Insurance Program Research Articles

ANALISIS PARTISIPASI PROGRAM ASURANSI NELAYAN MANDIRI TERPERCAYA DI KOTA SIBOLGA

The purpose of this research is to analyse the participation of the trusted independent fishermen insurance program in sibolga city. Descriptive qualitative research type. Data collection methods are observation, interview and documentation. Information in this research totalled 5 people from small fishermen and traditional fishermen and the main informant in this research was the sibolga city marine and fisheries office. The number of fishermen who participated in the independent fisherman insurance programme in sibolga city amounted to 800% of fishermen or 69% of this programme recorded since 2012 and this is the first life insurance provided to fishermen. While the number of fishermen who do not participate in the independent fishermen insurance programme is 359 fishermen or 31%. The reason for fishermen who do not participate in the independent fishermen's insurance programme is because fishermen think that there are many cases of fraudulent insurance and fishermen are wary of the programme, then low public knowledge of the independent fishermen's insurance programme, besides that they also think that by following the insurance, they pray for us to be harmed in business. Whereas this government programme is very helpful to the community in the event of accidents and unwanted events when sailing for fishing.

Drivers of universal health coverage in Makueni county, Kenya: Lessons for the Global South

All UN member States committed to realizing universal health coverage (UHC) when they included UHC as Target 3.8 in the Sustainable Development Goals in 2015. However, the global commitment to UHC has not been matched with action on the ground. According to the World Health Organization, about half of the world population lacks full coverage for essential health services. To accelerate progress toward UHC, a close understanding of factors that drive adoption of UHC policies at the national and local levels is essential. The purpose of this study was to investigate the impetus for establishing a sub-national health insurance program in Kenya—the Makueni county government health insurance program (MakueniCare)—which led to increasing the percentage of the county population with health insurance, the majority of whom live in poverty, from 8.8% in 2013 to 91% in 2018. This qualitative case study drew on Kenyan law and policy documents as well as semi-structured interviews with 30 key informants in government and NGOs to understand the drivers that led to the establishment of MakueniCare. Findings revealed that several drivers—namely, global norms, decentralization, democratic competition, and the strategic action of social change-minded leaders—coalesced to influence the adoption of MakueniCare. The study offers timely insights into the factors driving UHC in Makueni, Kenya and lessons for other low- and middle-income countries working toward UHC.

THE IMPACT OF DRUG COST ON MEDICATION ADHERENCE IN NIGERIA: A PERCEPTION AMONG PHARMACISTS

Background: Given Nigeria's huge economic instability, medication expenses may significantly impact medication adherence, creating a barrier to the treatment of various ailments. The study aimed to assess pharmacists' perceptions about the impact of drug costs on medication adherence in Nigeria. Methods: The study was cross-sectional among practicing pharmacists across Nigeria. The 25 items semi-structured questionnaire was administered online using simple random sampling with the snowballing technique to recruit the pharmacists for the study. The collected data was coded into Microsoft Excel 2016 and subsequently analyzed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were utilized to summarize the data, providing an overview of the demographic characteristics and key findings. Inferential statistics, specifically Pearson’s Chi-square test, were employed where applicable to determine the relationships between variables. Results: Total 161 pharmacists responded to the survey, giving an 80.5% response rate. The respondent rate was mainly young pharmacists (20–30 years old; 82.6%) and predominantly male (51.6%). Almost all the respondents possess only a bachelor of pharmacy degree (91.9%). Total 90% have practiced for 5 years or less, mostly in community settings (60.9%). Generic substitution has been cited as the most important technique to manage drug costs. Non-adherence due to cost was associated with practice settings, whereas adherence counseling was correlated with gender and setting of practice. All differences were not statistically significant at p<0.05. Conclusions: Most participants believe that the cost of medication is a major barrier to accessing quality healthcare and drives massive non-adherence among those who can barely afford the medicines. Implementing a comprehensive national strategy to enhance the healthcare system, expand the reach of the national health insurance program, and promote cooperation among healthcare practitioners will result in improved clinical outcomes for patients. Peer Review History: Received 22 May 2024; Revised 11 July 2024; Accepted 26 August; Available online 15 September 2024 Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Dimensions of micro-insurance and their relationship to achieving insurance coverage / applied research in the Iraqi general insurance company

The research aims to determine the nature relationship Link Between dimensions Microinsurance represented by (low-income groups, reasonable cost, low premium, low coverage) in the dependent variable insurance coverage with its two dimensions represented by (access, use), and the degree of arrangement of those dimensions according to their priorities, Incarnated The research problem that the researcher came up with during field visits to the researched company in the training phase, and reviewing the approved insurance programs, it was noted that the company lacks insurance programs and production plans, marketing documents that cover risks to low-income groups, and the lack of a tool that enables the insurance service to reach all segments of society. The descriptive analytical approach was adopted, and in light of it, the questionnaire was prepared as a main tool in obtaining data from the research community, which numbered (55) people who were in Levels Administrative (senior, middle, and executive) departments in the Iraqi General Insurance Company were tested with a set of appropriate statistical methods. The data was analyzed based on ready-made statistical programs (Spss v.28) to calculate (weighted arithmetic mean, standard deviation, coefficient of variation, Pearson correlation coefficient, a test z), and the research reached a set of results, the most prominent of which was: There is a positive correlation strong and moral Between the dimensions of a For micro insurance Combined and insurance coverage, Its value reached(0.815).

Directional aspects of crop yield correlation: Implications for insurance rating and contract design

AbstractWe estimate directional anisotropic models of linear correlation for crop yields. We find that directional distances (i.e., the degree to which yield correlation decays depending on direction) tend to differ from one another, with east to west distances being “longer” than north to south distances (i.e., correlation tends to decline slower in the east to west direction), at least for the major crops of corn and soybeans. Results for wheat are somewhat ambiguous. However, in all cases, average yield aggregates made up of east to west linked counties tend to be more accurate than is the case for north to south linkages. Implications for rating and contract design in the US area yield federal crop insurance program are offered.

Barriers to Enrolment into Health Insurance Schemes in Nigeria: The case of Niger State Contributory Health Insurance Scheme

Niger State government has keyed into the health insurance program of the federal government since 2019, with the establishment of the Niger State Health Insurance Scheme. Although the scheme has beautiful mission for the formal and the informal sector workers as well as the students in tertiary institutions and the vulnerable groups, it is yet to enjoy reasonable patronage. Studies on barriers to enrolment into health insurance were mostly conducted in matured health insurance settings, where barriers to enrolment do with operational concerns. It is not clear whether operational concerns may affect enrolment in Niger State where the health insurance scheme is at the take-off stage. Using qualitative research design to explore the enrolment barriers, this study has drawn a sample of 22 respondents across the major tribes, religions, enrolment category and senatorial zones of the state. Four enrolment officers were also part of the respondents. An in-depth interview was conducted on the respondent and the results were analysed in themes. The findings of the study showed that lack of trust in anything government is the major barrier to enrolment among the public sector workers due to their prior experiences of failed schemes run by government. However, inadequate sensitization about the requirements, procedures for enrolment, cost and benefits of the scheme were the barriers to enrolment among the informal and the private sector workers. The enrolment of the vulnerable groups is undermined by the lack of social register from where the list of the qualified people would be extracted. In addition, the lack of National Identification Number, which is the pre-requisite for enrolment, deters enrolment of the vulnerable groups. The problem of insecurity in the state also affects outreach and enrolment. Necessary suggestions are given to the government.

Quantitative release assessment for beta-lactamase-producing Escherichia coli of dairy origin into vegetables

Abstract Outbreaks of food poisoning associated with vegetables contaminated with Escherichia coli have been reported globally. This study was conducted to assess the probability of releasing beta-lactamase-producing E . coli of dairy farm origin into vegetables in Japan. A release assessment model connecting dairy farms to vegetable farms was developed. Data on the indicated diseases and antimicrobial use in dairy cattle were obtained from the agricultural insurance program in Hokkaido Prefecture between 2016 and 2019. Data on bla -harboring E . coli in cattle were obtained from the Japan Veterinary Antimicrobial Resistance Monitoring System. Microbiological field sampling was conducted at dairy and vegetable farms. Inoculation experiments in vegetables were conducted. All processes in the model simulation were iterated for 1000 times. The estimated proportion of dairy farms holding cattle with bla -harboring E . coli was 6.00% (95% CI: 4.81–7.35%). Beta-lactams were used in 71.76% (333,098/464,204 average annual cases) of indicated diseases. The estimated concentration of bla -harboring E . coli in mixed fresh manure at affected farms was 3.33 log 10 CFU/g (95% CI: 3.33–3.34). The concentrations were reduced to 0.83 (95% CI: 0.34–1.25) and −0.54 log 10 CFU/g (95% CI: −1.04 to −0.05) in soil after immature manure, and slurry spraying, respectively. The estimated concentrations in the soil of fields of radish, leafy vegetables, tomato, and spring-seeded and autumn-seeded onions at harvest were −1.99 (95% CI: −2.48 to −1.57), −2.87 (95% CI: −3.36 to −2.42), −3.82 (95% CI: −4.32 to −3.40), −5.36 (95% CI: −5.85 to −4.93), and −5.94 (95% CI: −6.43 to −5.52) log 10 CFU/g, respectively. The concentrations in the bodies of leafy green spinach and lettuce were −9.88 (95% CI: −10.38 to −9.43) and −10.91 (95% CI, −11.52 to −8.05) log 10 CFU/g, respectively. The probability of ingesting bla -harboring E . coli of dairy origin with raw vegetables in Japan was thus assessed to be very low. One Health impact statement This study applied a release assessment in the World Organisation for Animal Health framework for antimicrobial resistance risk assessment to connect the antimicrobial use for dairy cattle, manure production and vegetable farming. As vegetable is often consumed raw, the assessment is directly associated with human health. Although the environmental continuum was not explored, the reduction of the hazard on the soil of vegetable farms was considered. The study involved the engagement with dairy and vegetable farmers and the agriculture industry in understanding farming behavior and value chain. The approach in this study can be applied to the complex problems across the animal-human-environment interface.

Bargaining on price on behalf of price-insensitive downstream consumers

There are settings in which prices are negotiated by procurement agents and final consumption decisions are made by end users who are indifferent to negotiated prices. For example, a patient seeking medical treatment is indifferent to the treatment's cost if it is covered by his insurance program. We study bargaining for per-unit prices between suppliers and an intermediary who represents price-insensitive consumers. Under the commonly used simultaneous bargaining framework we show that, if suppliers have sufficiently high bargaining power, the resulting prices will exceed the value of the good (or service) being delivered. This overpricing is solved if simultaneous negotiations are replaced by sequential ones. The theoretical problem with sequential negotiations is that they necessitate treating the suppliers asymmetrically, even if they are symmetric; the empirical problem with sequential negotiations is that the negotiations-order is unobservable. We propose a multi-period model that resolves these issues: overpricing is prevented and all suppliers are treated the same. In this model, the result about sequential negotiations is utilized in order to produce (asymmetric) off-path threats. These threats sustain symmetric on-path play.

Fiscal Policy’s Function in Reducing Economic Downturn

Fiscal policy drives a nation’s economic activity by taxing and spending by the government. It is essential for preventing economic downturns. Generally, it operates as follows: A rise in government spending Business and consumer spending typically decreases during recessions, which lowers the economy’s total demand. The government can spend more on infrastructure, services, and public initiatives to make up for this. Quick economic stimulation results in more demand for goods and services as well as the creation of jobs. Tax Rebates: Lower taxes generate more cash for businesses and consumers alike. More money is available for both individuals and companies to invest in and expand their businesses. It is possible to counteract the drop in private sector demand by increasing spending and investment. Transfer Payments: The government may also raise transfer payments to pay for social security, unemployment insurance, and other welfare programs. These payments shield the purchasing power of those who are adversely affected by the recession and aid in stabilizing the economy. Automatic Stabilizers: Without the need for new legislation, some components of fiscal policy automatically promote economic stabilization. For instance, lower-class and impoverished households benefit from automatic stabilizers that reduce taxes in reaction to slower economic development and falling revenues. Unemployment insurance and progressive income taxes are two instances of these stabilizers. As a result, aggregate demand is sustained. Debt and Budget Deficits: During a recession, the government may have a budget deficit if expenditure exceeds revenue. This may lead to an increase in the national debt, but this is typically justified as a benefit to the economy. The theory is that the economy will eventually recover from the short-term debt increase due to the stimulus’s long-term impacts, improving the country’s financial situation. The Multiplier Effect: The economy may be impacted in a number of ways by the government’s increased expenditure and tax incentives. For example, when the government funds a new infrastructure project, the workers employed to complete it spend their earnings on goods and services, increasing demand and economic activity as well as the profits of themselves and other firms. Generally speaking, the goal of fiscal policy is to boost the economy during recessions in order to lessen their severity and hasten their recovery.

Perceptions of government-assisted payors: a survey and analysis of American Shoulder and Elbow Surgeons current Medicare, Medicare Advantage, and Medicaid practice allocation

Significant discrepancy and variance exist in the United States health care system with regard to patient access to medical care based on a patient's insurance type, whether that be government-assisted or a private insurer. There are currently 3 major government-assisted insurance programs, Medicare, Medicare Advantage, and Medicaid, each of which has its own patient mix and regulatory processes that govern care delivery. The purpose of this study was to evaluate the current perceptions of shoulder and elbow surgeons surrounding practice patterns and barriers to access for patients whose primary insurance is a government-assisted payor. This was a national, observational study that surveyed the American Shoulder and Elbow Surgeons (ASES) society membership. This 15-question survey assessed surgeon demographics, practice types, reimbursement models, as well as rates and trends of their access to patients with government-assisted insurance. Subgroup analysis between practice type and barriers to access for patients with one of these 3 government-assisted insurance were also analyzed and compared. Pearson χ2 test or Fisher exact test was used to test association between categorical responses and categorical/binary respondent characteristics. A P value<.05 was deemed statistically significant. A total of 257 ASES members completed the survey. Mean years in practice for respondents was 14. For Medicare patients, the most common perceived barriers were reimbursement (49%) followed by administrative burden (33%) and then implant reimbursement at the surgeon's primary surgical facility (32%). For Medicare Advantage patients, the most common barrier to access was administrative burden (52%), reimbursement (50%), and the patient's ability to access perioperative services such as physical therapy and home health (40%). The most common barriers for Medicaid patients were relatively evenly distributed between reimbursement (62%), low patient engagement in their care (61%), and patient's ability to access perioperative services (60%). Among members of the ASES, barriers to patient access varied by government-assisted payor. For Medicare advantage, administrative burden was the largest barrier to access. Whereas for Medicare and Medicaid, reimbursement was the most significant barrier. Further investigation and understanding of these barriers to patient access are necessary to improve availability of shoulder and elbow subspecialized care to a broader population of patients insured by government-assisted payors.

Citizens' rights in obtaining optimization of the implementation of the national health insurance program

This study aims to analyze the rights of citizens in obtaining optimization of the implementation of the national health insurance program. This research is in the form of normative or doctrinal legal research/library research, using a statutory approach and conceptual approach. The results of the study reveal that the implementation of the right to health based on the mandate of the 1945 Constitution in Indonesia has not been maximally implemented. This can be seen from the application in terms of facilities, health workers and the application in terms of the national health insurance system. Optimizing the implementation of the guarantee with the issuance of Presidential Instruction of the Republic of Indonesia Number 1 of 2022 concerning Optimizing the Implementation of the National Health Insurance Program was also found to be disharmonized with the principle of Portability and the non-fulfillment of the value of justice or equality of National Health Insurance participants, especially the rules on migrant workers. Therefore, it is necessary to conduct an evaluation related to the fulfillment of citizens' rights to health, as well as to review the Presidential Instruction of the Republic of Indonesia Number 1 of 2022 concerning Optimizing the Implementation of the National Health Insurance Program, especially regarding the obligations of pilgrims and migrant workers to remain active participants, so that the value of the principle of benefits can be obtained by all JKN participants fairly.

Increasing Knowledge About the Utilization of Public Health Insurance with Education RW 11 Jayagiri Village, Lembang District, West Bandung Regency

The community service aim to increase public understanding of the importance of health insurance. The implementation of activities carried out in August-October consists of preparation, implementation and closing which is carried out in the community in RW 11 of Jayagiri Village. Jayagiri Village is located in Lembang District, West Bandung Regency. The target number of community service activities is 40 people, consisting of elements: Jayagiri Village community, especially in RW 11, health cadres, and village governments and related agencies. The result of the analysis showed that before the implementation of counseling, only 54% of the public understood about health insurance and after counseling it rose to 63%, or an increase of 9%. The number of respondents was 29 people, with answers considered valid amounting to 28 respondents. It can also be seen below public understanding of health insurance increased by 7%, understanding of the components of health insurance increased by 11%, thus significantly encouraging understanding of health insurance by 25%. It also boosted public understanding of the risks in life which increased quite sharply by 21%. By having enough information about health insurance, people are better able to maintain health, prevent disease, and use preventive services provided by health insurance programs. Proper information about health insurance helps people understand the level of financial protection they have in relation to health care costs, so they can avoid unwanted financial surprises and better manage their family budgets.

Knowledge, Attitude and Uptake of Formal Sector Social Health Insurance Programme in Akwa Ibom State, Nigeria

This study investigated knowledge, attitude and uptake of the formal sector social health insurance programme (FSSHIP), a social health insurance pool of the National Health Insurance Authority (NHIA) designed for federal civil servants in Nigeria. The study adopted a qualitative research design to achieve its objectives using federal civil servants in Akwa Ibom State as its population. A purposive sampling technique was adopted in the study and structured interview was used to generate primary data for the study. The thematic analysis method was used in analyzing the data. The result revealed that federal civil servants in Akwa Ibom State were aware of the National Health Insurance Scheme and equally demonstrated a positive attitude towards the Scheme. However, it was discovered that the level of uptake of the National Health Insurance scheme was very low. It was therefore recommended, among others, that sensitization that targets increasing utilization should be conducted for enrollees by the relevant stakeholders, while the scheme should be adequately funded to ensure quality service delivery.

The Job Loss Insurance Program as a Government Policy Response to Address the Impact of National Economic Fluctuations and Layoffs

Fluctuations in the national economy caused by several things, such as a decline in economic growth, the global economic crisis, and the COVID-19 pandemic, often lead to layoffs (PHK). Layoffs have various negative impacts on life, such as depression, mental health, financial problems, social relationships, decreased physical health, and impacts on careers. The JKP program is one of the policies to overcome these negative impacts. The JKP program is designed to provide financial support, job training, and access to labor market information for laid-off workers, with the aim of reducing the social and economic impact of layoffs and helping workers return to the labor market with better skills. The aim of this research is to explain the JKP program as a response to government policy in overcoming the negative impacts of layoffs. This research uses a qualitative and quantitative descriptive approach. The implementation of the JKP program has shown positive results, such as increasing people's purchasing power and contributing to economic recovery. However, there are several challenges in its implementation, including infrastructure, technical problems and uneven socialization. Periodic program evaluation is needed to address this problem and ensure the long-term effectiveness of the JKP program. This article also emphasizes the importance of collaboration between government and industry in improving the relevance and quality of vocational training. It is hoped that the JKP program can continue to adapt and improve protection for workers in Indonesia, thereby providing better economic and social stability

Health Insurance, Medicine, and Society in Taiwan: Chinese Authoritarianism, Taiwanese Ethnicities, and Global Actuarial Science

This article explores the history of the Chinese Nationalist Party (Kuomintang KMT) government’s expansion of health insurance in Taiwan from 1950 to the 2010s through the lens of ethnicity, politics and medicine. I argue that the KMT party-state’s expansion of health insurance privileged government employees who were the core supporters of the ruling party. By comparing the history of the insurance programs for government employees and laborers, the article makes the case that KMT provided better coverage, lower premiums, and less medical gatekeeping for Chinese waisheng government employees who fled to Taiwan with the KMT than for ordinary Taiwanese bensheng laborers. Global actuarial science experts from the United Nations International Labor Organization also buttressed such a discriminatory process. This China-centered approach towards universalizing healthcare on the island became increasingly challenged by provincial legislators, labor activists, and the emerging political opposition that promoted local Taiwanese concerns on healthcare equity and access. This article concludes that this dual process of KMT’s population management and leveraging of United Nations actuarial expertise as the Republic of China became symbolic of the bio-geopolitics that animated the history and development of health insurance in Taiwan.

Maternal autoimmune disease and offspring risk of haematological malignancies: a case–control study

Autoimmune diseases are known to be associated with an increased risk of cancer. Whether maternal immune dysregulation can have an impact on the development of haematological malignancies in offspring remains uncertain. Therefore, we explored the association between offspring risk of haematological malignancies and maternal autoimmune disease using a real-world nationwide population-based study. In this case-control study, we identified 2172 children with haematological malignancies between 2004 and 2019 from Taiwan's National Health Insurance program and compared them with population-based controls without haematologic malignancies, who were matched with each individual at a ratio of 1:4. The medical information of the autoimmune mothers were obtained from the Taiwan Maternal and Child Health Database. Conditional logistic regression was used to estimate the odds ratio for haematologic malignancy in offspring. Furthermore, subgroup and stratified analyses were conducted. Among the rheumatologic diseases in our study, Crohn's disease was the most common disease both in the haematological malignancy group (1.1%) and the control group (0.9%). In multivariable analysis, the odds ratio for haematological malignancy in offspring with maternal autoimmune diseases was 1.2 (95% confidence interval [CI] 0.91-1.58). The overall risk of haematologic malignancy was not significantly higher when adjusted for specific risk factors, including neonatal age, maternal age, family income, urbanization, maternal occupation, birth weight, or maternal comorbidity, except for prematurity. When comparing different autoimmune diseases among haematological malignancies and the control group, maternal psoriatic arthritis/psoriasis had the highest adjusted overall risk for haematological malignancies (adjusted OR 2.11, CI 0.89-5), followed by ankylosing spondylitis (adjusted OR 1.45, CI 0.7-3), autoimmune thyroiditis (OR 1.26, CI 0.57-2.81), systemic lupus erythematosus (OR 1.21, CI 0.48-3.02), Crohn's disease (OR 1.19, CI 0.75-1.9), and Sjogren's syndrome (OR 1.18, CI 0.65-2.15), but no significance was reached in these analyses. Multivariable analysis of risk factors associated with haematological malignancy subtypes was done. It showed no associations between maternal autoimmune disease and childhood haematological malignancies. We found no significant relationship between maternal autoimmune disease and childhood haematological malignancies. The influence of maternal immune dysregulation on the next generation with respect to haematological malignancies development may be limited. There was no funding source for this study.

Health insurance, social safety net and maternal health service utilisation in Pakistan: a population based cross-sectional study

ObjectiveThe objective of the study is to examine the impact of health insurance and social safety net programmes on maternal health service utilisation (MHSU) in Pakistan.DesignCross-sectional.SettingsData were obtained from Pakistan...

Health Insurance Factor Analysis

This paper explores the intricacies of health insurance costs in the United States, emphasizing the Affordable Care Act's (ACA) role in reform. Employing a "health insurance factor analysis" approach, the study identifies key determinants using data visualization and regression models. Factors such as age, BMI, family size, gender, smoking status, and geographic region significantly influence insurance prices. The research evaluates various regression models and neural networks, with linear regression standing out for its high accuracy. The findings underscore the impact of smoking, medical history, and coverage level on insurance costs. Despite dataset limitations and sample size considerations, this study contributes to a nuanced understanding of health insurance pricing, aiding insurers, policymakers, and individuals in decision-making. By integrating data insights and predictive models, the research advances comprehension of the complex relationships shaping health insurance costs. The ultimate goal is to optimize insurance programs and promote accessible and affordable health insurance for all.

Analysis of the Governance System of National Health Insurance Referral Patients at the Outpatient Polyclinic of Dian Harapanjayapura Hospital, Papua

The National Health Insurance (JKN) program, which has been running since January 1, 2014, has been widely benefited by most of the community. This program makes it easy for the public to access health services. However, the implementation of JKN for nine years often faces problems and challenges, one of which is governance. Many parties involved in this JKN program include BPJS Kesehatan as the organizer, the Ministry of Health as a regulator, Health Facilities (hospitals) as service providers and Professional Associations. This research is a qualitative research with a type of program review (governance system). The data collection process is carried out by conducting observations, interviews, analysis and documentation. Data analysis is in the form of an explanation of the situation being studied, while the presentation is in the form of a story explanation. This is in accordance with descriptive research which is the study of observations on the object of research to obtain an overview and actual circumstances. This research has been conducted at Dian Harapan Jayapura Hospital in Papua in February 2024. Based on the results of the study, it was found that inputs, processes and outputs related to the governance of National Health Insurance referral patients at the Outpatient Polyclinic of Dian Harapan Jayapura Hospital Papua were based on an assessment of human resources, facilities and infrastructure, Standard Operational Procedures, constraints and problem solving processes. The results of the study based on the influence of Human Resources show that training related to BPJS has not been carried out evenly for all personnel, including the evaluation of services has not been carried out regularly. The Assessment of Facilities and Infrastructure is considered to have been fulfilled only due to disturbances in the queue machine, the V-Claim application and Scan Finger interference. The assessment of SPO is considered to be available and understood, but there has been no routine evaluation to assess the progress of SPO implementation. The assessment of the obstacles that are often experienced is the disruption of the V-Claim Application and the queue system is still offline because the patient has not used the Mobile JKN Application so that the patient comes early in the morning to take the queue number. In terms of handling problems in stages starting from internal, if necessary, coordination between units or coordination with management with higher authority will be carried out. The conclusion in this study is that Human Resources have a great influence on services, in terms of the number that has been fulfilled, it is still necessary to evaluate the progress of services such as obstacles to delays in the doctor's practice schedule to be corrected according to the agreement so as not to affect service satisfaction. Regarding Facilities and Infrastructure, it is still considered good, it only needs to be added to facilitate online registration by increasing the benefits of the Mobile JKN Application, including the Queue Display facility at the Polyclinic. The applicable Standard Operational Procedures have been implemented, but there has not been a routine evaluation of the implementation of the SPO has been carried out appropriately or still requires additional SPOs to support services. Regarding obstacles and the solution of obstacles, it is considered good. Each officer is already independent in handling problems.

Can Social Health Insurance Improve Mental Health? An Analysis of Supplementary High-Cost Illness Insurance in China.

China introduced an innovative Supplementary High-Cost Illness Insurance (SHCII) program to enhance existing social health insurance by providing extra financial support for individuals facing catastrophic illnesses in 2015. The SHCII has notably increased access to healthcare and alleviated financial strain for economically disadvantaged individuals. However, there is a lack of information regarding the program's impact on the mental health of its beneficiaries. This study aims to assess the impact of SHCII on the mental well-being of middle-aged and older individuals. Using data from the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018), this study examined how SHCII affects mental health among middle-aged and older individuals in China using propensity score matching with the time-varying difference-in-differences method. We found that SHCII implementation can significantly reduce the Center for Epidemiologic Studies-Depression Scale scores of middle-aged and older individuals. This reduction was more pronounced among older individuals with poor self-rated health, chronic disease, and low household wealth when compared to their counterparts. The implementation of SHCII has had a significant and positive impact on mental health outcomes. We recommend that governments consider expanding the program to other areas within China, focusing especially on the most economically disadvantaged segments of the population.