a “quantitative methodology” approach, with the use of pretested self-administered questionnaires. The mean age of the respondents was 37.85 years ± standard deviation of 7.51 years. In setting the health insurance premium, majority, 59.3% of the respondents preferred government use percentage of gross salary rather than estimated amount. They suggested around 2.18% of their gross salary as premium and an additional 30.26% of their gross salary as contribution to the premium from their employer. On an average, they were only willing to pay one thousand seven hundred and eighty naira and 32 kobo (N1,780:32) in a month to have themselves, their spouse and 4 dependants covered by an health insurance scheme. The study indicated the predictors of demand for health insurance as being married, having spent 10 years and more in civil service, and perceived importance (value) of health insurance. The latter implies that there is an association between value attached to health insurance and its demand such that those who felt health insurance was important were 6 times more likely to prefer it as method of service payment than those who did not see the importance of health insurance.

Outpatient antibiotic prescribing for acute respiratory infections in Vietnamese primary care settings by the WHO AWaRe (Access, Watch and Reserve) classification: an analysis using routinely collected electronic prescription data

This study aims to investigate patterns of antibiotic prescribing and to determine patient-specific factors associated with the choice of antibiotics by the World Health Organization's Access-Watch-Reserve (WHO AWaRe) class for acute respiratory infections (ARIs) in rural primary care settings in northern Vietnam. We retrospectively reviewed health records for outpatients who were registered with the Vietnamese Health Insurance Scheme, visited one of 112 commune health centres in 6 rural districts of Nam Dinh province, Vietnam during 2019, and were diagnosed with ARIs. Patient-level prescription data were collected from the electronic patient databases. We used descriptive statistics to investigate patterns of antibiotic prescribing, with the primary outcomes including total antibiotic prescriptions and prescriptions by WHO AWaRe group. We identified patient-specific factors associated with watch-group antibiotic prescribing through multivariable logistic regression analysis. Among 193,010 outpatient visits for ARIs observed in this study, 187,144 (97.0%) resulted in an antibiotic prescription, of which 172,976 (92.5%) were access-antibiotics, 10,765 (5.6%) were watch-antibiotics, 3366 (1.8%) were not-recommended antibiotics. No patients were treated with reserve-antibiotics. The proportion of watch-antibiotic prescription was highest amongst children under 5-years old (18.1%, compared to 9.5% for 5-17-years, 4.9% for 18-49-years, 4.3% for 50-64-years, and 3.7% for 65-and-above-years). In multivariable logistic regression, children, district, ARI-type, comobid chronic respiratory illness, and follow-up visit were associated with higher likelihood of prescribing watch-group antibiotics. The alarmingly high proportion of antibiotic prescriptions for ARIs in primary care, and the frequent use of watch-antibiotics for children, heighten concerns around antibiotic overuse at the community level. Antimicrobial stewardship interventions and policy attention are needed in primary care settings to tackle the growing threat of antibiotic resistance. This work was supported through Australian government and UK aid from the UK government funding to FIND (Foundation for Innovative New Diagnostics) grant number FO17-0015, in addition to a Wellcome Trust grant (213920/Z/18/Z), and an Oxford University Clinical Research Unit internal grant from the Wellcome Trust Africa Asia Programme core grant in Vietnam (106680/Z/14/Z).

Knowledge and Determinants of Hepatitis B Virus Testing and Vaccination Status among Sickle cell Disease Patients

Background: Sickle cell anemia patients are a cohort of at-risk individuals for Hepatitis B virus infection due to their life-long dependency on transfusion therapy. The World Health Organization (WHO) recommendations stipulates testing and vaccination for at-risk individuals.
 Objective: The objectives of the present study are to assess the level of knowledge of sickle cell disease patients to HBV infection, identify their HBV vaccination status and to assess the barrier that prevents patients from being tested and vaccinated for HBV infection.
 Materials and Methods: This was a cross-sectional study. The subjects comprised of 120 sickle cell disease patients who were recruited through consecutive sampling using pretested, semi-structured, self-administered questionnaires and data was analyzed with statistical package for social sciences (SPSS) for Microsoft Window Version 23.
 Results: The mean age of the respondents was 24 +6 years. About 57.5% of the respondents are aware of Hepatitis B virus infection but only 15% had good knowledge of the disease. About 80.8% of the respondents have not been tested for Hepatitis B infection while 70% has not been vaccinated. The cost of testing for HBV infection and vaccination was identified as a major factor that prevented many of the patients from identifying their HBV status as well as getting vaccinated as about 80% of the respondents have not been tested due to high cost of testing while 84.2% have not been vaccinated due to high cost of the vaccine.
 Conclusion: There should be universal health education to sickle cell anemia patients on the need for Hepatitis B virus infection test and vaccination as well as a health insurance scheme that will cover the cost of Hepatitis B virus testing and vaccination for patients.

Understanding inactive membership in voluntary contributory schemes: A case study of micro‐traders in Kenya

SummaryMotivationThe provision of health insurance is a public policy response to address the problem of catastrophic health expenditure, which leads to deprivation. Studies show a low uptake of health insurance among informal workers, but the focus has been on understanding enrolment behaviour. Little attention has been paid to understanding inactive membership among informal workers.PurposeThis article asks why informal workers in Kenya are abandoning health insurance schemes. It uses micro‐traders as a case study to understand inactive membership among voluntary contributors in Kenya's national health insurance scheme.Methods and approachBased on primary data combining qualitative and quantitative methods, the article compares inactive members with active and non‐members to identify factors contributing to inactive status.FindingsThis article contends that unmarried voluntary contributors who consider themselves to be healthy and are own‐account workers with low and irregular earnings are more likely to drop out of the scheme. The key drivers of “inactiveness” are the inability to commit to the payment of regular premiums, due to the irregularity of earnings, the change of employment status from formal to informal, and dissatisfaction with scheme services.Policy implicationsSince unmarried, “healthy,” voluntary contributors are more likely to drop out, this creates problems of adverse selection in cases where the scheme retains “unhealthy” members, who are more likely to claim benefits. When “healthy” members drop out, this may force the scheme to increase the level of premiums, since contributory schemes rely on members' contributions. An increase in premiums may trigger further dropouts, which is counterproductive in relation to the global agenda of increasing access to essential health care.

Improving health and social care services for slum-dwelling older adults: Perspectives of health professionals.

BackgroundBesides confronting the challenges of a growing older population, developing countries are dealing with limited resources and infrastructure, to ensure good health and social care services. One of these developing countries facing these challenges is Ghana. The healthcare system in Ghana currently does not have specialized geriatric services and is funded through the National Health Insurance Scheme (NHIS), private insurance companies and an out-of-pocket expenditure system. Social care services are important in improving Quality of Life (QoL) as it helps in building and strengthening relationships while also keeping slum-dwelling older adults active. There are various challenges with the health and social care of older adults in slums and practical ways to improve these have not been explored among the providers of this care.AimsThis study, therefore, aimed to explore (1) the views of health professionals on older slum-dwelling adults' health and social care needs, access, and use, and (2) recommendations for improving access to health and social care services among slum-dwelling older adults.MethodA qualitative exploratory descriptive approach was used among health professionals by conducting a focus group discussion (FGD) and interviews. A semi-structured interview guide was used to collect data from each participant.ResultsA total of 27 participants took part in the study. In the analysis of transcripts, 3 themes and 14 subthemes were conceptualized. Financial difficulties, queueing issues, distance to health facilities, health illiteracy and negative attitude of health professionals were identified as some barriers to the utilization of formal healthcare services. Social care services were described as non-existent, not structured, and having limited resources to cater for attendants. The health professionals also provided recommendations for improvement.ConclusionHealth professionals in this study discussed barriers to access and use of health and social care services. Addressing these barriers is essential to improve the use of formal health and social care services and diminish health inequity among older adults.

ADHD diagnosis and methylphenidate consumption in children and adolescents: A systematic analysis of health databases in France over the period 2010-2019.

ContextADHD is the most common mental disorder in school-aged children. In France, methylphenidate is the only drug authorized for ADHD. Here, we describe the pattern of ADHD diagnosis and methylphenidate prescription to children and adolescents from 2010 to 2019.MethodsWe conducted a retrospective cohort study of all beneficiaries of the French general health insurance scheme (87% of the population, 58 million people). We extracted information for all children and adolescents aged 0–17 years who received: (1) A diagnosis of ADHD (34,153 patients). (2) At least one methylphenidate prescription (144,509 patients). We analyzed the clinical, demographic, institutional, and social parameters associated with ADHD diagnosis and methylphenidate consumption in France.ResultsThe ADHD diagnosis among children and adolescents increased by 96% between 2010 and 2019. ADHD diagnosis affects more boys than girls. About 50.6% of children hospitalized with a diagnosis of ADHD in 2017 also had another psychiatric diagnosis. The rate of children hospitalized with an ADHD diagnosis and treated with MPH varied between 56.4 and 60.1%. The median duration of MPH treatment for a 6-year-old ADHD child initiated in 2011 is 7.1 years. In 2018, 62% of ADHD children were receiving at least one psychotropic medication. Between 2010 and 2019, methylphenidate prescription increased by +56% for incidence and +116% for prevalence. The prevalence of methylphenidate prescription reached between 0.61 and 0.75% in 2019. Boys are predominantly medicated. The median duration of treatment among 6-year-olds in 2011 was 5.5 years. The youngest children received the longest treatment duration. Diagnoses associated with methylphenidate prescription did not always correspond to the marketing authorization. Among children receiving the first prescription of methylphenidate, 22.8% also received one or more other psychotropic drugs during the same year. A quarter of initiations and half of renewals were made outside governmental recommendations. Educational and psychotherapeutic follow-up decreased from 4.1% in 2010 to 0.8% in 2019. French children and adolescents, who were the youngest in their class were more likely to be diagnosed (55%) and prescribed methylphenidate (54%). Children from disadvantaged families had an increased risk of ADHD diagnosis (41.4% in 2019) and methylphenidate medication (25.7% in 2019).

Effect of Healthcare Financing on Performance of Sub County Hospitals in Trans Nzoia County, Kenya

The main purpose of the study was to examine the effect of Healthcare Financing on Performance of Sub County Hospitals in Trans Nzoia County, Kenya. The study focused on the following specific objectives: To assess the effect of public health insurance scheme on Performance of Sub-County Hospitals in Trans Nzoia County, Kenya., and to examine the effect of devolved health services financing on Performance of Sub-County Hospitals in Trans Nzoia County, Kenya. The study was anchored on the Systems Theory by Kataz and Khan, and governance theory. The study targeted the 164 healthcare providers and patients of sub-county hospitals in Trans Nzoia County using census method since the target population was small and reachable. A descriptive research design was adopted with the questionnaire used as a data collection instrument which include both qualitative and quantitative data. The SPSS v26 software was used in establishing the effect of the independent variables on the dependent variable through the employment of ANOVA, regression and correlation analysis techniques in data analysis. The study findings indicated a statistically significant effect between the variables that led to the prediction of the dependent variable. The F-ratio (F=10.578) which was greater than the significance level of .05 depicted an overall regression model that was used to measure the dependent variable by the predictor variables. The results of the study will be expected to contribute towards the existing findings as well as forming a basis for future scholarly work in the field of healthcare financing on performance of the health facilities. This research will be important to the county governments, and in particular management of sub-county hospitals and in improving the scholarly literature reservoir. Keywords: [Health Care Financing, Financing Challenges, Universal Healthcare, Performance]

The Effect of Adequate Funding and Health Service Provision on Micro Health Insurance Growth: The Case of BEPHA in the NWR of Cameroon

Purpose: Inadequate financial support and provision of poor-quality health services among the health facilities are major causes behind poor performance of Community Health Financing (CHF). The objective of this study was to investigate the effect of adequate funding and health service provision on micro health insurance growth, taking BEPHA as a case study.
 Methodology: The descriptive and explanatory research designs were used in this study. Data was collected by administering questionnaires to 400 respondents. Interviews were also carried out on 10 staff of BEPHA. Data were analyzed using descriptive statistics, correlation, and multiple regression analysis.
 Findings: In results regarding BEPHA financing, 70% of those interviewed believed it is high while 30% indicated that it is low. Out of 400 participants 191 (47.8%) of them perceived services offered by BEPHA partner hospitals as fair while 182 (45.5%) perceived their services as good. The correlation results showed a strong positive and significant relationship between sufficiency of BEPHA financing (r= 0.802, p < 0.05) and quality of BEPHA health services (r = 0.667, p < 0.05) with the growth of BEPHA as a health insurance scheme. The multiple regression analysis results showed that sufficiency of BEPHA financing (β=0.166; p < 0.1), has a positive and significant effect on growth of BEPHA. The quality of BEPHA health services (β=0.200; p < 0.1) also has a significant positive effect on growth of BEPHA. Concisely, the study revealed that the funding and quality of BEPHA health services can determine the variations in the growth of BEPHA health insurance scheme.
 Recommendations: This study thus recommended that, the scheme should reduce the waiting period for minor health risk to at most 2 weeks while the 6 months waiting period for major health risk including delivery should be reduced to one (01) month to increase finances from large enrolment. It also recommended the sensitization of health personnel on good customer service principles to increase service quality at these partner health facilities.

Readiness of Ghanaian health facilities to deploy a health insurance claims management software (CLAIM-it).

IntroductionInadequate, inefficient and slow processing of claims are major contributors to the cost of health insurance schemes, and therefore undermining their sustainability. This study uses the Technology, Organisation and Environment (TOE) framework to examine the preparedness of health facilities of the Christian Health Association of Ghana (CHAG) to implement a digital mobile health insurance claims processing software (CLAIM-it), which aims to increase efficiency.MethodsThe study used a cross-sectional mixed method design to collect data (technology and human capital capacity and baseline operational performance of claims management) from a sample of 20 CHAG health facilities across Ghana. While quantitative data was analysed using simple descriptive statistics statistics (frequencies, mean, minimum and maximum values), qualitative interviews were recorded, transcribed and abstracted into two major themes that were reported to re-enforce the quantitative findings.ResultsThe quantitative results revealed challenges including inadequate computers and accessories, adequate numbers and skills for claims processing, poor intranets and internet access, absence of a robust post-implementation support system and inadequate standard operating procedures (SOPs) for seamless automation of claims processing. In addition to the above, the qualitative results emphasised the need to make CLAIM-it more flexible and capable of being integrated into third-party softwares. Notwithstanding the challenges, decision-makers in CHAG health facilities see the CLAIM-it software as having better functionality and superior capabilities compared to existing claims processing systems in Ghana.ConclusionNotwithstanding the challenges, the CLAIM-it software is more likely to be adopted by decision-makers, given the positive perception in terms of superior functionality. It is important that key actors in claims management at the National Health Insurance collaborate with relevant stakeholders to adopt the CLAIM-it software for claims processing and management in Ghana.

Barriers to Community-Based Primary Health Care Delivery in Urban China: A Systematic Mapping Review.

Providing access to a range of basic health services, community-based primary health care (CB-PHC) plays a vital role in achieving the goal of health for all. Driven by a strong political commitment, China’s CB-PHC progress in the past decade has been swift and impressive. However, a well-functioning delivery system for care has yet to be established. This systematic mapping review synthesizes selected evidence on barriers to CB-PHC delivery in urban China and draws lessons for policy development. We performed searches on five electronic databases: CINAHL, MEDLINE, Scopus, Web of Science, and China National Knowledge Infrastructure, and included studies published between 2012 and 2021. The Downs and Black and Critical Appraisal Skills Program checklists were used to assess the quality of eligible papers. We conducted our searches and syntheses following the framework set out in the Primary Health Care Performance Initiative (PHCPI). We synthesized the results of the included studies using a thematic narrative approach and reported according to PRISMA guidelines. Six salient barriers arose from our syntheses of 67 papers: lack of comprehensive health insurance schemes, lack of public awareness, superficial care relationships, gaps in communication, staff shortages and poor training, and second-rate equipment. These barriers are grouped into three subdomains following the PHCPI framework: access, people-centered care, and organization and management. A host of negative impacts of these barriers on community-based health care were also identified. It was not possible to determine clear causes of these barriers from the contributing evidence because of the lack of conceptual frameworks and research methods constraints. Non-eastern regions of China and access-related barriers require further exploration. It follows that, at the national level, the problems are likely more severe than the research suggests.

Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China

BackgroundChina expanded health coverage to residents in informal economic sectors by the rural new cooperative medical scheme (NCMS) for rural population and urban resident basic medical insurance scheme (URBMI) for non-working urban residents. Fragmentation of resident social health insurance schemes exacerbated the health inequity and China started the integration of urban and rural resident medical insurance schemes since 2016. Beijing finished the insurance integration in 2017 and has been implementing a unified urban and rural resident basic medical insurance scheme (URRBMI) since the beginning of 2018. This study aims to examine changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes.MethodsWe used household survey data from Beijing Health Services Survey in 2013 and 2018. Respondents who were 15 or older and covered by URBMI, NCMS or URRBMI were included in this study. Our study finally included 8,554 individuals in 2013 and 6,973 individuals in 2018, about 70% of which were rural residents in each year. Descriptive analysis was used to compare the healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure between different groups. A series of two-part regression models were used to analyze the changes of healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure.ResultsFrom 2013 to 2018, urban–rural disparity in outpatient care utilization seemed widened because urban residents’ utilization of outpatient care increased 131% while rural residents’ utilization only increased 72%; both rural and urban residents’ spending on outpatient care increased about 50%. Utilization of inpatient care changed little and poor residents still used significantly less inpatient care compared with the rich residents. Poor residents still suffered heavily catastrophic health expenditures.ConclusionFrom 2013 to 2018, residents’ utilization of healthcare, especially outpatient care, increased in Beijing. Health insurance reforms increased residents’ utilization of healthcare but failed to reduce their healthcare financial burden, especially for poor people. Our study advocates more pro-poor insurance policies and more efforts on the efficiency of health system.

Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Cervical Cancer Screening in Gynecological Practices in Germany.

Simple SummaryThe outbreak of the coronavirus disease 2019 (COVID-19) is a major challenge for healthcare systems and impedes cancer screening programs worldwide. However, no research has been performed that analyzes the effects of the COVID-19 pandemic on the newly implemented German Cervical Cancer Screening (CCS) program. Here, we showed a severe clinically relevant decrease of patients receiving CCS in Germany between the pre-pandemic time period of 2018–2019 and the pandemic years of 2020–2021. Given that this sudden drop in number of CCS per practice is unlikely, our data suggest a dramatic number of underdiagnosed cervical precancer lesions that may lead to increased cervical cancer burden in the future.Purpose: the aim of this cross-sectional study was to analyze the impact of the COVID-19 pandemic on Cervical Cancer Screening (CCS) in gynecological practices in Germany. Methods: The basis of the analysis was the Uniform Evaluation Standard (EBM) of the Statutory Health Insurance Scheme. This cross-sectional study included all women aged ≥20 years with at least one CCS (clinical and cytological examination) in 223 gynecological practices in Germany during the period 2018–2021. The number of patients with CCS per practice was shown for each year. The average number of patients per year was compared between the pre-pandemic time period (2018, 2019) and the pandemic time period (2020, 2021) using Wilcoxon tests. Analyses were conducted separately for clinical investigations and cytological investigations and were also stratified by age group (20–34, 35–50, >50 years). Results: CCS in gynecological practices significantly decreased in Germany between the pre-pandemic time period of 2018–2019 and the pandemic years of 2020–2021. This decrease was observed in all age groups but was stronger in women aged 20–34 (−25.6%) and weaker in women aged >50 (−15.2%). Conclusions: We found a statistically and clinically relevant decrease of patients receiving CCS in gynecological practices in Germany. This finding is even more exceptional because the new screening algorithm with direct invitations for each patient started in 2020 and was supposed to lead to a higher number of patients in its first years. However, the observed decline in the detection of cervical precancer lesions may lead to increased cervical cancer burden. Risk-based screening strategies and further measures are necessary to adapt to the ongoing COVID-19 pandemic and return to pre-pandemic CCS numbers.

Does free health insurance improve health care use and labour market outcomes of the elderly in Ghana?

Affordable access to health care was a challenge for the elderly in Ghana until the introduction of the National Health Insurance Scheme in 2003, where the elderly were exempted from premium payments. The study employs household-level data from the Ghana Living Standard Survey to investigate whether exempting the elderly from health insurance premium payments affects healthcare utilisation and labour market outcomes of the elderly in Ghana. The study finds that having health insurance increases the elderly visits to a health facility and the probability of being treated by health professionals. For labour market outcomes, the results indicate that free health insurance increases both the number of hours worked and earnings of the elderly and the size of the increase in earnings in agriculture is slightly larger for females than with males.

Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a community-based, cross-sectional study

ObjectivesTo examine how clients perceived the quality of healthcare they received and identify associated factors both at the individual and facility levels.DesignA community-based, cross-sectional study.SettingTwo rural districts of northeast Ethiopia,...

Disparity in Catastrophic Healthcare Expenditures Across Households’ Income Groups in Nigeria: The Lens of Foster-Greer-Thorbecke Poverty Indices

The Nigeria health care system seems to have continue in the downturn trend as a result of the decay in public health care system and this have continued to drive the rising health care financed by out-of-pocket expenditure health hence, the study examined the disparity in Catastrophic Healthcare expenditures across Households income groups in Nigeria using the Nigeria Health and Demographic Survey 2018. The study employed the Foster-Greer-Thorbecke indices and the logit model. Findings from the study showed that some household and individual characteristics are associated with catastrophic health expenditure in Nigeria. Many households experience catastrophic health payments due to factors such as age, education of household head, health insurance status, geo- political zone, type of health facilities visited, and type of illness suffered. Governments are yet to find fair and innovative ways of financing the health system so as to reduce the financial burden of out-of-pocket payments on households and individuals in Nigeria. There is also urgent need for increased financial protection as well as insurance coverage through small credit and rural households’ contribution scheme as an alternative to the National Health Insurance Scheme to enhance health financing option that could reduce the huge private health cost of out-of-pocket expenditure. There is need for pressure on the legislature to provide a bill that disallow health care tourism for public office holders abroad as way of checkmating the better health care system in Nigeria. Keywords: Health care, Inequality, Income groups, private health cost, households DOI: 10.7176/JESD/13-20-03 Publication date: October 31 st 2022