National Health Scheme Research Articles

Study on Drug Utilisation in Medicine Department Under National Health Scheme of Ayushman Bharath Arogya Karnataka in Tertiary Care Teaching Hospital

Study on Drug Utilisation in Medicine Department Under National Health Scheme of Ayushman Bharath Arogya Karnataka in Tertiary Care Teaching Hospital

Healthcare Providers’ Engagement in Strategic Purchasing of Outpatient Services: A Cross-sectional Analysis of the National Health Scheme in Kenya

Abstract Background: National Health Insurance Fund (NHIF) outpatient services operate under capitation, and are strategically designed to enhance quality, equity, and affordability. However, despite this strategy, providers often demand out-of-pocket payments. This study investigates provider participation in strategic purchasing and its impact on NHIF’s outpatient service delivery. Methods: A cross-sectional analytical study was conducted among 66 healthcare managers from facilities accredited to provide NHIF outpatient services in two counties in Kenya. The data were collected using structured questionnaires. Logistic regression analysis was performed to assess the association between study variables. Results: Most respondents were male (36, 55%). The provision of NHIF outpatient services was significantly correlated with the monitoring provider performance by NHIF and the county department of health (Pmultivariate=0.024). There was a 31-fold increase in the likelihood of provision for monitored facilities. A significant difference (p=0.005**) was observed in monitoring health facilities. Monitoring was more common among private healthcare providers than public and faith-based health facilities. Conclusion: The involvement of healthcare providers in strategic purchasing has not yet been achieved. County and NHIF quality assurance departments should regularly monitor providers’ performance to ensure the delivery of equitable and high-quality healthcare.

Funding Pattern Comparison Pre- and Post-Ayushman Bharat National Health Scheme (AB-PMJAY) in Active Females Undergoing TKA for Advanced Knee Arthritis with Clinical, QoL Analysis and AB-PMJAY Technical Data.

Patients visiting for Knee Arthroplasty have often been treated at neighborhood clinics and bonesetters. India floated world's largest publicly funded national health insurance program -AB-PMJAY covering Knee Arthroplasty. AB-PMJAY's data for Arthroplasty has not been published. A Prospective study from Jan 2016- Jan 2023 on females undergoing TKA. Age, DEXA Score, Walking Ability, KSS, 10MWT, SF36 Scores, Funding Pattern before and after AB-PMJAY, Time to Approval, Time to discharge, Time to Query reply and Rejection Rates were documented. 790 patients (91.86%) received treatment previously. 650 (78.54%) patients lived with family & 32 patients lost to follow-up. 37.67% & 62.32% patients had Grade. 3 & 4 osteoarthritis respectively. Commonest comorbidity was Vitamin D deficiency followed by Menopause and Hypertension. Post-treatment Vitamin D deficiency reduced from 68.59% to 2.17% at 3 months. Post-surgery, Functional Scores improved significantly at 1st and 6th month. VAS dropped significantly from 7.8 to 3.6 at 1st month follow up. At 6 months, 81.52% patients were independent outdoor walkers compared to 9.42% (baseline). Average hospital stay-54 hours and Return to work- 42 days. Central health scheme beneficiaries rose significantly from 12% (pre-PMJAY) to 42% (post-PMJAY). With AB-PMJAY, no rejection for surgical procedures, Time to surgery approval was 16 hours (mean) and Time to Discharge was 8 hours (mean). Time to reply was 6 hours (mean). Evident rise in patients getting TKA done through AB-PMJAY. TKA has become an affordable and achievable target for financially deprived patients, post regulation of knee implant prices & AB-PMJAY.

A cost-utility analysis of BRCA1 and BRCA2 testing in high-risk breast cancer patients and family members in Thailand: a cost-effective policy in resource-limited settings.

Screening for germline pathogenic BRCA1 or BRCA2 variants (gBRCA) in high-risk breast cancer patients is known to be cost-effective in high-income countries. Nationwide adoption of genetics testing in high-risk breast cancer population remains poor. Our study aimed to assess gBRCA health economics data in the middle-income country setting of Thailand. Decision tree and Markov model were utilized to assess cost-utility between the testing vs. no-testing groups from a societal and lifetime perspective and lifetime. We interviewed 264 patients with breast/ovarian cancer and their family members to assess relevant costs and quality of life using EQ-5D-5L. One-way sensitivity, probabilistic sensitivity (Monte Carlo simulation), and budget impact analyses were done to estimate the outcome under Thailand's Universal Health Coverage scheme. The predicted lifetime cost and Quality-adjusted Life Years (QALY) for those with breast cancer were $13,788 and 10.22 in the testing group and $13,702 and 10.07 in the no-testing group. The incremental cost-effectiveness ratio for gBRCA testing in high-risk breast cancer patients was $573/QALY. The lifetime cost for the family members of those with gBRCA was $14,035 (QALY 9.99), while the no-testing family members group was $14,077 (QALY 9.98). Performing gBRCA testing in family members was cost-saving. Cost-utility analysis demonstrated a cost-effective result of gBRCA testing in high-risk breast cancer patients and cost-saving in familial cascade testing. The result was endorsed in the national health benefits package in 2022. Other middle-income countries may observe the cost-effective/cost-saving aspects in common genetic diseases under their national health schemes.

Impact of Technological Changes on Health Insurance Adoption in Rural Area

This study examines attitudes, actions, and willingness of rural residents to sign up for and pay for health insurance. It explores national health programs, statistical assessments of health insurance in rural populations, and responses to rural communities' attitudes and behaviors towards health insurance. Access to quality healthcare is a basic human right, but rural residents face increasing challenges due to rising healthcare costs. Health insurance can help address these issues. However, awareness, perception, and behavior related to health insurance are still limited among rural residents. Barriers such as high delivery costs and lack of awareness hinder insurance adoption in rural areas. Education on the importance of health insurance and providing financial stability for major illnesses and hospitalization are crucial. This study aims to evaluate rural residents' perceptions, actions, and willingness to sign up for and pay for health insurance, alongside analyzing national health programs and schemes.

To Study the Knowledge of Government National Health Scheme among Youth Aged 18 to 25 in Rahata Taluka of Ahmednagar District

Background: Universal health coverage is target 3.8 of the Sustainable Development Goals. In many lower middle-income countries, however, major coverage gaps exist. Established and executed by four public insurance companies, the primary objective of the Universal Health Insurance Scheme (UHIS) under the National Health Insurance Scheme (NHIS) is to provide health insurance coverage for poor, economically weaker families. The lofty objectives of the National Health Service are not only predicated on healthy graduates of tertiary institutions but also graduates who are confident in making informed health‑related decisions. Therefore, Corp members’ awareness, knowledge, and perception of the National Health Scheme and its programs become imperative. These schemes play a crucial role in solving many socio-economic problems that beset Indian society thus; their awareness is a must for any concerned citizen. Methods: The study was conducted using cross-sectional quantitative research methods. Simple random sampling and one-on-one interviews were used to collect data. A pretested questionnaire tool was used. 277 male and female youth were included from Rahata talukas in Ahmednagar district. Analysed using IBM SPSS with the help of tables and graphs. Result: In Present Study 277 of the youth from Rahata Taluka were interviewed. The mean age of respondent was 22.86 ± 1.24 years. 15.9 % Male and 16.2 % female youths reported that aware of National health Scheme. 56.3 % youths know the one health scheme. 7.9 % of male and 12.3 % female reported that there had health insurance. 7.9 % of male and 4.0 % female youth are aware of renewal of the scheme. 7.9 % male and 12.3 % female youth know the document required for the scheme. 11.9 % of male and 16.2 % female youth reported that there gets response about there the scheme in the hospital. 7.9 % male and 7.9 % female youth aware of the implementation of the scheme. According to getting information of national health scheme ......

Knowledge about National Health Schemes among Patients Attending Rural Health Training Centre of Medical College, Visnagar – A Cross Sectional Study

Context: Around 70% of the Indian population resides in rural areas and around 28% of the population live in below poverty line. Coverage of various health schemes falls short of the desirable coverage of 25% according to the National Health Policy. Out-of-pocket medical expenses account for more than four-fifths of total health-care spending in India. The major reason for low coverage in India is the lack of awareness of the health insurance schemes among people. Studies regarding government health schemes in the rural population are scarce. Hence, this study was conducted. Aims: The aim of this study was to assess the knowledge about national health schemes and to determine the association between knowledge with various sociodemographic variables among patients attending Rural Health Training Centre (RHTC) of Medical College in Visnagar. Settings and Design: A cross-sectional study was carried out among 107 patients attending the Outpatient Department at RHTC for 3 Months. Subjects and Methods: Data were collected with convenience sampling technique using a pretested, semi-structured questionnaire. Knowledge scores were used to categorize into good and poor knowledge. Statistical Analysis Used: The responses were entered and statistically analyzed by using SPSS v. 20. Chi-square test was applied to know the association between demographic variables and knowledge. Results: Only 35 (32.71%) participants ever applied while only 32 (29.90%) participants ever received benefit from any government health scheme. Furthermore, 66 (61.68%) participants had heard about Pradhan Mantri Jan Arogya Yojana which is highest. Out of all schemes, knowledge about Integrated Child Development Services Scheme was highest among participants, 39 (36.44%) participants knew about its benefits, 39 (36.44%) about beneficiary, 27 (25.23%) knew how to avail benefits, 26 (24.29%) about portability and 26 (24.29%) about goal. Awareness regarding various schemes was proportionately higher, 40 (52.63%), in age ≤30 and in male sex, 46 (60.52%), and card availability, 63 (82.89%). Conclusions: It is evident from the present study that knowledge regarding various health schemes in the study population is inadequate.

Resilience in healthcare supply chains: a review of the UK’s response to the COVID19 pandemic

PurposeThe purpose of this explorative research is to analyse the resilience of the United Kingdom's (UK) healthcare supply chains from a customer’s perspective in the light of the coronavirus pandemic.Design/methodology/approachUsing the capabilities of preparedness, robustness, recovery and adaptability as the foundational percept for supply chain resilience, 22 healthcare professionals in 17 of the UK's National Health Scheme (NHS) Trusts were interviewed to explore their personal and organisational approaches adopted relative to the provision of eye protection, gloves, gowns, aprons, masks and respirators. The Dynamic Capabilities View is mapped to the resilience capabilities and used to analyse the data from a transformational supply chain research perspective.FindingsThe supply chains were largely unprepared, which was not particularly surprising even though the availability of gloves was significantly better compared to the other personal protective equipment (PPE). Techniques adopted to ensure robustness and recovery revealed the use of unsanctioned methods such as extended use of PPE beyond recommended use, redefinition of guidelines, protocols and procedures by infection control and the use of expired PPE – all of which compromised customer well-being.Research limitations/implicationsAs the paper views resilience through the lens of customers, it does not provide the perspectives of the supply chain practitioners as to the reasons for the findings and the challenges within these supply chains.Practical implicationsThe compromise of the well-being of healthcare workers due to the vulnerabilities of healthcare supply chains is highlighted to managers and prescriptions for post-disruption adaptability are made.Originality/valueThis paper introduces transformative research to supply chain resilience research by uniquely looking at resilience from the customers' well-being perspective.

The politics of funding universal healthcare: Diverting local tobacco taxes to subsidise the national health scheme in Indonesia

AbstractIn Indonesia, the national universal health coverage scheme (Jaminan Kesehatan Nasional [JKN]) has consistently overspent against its budget since it was introduced in 2014. In 2017, a new regulation diverted 37.5% of tobacco tax revenue collected at the district and city level to the central government in order to increase government contributions to the JKN. Through a review of policy documents and interviews and focus group discussions with relevant stakeholders, this article explores the history of the JKN and its relationship to local tobacco taxes. Offering an ex‐post assessment of the policy and its implementation, we find it negative on three fronts: funding for local anti‐smoking initiatives and services was cut, the procedures for implementing the policy were complex and time‐consuming, and it did not contribute as much as anticipated to the JKN. These findings underscore potential pitfalls of politically motivated policy that fails to consider implementation and impact. We recommend that the policy be revoked, and local tobacco tax revenue reallocated to its initial purpose, which includes promoting local smoking prevention programs and health service delivery.

Psychoanalysis in India: a story of ascent, decline and revival

Psychoanalysis has been around in India for over a century now, beginning with the works of G.S. Bose in 1910s. However, the popularity, acceptability and accessibility of Psychoanalytic Psychotherapy has had a fluctuating course in the mental health arena of the country. The initial enthusiasm seems to have been circumscribed within the academic community and appears to have taken objections with its ‘foreign origin and roots’. This approach to psychotherapy was seen as alien to the Indian culture and was not welcome warmly as a treatment strategy. However, there have been some recent attempts in making this style of thought and school popular and accessible in clinical settings and there seems to be a slow but gradual increase in the usage of Psychoanalytic thinking in both clinical and non-clinical settings. The paper reviews the history and describes the current state of Psychoanalytic Psychotherapy in India and highlights the difficulties in accessing the therapy within the national health schemes.

Caregiver’s perception of barriers to implementation of the 'Rights of Persons with Disabilities (RPWD) Act, 2016 in India'

ABSTRACT This study was planned to study caregiver’s perception of barriers to implementation of the Rights of Persons with Disabilities (RPWD) Act, 2016 in India. An online cross-sectional survey was carried out among parents of children with disabilities. A prevalidated structured and semi-structured questionnaire was used. Results of structured items are summarized as mean (SD), frequencies and percentages. For open-ended questions, responses were analyzed by manual content analysis; results were presented in the form of a framework. From 316 responses, 44.8% of respondents availed disability certificate however utilization was largely limited to travel and educational settings. 82.2% of respondents were not aware of any of the national health schemes. Only 6.2% of children could engage in play activity at the playground. Accessibility, health issues and social stigma were the main barriers to recreation for children with disabilities. While 25.8% of children did not attend school at all, 58.1% of children attending normal school were facing difficulties due to lack of appropriate school infrastructure, transportation issues, and untrained teachers. Responses to open-ended questions were predominantly related to needs of homegrown research, better infrastructure, and trained teachers in schools, life security of child and development of national registry for better health information. The study highlights the importance of implementation of concrete strategies at every level of policy decisions to create more awareness regarding RPWD act in India.

Stakeholder perspectives on the integration of oral health into national health schemes: A mixed-method study research design in Delhi, India.

Aim and Objectives:To assess the factors and perception of various stakeholders on the integration of oral health into the national health schemes using a mixed-method research design.Materials and Method:A mixed-method study was carried out in 2018 in two phases. In the first phase of the study, a pretested and prevalidated self-designed close-ended questionnaire was used to assess the knowledge, attitude, perception, barriers, myths, and feasibility of the integration of oral health in national health schemes. This questionnaire was administered to 96 stakeholders consisting of a medical officer (MO), accredited social health activists (ASHA), auxiliary nurse midwifery (ANM), and dental surgeon in nine Delhi Government dispensaries. The questionnaire consisted of 42 close-ended questions and four open-ended questions. The domains and themes were identified along with the challenges and opportunities of integration for focus group discussion (FGD) after analyzing the results of the first phase. The FGD consisted of seven members representing each of the above stakeholders along with one moderator and one recorder.Results:88.3% of the ASHA workers and 85.7% of the ANM accepted that oral screening should be incorporated in their routine practice. The major barrier to the incorporation of oral health in general health was the lack of training and insufficient provision of monetary incentives. Job burnout, work situation, inadequate pay, opportunities, workload, and limited carrier development were the demotivators, whereas respect, goodwill, and recognition from the general public were the inducers.Conclusion:There was a strong agreement for National Oral Health schemes to be given space and priority in India. The majority agreed that they can be used as a medium for imparting oral health education. The majority of the stakeholders believed that oral health should be a part of general health and they are open to any scheme or program which would add an oral health component.

A Case Based Study on the Implementation of National Health Schemes on Treatment Techniques of Lung Cancer

A Case Based Study on the Implementation of National Health Schemes on Treatment Techniques of Lung Cancer

Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India

With ageing population and higher prevalence of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) in older patients, more and more living donor liver transplants (LDLTs) are being considered in this group of patients as eligibility for deceased donor liver transplant is restricted to those aged 65 years and younger. However, the short- and long-term outcomes of this group have not been reported from India, which does not have a robust national health scheme. The aim of this study was to provide guidelines for transplant in this group. All patients aged 60 years and older (group 1) who underwent LDLT in our centre between January 2006 and December 2017 were studied. A propensity score-matched group in 1:2 ratio was created with comparable sex and Model for End-Stage Liver Disease score (group 2). The 2 groups were compared for duration of hospital stay, surgical complications, hospital mortality and 1-, 3- and 5-year survival. Group 1 consisted of 207 patients, and group 2 had 414 patients. The number of patients in group 1 gradually increased with time from 4 in 2006 to 33 in 2017 accounting for 15% of total cases. Group 1 had more patients with viral hepatitis, NASH and HCC, and they had a higher 30-day mortality due to cardiorespiratory complications. Although 1- and 3-year survival was similar, the 5-year survival was significantly lower in group 1. Five-year survival was lower in the elderly group due to cardiorespiratory complications and recurrence of HCC. Outcomes in the elderly group can be improved with better patient selection and preventing HCC recurrence.

An Australian reflects on the Collings report 70 years on.

The publication of ‘General Practice in England Today — a Reconnaissance’ in the Lancet of 25 March 1950 made its Australian author, Dr Joseph Silver Collings, the National Health Scheme’s first whistleblower.1 It also ruined any chance of an academic or administrative career in the UK. Its unflattering description of English general practice angered the medical profession, particularly the British Medical Association (BMA). The Nuffield Provincial Hospital Trust who had funded it were not prepared to have their name associated with it. The Ministry of Health and the Chief Medical Officer who had directed the research underlying it remained silent. Joe Collings, as he preferred to be called, conducted the first evaluative research on general practice published in the English world.2 Challenging the smugness of British medicine, Collings was denied due recognition with his approach labelled unorthodox, and his sampling of English general practice considered fatally skewed. Joe was portrayed as a brash, inexperienced Australian influenced by American concepts with limited experience of British medicine. All those with direct knowledge of those times are now dead, so we must rely on records to ascertain what happened. Joe was a meticulous archivist and his wife Bett preserved his papers in the National Library of Australia.3 Extensive Rockefeller Foundation archive documents add to our knowledge of his activities.4 Joe had experienced general practice in two pioneering universal healthcare insurance systems, New Zealand and Manitoba, Canada, where the reformers sought his opinions. The Rockefeller Foundation funded him for 3 months in 1948 to explore medical educational developments in …

Health and Wellness Centre for Better Health Care Delivery System in India: A Mirage or a New Hope Glass

India is the hub of national health schemes and is now first country by implementing the world’s largest national health protection scheme i.e. Ayushman Bharat Yojana...

A Model for Prediction of Kidney Cancer Using Data Analytics Technique

Across the globe, kidney cancer and other cancerous diseases has been a threat to human lives. The incidence and mortality rate represent a significant and growing threat to both developed and developing countries especially in Africa, where most cancers are diagnosed at an advanced stage. This typically contributes to its complications and high rate of mortality, and has been attributed to limited awareness of early signs and symptoms of the disease, lack of detective mechanism and inaccessible cancer care in our health care centres. To preclude the harm and mortality caused by the disease, an intelligent mechanism for early prediction and prognosis of the syndrome is vital. However, early detection and prognosis requires an accurate information and analytic procedure that will assist and equip the health-care providers/public with the skills to identify early the indicators of the disease. Efforts in this work, produced a model for early prediction of kidney cancer using data analytic approach. Dataset and reports pertaining to the disease were acquired from selected private and public hospitals in fifty-two (52) selected LGA in Nigeria. A two-layered classifier system consisting of Artificial Neural Networks (ANN) and Decision Tree (DT) designed for the work was successfully employed in the model building. Waikato Environment for Knowledge Analysis (WEKA) platform was used for the experiment. The performance of the classifiers considered was compared using standard metrics of accuracy and time taken as benchmark. Experimental results show that the J48 decision tree algorithm outperform all other algorithms in the classifier family with correctly classified instances of 74.7%, F-Measure of 0.614, TP rate of 0.747, FP rate of 0.135, precision and recall of 0.687 and 0.714 respectively. It took the algorithm, 0.03 seconds to build the model. The performance of this algorithm proved its suitability as a valuable tool for the research purpose. The model will in no small measure support the efforts of the national health scheme in preventing the disease mortality rate.

Drug abuse and HIV risk- An autopsy based study

Substance abuse is a major public health problem all over world and showing rising trends in current scenario. Drug abusers are more prone to viral infections like HIV, Hepatitis B, Hepatitis C due to sharing of common needles. Therefore present study aim is to find out the prevalence of HIV among dead bodies (Claimed and unclaimed both) having documented history of drug abuse brought for autopsy. Out of 200 cases, 100 cases had known identities and 100 had unknown identities. 177 cases (88.5%) were males and 23(11.5%) were females. Out of 200 cases, 86 cases (43%) had positive history of drug abuse. History of drug abuse was present in 79% of unclaimed cases as compared to 7% in claimed cases. HIV was four times more prevalent among unknown cases compared to known cases. HIV positive cases were found only in male individuals (5.64 %). Majority of cases (79.06%, 68 out of 86 cases) having history of drug abuse was found in age group of 21-50 years. Maximum prevalence of drug abuser with positive HIV infection was found in age group of 31-40 years (44.4%, 4 out of 9 cases). 1(14.28%) case was found ELISA positive among 7 known individuals with history of drug abuse, and 8(10.12%) cases were among 79 unknown individuals with history of drug abuse.Results of this study help in highlighting the fact that HIV infection is more common among intravenous drug users (IDUs). Substance abuse causes overburdening of state and national health schemes. Therefore mental health literacy can be a part of de-addiction programs. Keywords: HIV, Claimed cases, Unclaimed cases, Intravenous drug user (IDU).

Access to health care for migrants in the Greater Mekong Subregion: policies and legal frameworks and their impact on malaria control in the context of malaria elimination.

The launch of the Global compact for safe, orderly and regular migration in December 2018 marked the first-ever United Nations global agreement on a common approach to international migration in all its dimensions. The global compact aims to reduce the risks and vulnerabilities migrants face at different stages of migration, by respecting, protecting and fulfilling their human rights and providing them with care and assistance. A key example of the intersection of the right to health and migration is seen in the Greater Mekong Subregion (GMS) - comprising Cambodia, Lao People's Democratic Republic, Myanmar, the People's Republic of China (Yunnan Province and Guangxi Zhuang Autonomous Region), Thailand and Viet Nam. The GMS has a highly dynamic and complex pattern of fluctuating migration, and population mobility has been identified as an important concern in the GMS, since five of the six GMS countries are endemic for malaria. Based on the concept of universal health coverage, and as endorsed by the 61st World Health Assembly in 2008, migrants, independently of their legal status, should be included in national health schemes. This paper summarizes work done to understand and address the legal obstacles that migrants face in accessing health services in the GMS countries, and the impact that these obstacles have in relation to elimination of malaria and containment of artemisinin resistance. Despite efforts being made towards achieving universal health coverage in all the GMS countries, no country has current health and social protection regulations to ensure migrants' access to health services, although in Thailand documented and undocumented migrants can opt for acquiring health insurance. Additionally, there is a lack of migrant-inclusive legislation in GMS countries, since barriers to accessing health services for migrants - such as language and/or socioeconomic factors - have been scarcely considered. Advocacy to promote legislative approaches that include migrants' health needs has been made at global and regional levels, to overcome these barriers. Assistance is available to Member States for reviewing and adopting migrant-friendly policies and legal frameworks that promote rather than hinder migrants' and mobile populations' access to health services.

An evaluation of health systems equity in Indonesia: study protocol

BackgroundMany low and middle income countries are implementing reforms to support Universal Health Coverage (UHC). Perhaps one of the most ambitious examples of this is Indonesia’s national health scheme known as the JKN which is designed to make health care available to its entire population of 255 million by end of 2019. If successful, the JKN will be the biggest single payer system in the world. While Indonesia has made steady progress, around a third of its population remains without cover and out of pocket payments for health are widespread even among JKN members. To help close these gaps, especially among the poor, the Indonesian government is currently implementing a set of UHC policy reforms that include the integration of remaining government insurance schemes into the JKN, expansion of provider networks, restructuring of provider payments systems, accreditation of all contracted health facilities and a range of demand side initiatives to increase insurance uptake, especially in the informal sector. This study evaluates the equity impact of this latest set of UHC reforms.MethodsUsing a before and after design, we will evaluate the combined effects of the national UHC reforms at baseline (early 2018) and target of JKN full implementation (end 2019) on: progressivity of the health care financing system; pro-poorness of the health care delivery system; levels of catastrophic and impoverishing health expenditure; and self-reported health outcomes. In-depth interviews with stakeholders to document the context and the process of implementing these reforms, will also be undertaken.DiscussionAs countries like Indonesia focus on increasing coverage, it is critically important to ensure that the poor and vulnerable - who are often the most difficult to reach – are not excluded. The results of this study will not only help track Indonesia’s progress to universalism but also reveal what the UHC-reforms mean to the poor.