Impact Of National Health Insurance Research Articles

Impact of national health insurance and socioeconomic disparities on newborn hearing screening performance in South Korea: A nationwide population-based evaluation

ObjectivesThis study aimed to assess the impact of national health insurance coverage on newborn hearing screening (NHS) outcomes by analyzing hearing questionnaires from the National Infant Health Check-up Program (NIHCP) in South Korea. MethodsThis study evaluated the performance and referral rates of NHS using nationwide data from 814,875 infants enrolled in the 4-month NIHCP from January 2017 to December 2019. This period encompasses the periods before and after the National Health Insurance in South Korea began covering NHS expenses in October 2018. The study also investigated household income levels to determine their relationship with participation in the NIHCP and NHS outcomes. ResultsThe performance of NIHCP increased year-on-year, with NHS performance rates increasing from 88.5 % in 2017 to 91.5 % in 2019. Analysis by household income level revealed that the medical benefit recipients’ group had the lowest NHS performance rate of 81.9 % in 2019, whereas that of the higher income level group exceeded 90 %. The NHS referral rate remained consistent at 0.9 % nationally during the study period. ConclusionThe inclusion of NHS in national insurance coverage positively influenced its performance rates across South Korea. Nevertheless, the data indicate the need for more focused and customized support for low-income families to enhance early hearing detection and interventions in newborns and infants.

The impact of national health insurance on the cost of auricular reconstruction with skin expansion for microtia in China: A single-center retrospective study based on 1290 surgeries

BackgroundCongenital microtia presents challenges that encompass physical disabilities and psychosocial distress. It is reported that people with low income have a higher possibility of giving birth to babies with congenital malformations. At the end of June 2023, auricular reconstruction was partially incorporated into national health insurance in our hospital. MethodsBriefly, 1290 surgeries, including stage-I and stage-II auricular reconstruction with tissue expansion were performed in 2023, involving 779 patients. Patient data, including age, sex, length of stay, residence, and costs, were retrieved from the electronic medical record system. The final cost before and after health insurance coverage, as well as the medical insurance reimbursement ratio in each province and municipality were statistically analyzed. ResultsFollowing insurance coverage, a significant increase in the number of surgeries was observed (514 [39.84%] vs. 776 [60.16%], χ2 = 45.99, p = 0.000), with notable reductions in out-of-pocket costs for unilateral and bilateral stage-I and -II auricular reconstructions ($3915.01 vs. $6645.28, p < 0.05; $11546.80 vs. $5198.08, p < 0.05). Disparities in reimbursement rates across regions were evident, but showed no correlation to the local GDP per capita. There was a positive correlation between the length of stay and inpatient cost. Patient’s age was not related to the inpatient cost, but to the length of stay. ConclusionThe health insurance coverage for microtia treatment significantly alleviated financial burdens on the patients’ family and increased the number of auricular reconstruction surgeries. These findings underscore the critical role of insurance coverage in enhancing healthcare accessibility and affordability for patients with congenital microtia.

Evaluating the potential impact of National Health Insurance on medical scheme members' rights to have access to health-care services in South Africa

The National Health Insurance Bill proposes to establish a national health insurance scheme that aims to provide universal access to health-care services for everyone. Section 33 of the Bill also proposes to limit the provision of parallel services by medical schemes if such services are provided or covered by the tabled NHI scheme. The establishment of the NHI scheme is likely to have a negative effect on the existing access rights of general private health-care users, particularly members of medical schemes. The NHI scheme may enhance access to and the quality of health-care services for millions; however, enabling large portions of the population to access services currently provided by costly private practitioners - services at present almost exclusive to a minority - is not without its perils. It risks negatively impacting on existing access rights and reducing the quality currently enjoyed by users of private health-care services. The propriety of these potential infringements is not necessarily suspect, and may in fact be justifiable. However, this contribution argues that the limitation proposed under section 33 of the NHI Bill is cause for concern. The contribution explores the state's constitutional duty to observe and respect the right of members of medical schemes to access health-care services. It uncovers the constitutional shortcomings of the limitation, and argues that it does not appear to serve any particular legitimate economic or legal purpose.

The impact of national health insurance on the access of maternal care service for women in Indonesia

Background and purpose: The government of Indonesia has established national health insurance or Jaminan Kesehatan Nasional (JKN) since 2014 to meet the basic needs of appropriate public health, including women. However, maternal mortality rate in Indonesia is recorded to be higher than peers and decreases slowly. This paper aims to elaborate the impact of the national health insurance on the access to maternal care and services for women in Indonesia. Methods: This paper employs a secondary data analysis by using Indonesian National Socio-Economic Survey (SUSENAS) 2017 and applies propensity score matching methods. Within the sample, a treatment group is a group of women who are registered in the JKN, including the PBI and non-PBI participants, while the control group is a group of women who are not registered in the JKN, women who have other insurances and those who do not have any insurance. The total sample of the treatment group is 18,886 and the control group is 19,559 participants. There are two outcome variables in the analysis which reflect the access of health care and health services, which are child-birth service facility (CBSF) and Birth Attendant (BA), respectively. Results: The result shows that women who are the member of the JKN have greater probability in accessing formal health care and services during the maternity process. They tend to deliver babies in hospital and get helped by medical personnel. Moreover, by comparing the impact of the JKN in the rural and urban areas, the result shows that the probability of women in rural area to access health care and services is higher than women in cities. Conclusion: Based on these results, we can conclude that the JKN has improved the access for health care as well as medical services for maternity, in both rural and urban areas. However, the JKN program improvements are still needed, particularly in ameliorating the quality of JKN program, as well as expanding the number of participants to achieve a higher impact.

Lower socioeconomic status worsens outcome of patients with systemic lupus erythematosus independently of access to healthcare.

Socioeconomic status (SES) has been found to be associated with worse outcomes of systemic lupus erythematosus (SLE). The impact of national health insurance on SLE outcomes has not been explored. A retrospective inception cohort of patients older than 18years with SLE diagnosed and followed in lupus clinics of two large tertiary medical centers were included. Patients were stratified into three groups by SES: lower 25th quantile, middle 25th-75th quantile, and upper 75th quantile. Primary outcomes were all-cause mortality, development of end-stage kidney disease (ESKD), and score ≤ 4 on the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K) at the last visit. We identified 617 patients (548 females, 88.8%) with a median follow-up of 15 years (range, 8.0-23.0). Compared to the middle and upper SES groups, the lower SES group was characterized by younger age at disease onset (31.5years vs. 34.3 and 37.4years, respectively, p = 0.011) and higher rate of lupus nephritis (42.7% vs. 35.7% and 23.8%, respectively, p = 0.002). In multivariate models, patients in the middle and upper SES groups had a significantly lower risk of mortality (HR = 0.45; 95% CI, 0.24-0.82, p = 0.010) and ESKD (HR = 0.24; 95% CI, 0.08-0.73, p = 0.012), with no effect on the rate of SLEDAI 2K ≤ 4 (OR = 1.49; 95% CI, 0.92-2.40, p = 0.09). Even within a health system that provides high and equal accessibility to medical care, low SES is associated with worse outcomes of SLE. Policymakers should focus on managing possible barriers that prevent patients of lower SES from obtaining optimal care.

The impact of national health insurance on the access of maternal care service for women in Indonesia

Background and purpose: The government of Indonesia has established national health insurance or Jaminan Kesehatan Nasional (JKN) since 2014 to meet the basic needs of appropriate public health, including women. However, maternal mortality rate in Indonesia is recorded to be higher than peers and decreases slowly. This paper aims to elaborate the impact of the national health insurance on the access to maternal care and services for women in Indonesia.Methods: This paper employs a secondary data analysis by using Indonesian National Socio-Economic Survey (SUSENAS) 2017 and applies propensity score matching methods. Within the sample, a treatment group is a group of women who are registered in the JKN, including the PBI and non-PBI participants, while the control group is a group of women who are not registered in the JKN, women who have other insurances and those who do not have any insurance. The total sample of the treatment group is 18,886 and the control group is 19,559 participants. There are two outcome variables in the analysis which reflect the access of health care and health services, which are child-birth service facility (CBSF) and Birth Attendant (BA), respectively.Results: The result shows that women who are the member of the JKN have greater probability in accessing formal health care and services during the maternity process. They tend to deliver babies in hospital and get helped by medical personnel. Moreover, by comparing the impact of the JKN in the rural and urban areas, the result shows that the probability of women in rural area to access health care and services is higher than women in cities.Conclusion: Based on these results, we can conclude that the JKN has improved the access for health care as well as medical services for maternity, in both rural and urban areas. However, the JKN program improvements are still needed, particularly in ameliorating the quality of JKN program, as well as expanding the number of participants to achieve a higher impact.

The impact of National Health Insurance upon accessibility of health services and financial protection from catastrophic health expenditure: a case study of Savannakhet province, the Lao People\u2019s Democratic Republic

IntroductionMany schemes have been implemented by the government of the Lao People’s Democratic Republic to provide equity in health service utilisation. Initially, health service utilisations were fully supported by the government and were subsequently followed by the Revolving Drug Fund. In the 2000s, four health financing schemes, namely the Social Security Organization, the State Authority for Social Security, the Health Equity Fund and Community-Based Health Insurance (CBHI), were introduced with various target groups. However, as these voluntary schemes have suffered from a very low enrolment rate, the government decided to pilot the National Health Insurance (NHI) scheme, which offers a flat, co-payment system for health service utilisation. This study aims to assess the effectiveness of the NHI in terms of its accessibility and in providing financial protection from catastrophic health expenditure.MethodsThe data collection process was implemented in hospitals of two districts of Savannakhet province. A structured questionnaire was used to retrieve all required information from 342 households; the information comprised of the socioeconomics of the household, accessibility to health services and financial payment for both outpatient and inpatient department services. Binary logistic regression models were used to discover the impact of NHI in terms of accessibility and financial protection. The impact of NHI was then compared with the outcomes of the preceding, voluntary CBHI scheme, which had been the subject of earlier studies.ResultsUnder the NHI, it was found that married respondents, large households and the level of income significantly increased the probability of accessibility to health service utilisation. Most importantly, NHI significantly improved accessibility for the poorest income quantile. In terms of financial protection, households with an existing chronic condition had a significantly higher chance of suffering financial catastrophe when compared to households with healthy members. As probability of catastrophic expenditure was not affected by income level, it was indicated that NHI is able to provide equity in financial protection.ConclusionThe models found that the NHI significantly enhances accessibility for poor income households, improving health service distribution and accessibility for the various income levels when compared to the CBHI coverage. Additionally, it was also found that NHI had enhanced financial protection since its introduction. However, the NHI policy requires a dramatically high level of government subsidy; therefore, there its long-term sustainability remains to be determined.

355P - The impact of national health insurance of Indonesia on delay in diagnosis, treatment and survival of nasopharyngeal carcinoma patients

355P - The impact of national health insurance of Indonesia on delay in diagnosis, treatment and survival of nasopharyngeal carcinoma patients

Impact of National Health Insurance on Entry and Competition in Remote Areas, Evidence from Taiwan's Dental Market

AbstractThis paper assesses the change in the supply of dental clinics after the implementation of Taiwan's National Health Insurance (NHI). Even though the government has enforced lower prices of treatment since the implementation of NHI, the increase in use could actually result in higher revenue for dentists. The higher profit could prompt dentists to attempt to enter markets that were previously unprofitable. This paper tested if NHI increased the dental clinic supply in geographically isolated areas by investigating whether the required minimum market size was reduced. We found that following the implementation of NHI, the per‐dental clinic minimum market size significantly decreased. In addition, the decreased minimum market sizes were enabled by a corresponding increase in variable profits which is equal to the difference between price and average variable costs. This implies that the NHI‐enlarged health care demand compensates for the possible losses of dental clinics due to price regulation. Furthermore, the results also suggest that the post‐NHI dental market becomes more competitive when there is a second entrant in the market, and the level of competition approaches perfect competition when three and more dental clinics serve one market.

The impact of National Health Insurance on birth outcomes: A natural experiment in Taiwan

We estimate the impacts of the introduction of National Health Insurance in Taiwan in March 1995 on infant survival. Prior to NHI, government workers (the control group) possessed health insurance policies with comprehensive coverage for births and infant medical care services. Private sector industrial workers and farmers (the treatment groups) lacked this coverage. All households received coverage in 1995. Since stringent requirements for reporting births introduced in 1994 produced artificial upward trends in early infant deaths, we focus on postneonatal mortality. The introduction of NHI led to reductions in this rate for infants born in farm households but not for infants born in private sector households. For the former group, the rate fell by between 0.3 and 0.6 deaths per thousand survivors or by between 8 and 16%. A large decline of between 3.4 and 6.8 deaths occurred for pre-term infants—a drop of between 20 and 41%.

Heterogeneous Impact of Taiwan's National Health Insurance on Labor Force Participation of Married Women by Income and Family Structures

In this study, I investigate how the impact of the National Health Insurance (NHI) introduction in Taiwan in 1995 on the labor force participation (LFP) decisions of married women varies with income and family structures. Employing the difference-in-differences (DID) approach, I find that the NHI introduction reduced LFP of married women in the twenty-fifth to fiftieth percentiles of the income distribution between 17.8 and 21.7 percentage points (33%–40%). The difference-in-differences-in-differences (DIDID) results suggest that married women in different family structures (the presence of children under 3 or less healthy elderly household members) did not respond differently to the NHI introduction.

Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance

Incident and prevalent (I&P) rates in dialysis end-stage renal disease (ESRD) patients in Taiwan increased rapidly following the launch of National Health Insurance (NHI) in 1995. Our aim was to explore the impact of NHI on the status and trends of ESRD epidemiology in Taiwan. This study was conducted using retrospective cohort analysis of data collected from the Taiwan national dialysis registry. From 1990 to 2001, I&P rates of ESRD patients increased 2.6 times from 126 to 331 per million populations (pmp) and 3.46 times from 382 to 1322 pmp, respectively. Increasing ESRD was seen in patients who were middle-aged, elderly and who had diabetic nephropathy as their primary renal disease. The mean age of I&P patients increased by 7.2 years and 7.1 years, respectively. All of these parameters increased markedly in 1995, the year of NHI implementation. First-year mortality decreased to 7.8 per 1000 patient-months in 1994, and then increased to 18.0 in 2001. The cumulative survival rate of the elderly subgroup (age >65) in the incident 1990-1994 cohort was greater than in the 1995-1999 cohort. These data indicated that NHI implementation significantly influenced the inflow and the mortality of ESRD patients. In addition to presenting ESRD epidemiology in Taiwan, this study demonstrated that NHI implementation stimulated the growth of treated ESRD populations. Preventive plans mounted against chronic kidney diseases will be essential to reduce the growth of ESRD patient numbers and consequent economic burdens.

Impact of National Health Insurance on the Survival Rate of Patients with Osteosarcoma In Taiwan: Review of 74 Patients

The 2-year survival rate for high-grade osteosarcoma was 46.9% before the introduction of National Health Insurance (NHI) in Taiwan on March 1, 1995, but increased to 73.8% after the implementation of NHI. The 5-year survival rate also increased, from 37.5% to 63.6%. Between May 1990 and May 2001, 74 patients with high-grade osteosarcoma were treated at our hospital. Median age was 17 years (range, 7-63 years). Inadequate surgical margins, poor histologic response to chemotherapy, advanced stage of disease, and incomplete treatment were strongly associated with poor prognosis. Before NHI, 10 patients had incomplete treatment, mainly because of unaffordable medical fees. After NHI, only three patients had incomplete treatment, due to personal reasons. Patient survival improved dramatically with advances in multiagent chemotherapy, but it was the NHI that enabled patients to complete expensive treatment courses, including preoperative neoadjuvant chemotherapy, limb-salvage surgery, and postoperative adjuvant chemotherapy. The NHI also improved the accessibility of medical care, with more patients presenting in the early stages of disease and, as a result, it not only improved survival rate but also increased the number of patients undergoing limb-salvage surgery. We concluded that the NHI significantly improved the survival rate for patients with osteosarcoma in Taiwan.

The impact of National Health Insurance on neonatal care use and childhood vaccination in Taiwan.

The objective of this study was to assess the impact of National Health Insurance (NHI) on the utilization of neonatal care and childhood vaccination in Taiwan. Data are selected from two nationwide maternal and infant surveys undertaken in 1989 and 1996, which were funded by the Department of Health. The questionnaire was administered in all 23 administrative districts, including two metropolitan areas - the cities of Taipei and Kaohsiung. The first and second cohort consisted of 1641 and 3499 infants, respectively. This study used a bivariate probit estimation procedure to examine the factors that determine the probability of neonatal care use and vaccination by pooling the 2 years. Generally, the mothers who are older, more educated and more satisfied with birth delivery services were found to be more likely to use neonatal preventive care. The likelihood of receiving such care also tends to rise with advancing gestational age and higher probability of neonatal complication (icterus neonatorum) and being born in a hospital. The likelihood of care was also found to vary regionally with northern neonates having higher odds of receiving preventive care than non-northern neonates. In spite of having an insignificant impact on the use of care, NHI does lessen the inequality in use of these two services in various regions. However, regional variations in neonatal care use still exist. Residents of the southern area remain less likely to receive neonatal care than those of the northern area after NHI. This finding deserves serious consideration when attempting to design effective policies, such as expanding medical institutions in the aboriginal southern areas so as to increase the accessibility of such health care.

The impact of national health insurance on the utilization of health care services by pregnant women: the case in Taiwan.

Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.

The impact of national health insurance on the volume and severity of emergency department use

National Health Insurance (NHI) was introduced in Taiwan on March 1, 1995. To evaluate the influence of NHI on the volume and severity of emergency department (ED) visits, a retrospective analysis was conducted. The results showed that NHI did not result in a substantial increase in ED volume ( P > .05), but the severity as measured by triage nurses did increase ( P < .01). There was no change in the number of admissions to the intensive care units of patients transferred from smaller hospitals, but its percentage significantly decreased ( P < .05), which may be a result of the significant increase in the total number of interhospital transfers. It was hypothesized that the universal coverage and a copayment contributed to these changes.

The impact of national health insurance on the public hospital.

The impact of national health insurance on the public hospital.

EDITORS' PREFACE

Policy Studies JournalVolume 9, Issue 2 p. 188-188 EDITORS' PREFACE Ralph Straetz, Ralph Straetz RALPH A. STRAETZ is professor of health policy. Department of Politics, New York University. He is chairman of the Committee on Health Politics, Founder Editor of the Journal of Health Politics, Policy and Law. For seventeen years he directed HEW funded research training programs in health and mental health policy at NYU.Search for more papers by this authorMarvin Lieberman, Marvin Lieberman MARVIN LIEBERMAN is Executive Secretary, Committee on Medicine i n Society, New York Academy of Medicine. He received a J.D. from New York University School of Law and a Ph.D. in Political Science from New York University. He was formerly associate director of the Program in Health Policy, New York University and on the faculty of the New School for Social Research. He has edited The Impact of National Health Insurance on New York.Search for more papers by this authorAlice Sardell, Alice Sardell ALICE SARDELL is Assistant Professor in the Department of Urban Studies at Queens College, City University of New York. She received her Ph.D. in Politics from New York University where she held a Fellowship in Political Science and Health Policy Research. She has published articles and presented papers on health and welfare policy.Search for more papers by this author Ralph Straetz, Ralph Straetz RALPH A. STRAETZ is professor of health policy. Department of Politics, New York University. He is chairman of the Committee on Health Politics, Founder Editor of the Journal of Health Politics, Policy and Law. For seventeen years he directed HEW funded research training programs in health and mental health policy at NYU.Search for more papers by this authorMarvin Lieberman, Marvin Lieberman MARVIN LIEBERMAN is Executive Secretary, Committee on Medicine i n Society, New York Academy of Medicine. He received a J.D. from New York University School of Law and a Ph.D. in Political Science from New York University. He was formerly associate director of the Program in Health Policy, New York University and on the faculty of the New School for Social Research. He has edited The Impact of National Health Insurance on New York.Search for more papers by this authorAlice Sardell, Alice Sardell ALICE SARDELL is Assistant Professor in the Department of Urban Studies at Queens College, City University of New York. She received her Ph.D. in Politics from New York University where she held a Fellowship in Political Science and Health Policy Research. She has published articles and presented papers on health and welfare policy.Search for more papers by this author First published: November 1980 https://doi.org/10.1111/j.1541-0072.1980.tb02193.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume9, Issue2November 1980Pages 188-188 RelatedInformation

The cost of private-practice psychiatry under national health insurance.

National health insurance (NHI) will not simply redistribute the burden of medical expenses from the sick to the general taxpayer. With the insurance subsidy to demand, more people will seek more care than ever before. Investigation of the impact of NHI on the practice of psychiatry is particularly important since coverage for this specialty varies so much among the proposed NHI bills. Senator Edward Kennedy’s proposal, introduced in fall 1978 to the Senate’s health subcommittee, essentially excludes the private practice of psychiatry from coverage under NHL Other proposals have been more generous. The Health Care Insurance Act proposes unlimited coverage for the private practice of psychiatry.

Private practice of psychiatry: future roles.

Psychiatrists in private practice have contributed more to treating the mentally ill in America than is generally known. The private practice sector may be viewed as a massive national outpatient and inpatient service for the mentally ill. The impact of national health insurance on the future character of the private practice of psychiatry and the thorny problems to be resolved are discussed and compared with the experiences of England, the Soviet Union, and China. Future trends will most likely include increased emphasis on adjuvant techniques, greater emphasis on resident training in general psychiatry, briefer forms of therapy, and psychiatry's return to the medical model.