Partial Subsidy Research Articles

Affordability and adherence gains for Medicare Part D low-income subsidy recipients when low-income subsidy benefits expanded in 2024.

The lowest-income beneficiaries enrolled in the Medicare Part D prescription drug program receive "full subsidies" that waive the premium and deductible and impose minimal copayments. Those with slightly higher incomes and assets may be eligible for "partial subsidies." Prior to 2024, individuals receiving partial subsidies faced reduced Part D premiums and deductibles and paid 15% coinsurance. Under provisions of the Inflation Reduction Act, recipients of partial subsidies were upgraded to full subsidies beginning in 2024. The objective of this pilot study was to assess whether the new policy is likely to reduce cost-related nonadherence to prescribed medications- a common problem faced by older adults even among those receiving subsidies. To compare cost-related nonadherence among partial- vs full-subsidy recipients with similar characteristics. We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on low-income subsidy enrollment plus extensive survey-based information on financial resources necessary to establish program eligibility and rates of cost-related nonadherence. Explanatory variables included sociodemographic characteristics, economic resources, work status, and health variables. We found that the partial-subsidy group reported significantly more cost-related nonadherence (39% vs 22%; P = 0.01) arising both from a lower propensity to fill some prescriptions (23% vs 12%; P = 0.03) and to more delays in filling others (29% vs 8%; P = 0.03). The differences were more pronounced for women and racial and ethnic minority groups in contrast to men and majority populations, respectively. Because the study samples were small, we could not conduct a detailed regression analysis. The magnitude of cost-related nonadherence effects associated with partial-subsidy cost sharing suggests that the Inflation Reduction Act policy to expand low-income subsidies may boost medication adherence, most notably among women and racial and ethnic minority groups.

Impact of an oral care subsidization reform on intersectional inequities in self-rated oral health in Sweden

BackgroundOral health in Sweden is good at the population level, but seemingly with persisting or increasing inequities over the last decades. In 2008, a major Swedish reform introduced universal partial subsidies to promote preventive care and reduce the treatment cost for patients with extensive care needs. This study aimed to apply an intersectional approach to assess the impact of the 2008 subsidization reform on inequities in self-rated oral health among adults in Sweden over the period 2004–2018.MethodsData from 14 national surveys conducted over 2004–2018 were divided into three study periods: pre-reform (2004–2007), early post-reform (2008–2012) and late post-reform (2013–2018). The final study population was 118,650 individuals aged 24–84 years. Inequities in self-rated oral health were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 intersectional strata defined by gender, age, educational level, income, and immigrant status.ResultsOverall, the prevalence of poor self-rated oral health decreased gradually after the reform. Gender-, education- and income-related inequities increased after the reform, but no discernible change was seen for age- or immigration-related inequities. The majority of intersectional strata experienced patterns of persistently or delayed increased inequities following the reform.ConclusionsIncreased inequities in self-rated oral health were found in most intersectional strata following the reform, despite the seemingly positive oral health trends at the population level. Applying an intersectional approach might be particularly relevant for welfare states with overall good oral health outcomes but unsuccessful efforts to reduce inequities.

Medicare Part D low-income subsidies expanded in January 2024, but more needs to be done to ensure that eligible beneficiaries enroll.

The Inflation Reduction Act of 2022 extended full low-income subsidies (LIS) to a small group of Medicare Part D recipients with limited assets and incomes between 135% and 150% of the Federal Poverty Level beginning in January 2024. This policy may result in small enrollment gains among beneficiaries eligible for the new benefits, but the biggest problem with the current LIS program is underenrollment across all eligibility groups. Prior research has shown that underenrollment has been a persistent problem since the LIS program began in 2006, yet little has been done to correct the situation. To identify individual-level factors associated with failure to enroll among low-income beneficiaries eligible for both full subsidies and partial subsidies under the LIS program. We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on LIS enrollment plus extensive survey information on financial resources necessary to establish program eligibility. We conducted descriptive and multivariate analyses to identify factors associated with failure to enroll when eligible for either full or partial subsidies. Explanatory variables included sociodemographic characteristics, economic resources, work status, health variables, and source of prescription coverage (for nonsubsidized beneficiaries). In 2019, 73% of beneficiaries eligible for full subsidies under pre-Inflation Reduction Act LIS provisions were enrolled, compared with only 25% eligible for partial subsidies. The number of those estimated to be eligible for full subsidies but not enrolled (N = 3.9 million) was more than double that of those eligible but not enrolled for partial subsidies (N = 1.5 million). Factors associated with failure to enroll (older age, male sex, White race, married, higher education, higher income and assets, and excellent/very good health status) were similar for both groups. In multivariate analyses, the single strongest predictor of failure to enroll was receipt of income from work (odds ratio = 5.50; P < 0.001). Among the nonenrolled, 64% eligible for full subsidies and 75% eligible for partial subsidies maintained unsubsidized Part D coverage. Significant numbers of low-income Medicare beneficiaries are eligible for Part D subsidies but fail to enroll. Common characteristics distinguishing nonenrollees from enrollees include older age with higher proportions of White individuals, married individuals, higher income and assets, and better overall health. Two promising targets for increasing LIS enrollment are evidence of work income and unsubsidized Part D coverage.

Exploring mental health challenges and coping strategies in university students during the COVID-19 pandemic: A case study in Dhaka city, Bangladesh.

Mental health challenges have emerged worldwide during the COVID-19 pandemic. University students experienced changes in their lifestyles, academic life, family relationships, earning capacity, and support systems. This study explores the common mental health challenges in university students and their coping strategies using social support in the first wave of lockdowns in Dhaka city in 2020. By learning from young people's impacts and coping responses, we can help build an improved strategy for future events of this magnitude. A qualitative study design was employed to conduct 20 in-depth interviews and two focus group discussions with students from purposively selected three public and three private universities in Dhaka city and five key informant interviews with different stakeholders. We used inductive reflexive thematic analysis and applied six phases of the thematic analysis. Codes retrieved from two differently prepared codebooks were merged and compared to identify themes for a fair interpretation of the underlying data. Data were manually indexed, summarized, and interpreted to categorize codes into sub-themes leading to themes. Financial constraints, academic pressure, learning resources shortages, losing confidence, relationship breakup, excessive internet dependency, and traumatic experiences challenged the mental health conditions of the students unevenly across universities during the COVID-19 pandemic. Expressed mental health well-being impacts ranged from anxiety, stress, and depression to self-harm and suicidal ideation. Family bonding and social networking appeared as robust social support mechanisms to allow students to cope with anxiety, stress, and depression. Partial financial subsidies, soft loans to purchase electronic resources, faculty members' counseling, and sessional health counseling contributed to minimizing the mental health impacts of COVID-19. Mental health is still not a resourced area of health and well-being in Bangladesh. Concentration on developing strong social support and improving increased financial subsidies, including learning resources, can be effective in assisting students in coping with the common mental health burdens during pandemic periods. A national intervention plan should be immediately designed and implemented by engaging different stakeholders including healthcare professionals and establishing effective mental healthcare support centers at universities to avoid immediate and prolonged negative mental health impacts.

ASSESSING THE NEW INFLATION REDUCTION ACT’S IMPACT ON EXPANDING MEDICARE PART D LOW-INCOME SUBSIDIES

Abstract The recently enacted Inflation Reduction Act (IRA) of 2022 extends full low-income subsidies (LIS) to Medicare Part D recipients with limited assets and incomes up to 150% of the Federal Poverty level (FPL) beginning in 2024. Under current law, full Part D subsidies (no annual premiums and nominal cost sharing) are available only to those with incomes up to 135% of the FPL. Partial subsidies are available to those with incomes between 135% and 150% of FPL. Increasing the level of benefits to those currently only eligible for partial subsidies has the potential of significantly lowering out-of-pocket medication costs that pose a barrier to adherence for many low-income Medicare beneficiaries, but the outcome of the new policy will depend on how many enroll. Historically, enrollment among those eligible for partial subsidies has hovered around 30%, but the latest data on LIS participation rates are for 2014. We undertook this study to update LIS eligibility and enrollment numbers to 2019, with a particular emphasis on identifying characteristics of beneficiaries who may benefit from the new policy. Using data from the Medicare Current Beneficiary Survey, we determined that 73% of beneficiaries eligible for full subsidies under current law were enrolled, but only 25% eligible for partial subsidies were enrolled. We conclude that while the IRA will raise the overall level of Part D subsidies, it will be important to engage stakeholders and promote outreach to maximize participation in the leadup to implementation.

Increasing latrine sales among poor households in rural Cambodia using targeted subsidies: a randomized control trial

Abstract Because improved sanitation can improve public health but is lacking in many rural areas, many organizations use sanitation marketing to increase latrine coverage. In rural Cambodia, iDE has facilitated the sale of more than 395,000 pour-flush latrines since 2011 but recognizes that market actors are not incentivized to sell to the poorest households. Using a randomized controlled trial, in which poor households in treatment villages were offered partial latrine subsidies, this study investigated how subsidies affected latrine sales and program cost-effectiveness. Results show latrine sales among poor households that were offered subsidies increased by 14–16% compared to those that were not offered subsidies. Also, no significant effect on latrine sales among non-poor households was found, although lower village-level latrine coverage can reduce latrine sales to non-poor households. Cost-effectiveness analysis shows the increase in sales and thus economies of scale from subsidies yield lower per-latrine program costs compared to non-subsidy costs ($38 vs. $54). Well-targeted latrine subsidies can significantly increase latrine sales among poor households with minimal impact on latrine sales to non-poor households and favorable program cost reductions. However, subsidies must not be introduced into a market before baseline sanitation coverage is achieved to avoid market distortion effects.

O-080 Impact of age-limit policy change for assisted reproductive technology (ART) subsidy in Japan

Abstract Study question What was the impact on treatment age in Japan after a subsidy policy change that set age limits for assisted reproductive technology (ART) treatment? Summary answer The national policy introducing age limits in the subsidy may have promoted ART treatment among younger women. What is known already Japan has provided partial subsidies for ART treatment since 2004. To promote treatment at a younger age, the government introduced a subsidy policy in 2016 that set age limits: up to six treatment cycles for women younger than 40 years of age; and up to three cycles for women between 40 and 42 years old. However, two out of 47 prefectures continued to provide subsidies to women aged 43 and older. Study design, size, duration We conducted a time series analysis of the utilisation of ART before and after the introduction of age limits, using data from the Japanese national ART registry from 2012 to 2016. Participants/materials, setting, methods We described the number of fresh and frozen treatment cycles, comparing the number between 45 prefectures that followed the national policy change (hereafter, prefectures with age limits) and two prefectures that did not (hereafter, prefectures without age limits). Ordinary least squares regression models were used to assess the impact of the policy change by prefecture on the number of ART cycles by women of different ages. Main results and the role of chance The overall number of fresh and frozen ART cycles continuously increased in all age groups from 2012 to 2016. Meanwhile, the number of fresh ART cycles among women aged ≤ 36 and 37-39 years in 2016 increased from the previous year by + 4.0% and +1.8% in prefectures with age limits, whereas it decreased in prefectures without age limits: -3.1% and -2.3%, respectively. The number of fresh ART cycles among women aged 40-42 and 43-45 years in prefectures with age limits in 2016 changed by + 1.5% and -0.1%, respectively, whereas it increased considerably in prefectures without age limits by + 9.6% and +65.4%, respectively. Similar changes were shown for the frozen cycles. After controlling for underlying time trends and prefectural characteristics, the policy change significantly increased the number of fresh and frozen ART treatment cycles among women aged ≤ 36 years and decreased the treatment cycles of women aged 40-42 years. Limitations, reasons for caution We evaluated the change observed in the year of the policy change and could not assess longer-term trends. Additionally, unobserved factors might have contributed to the change in treatment numbers. Wider implications of the findings The introduction of a policy to set an age limit for the partial ART subsidy resulted in a significant increase in treatment even among age groups younger than the boundary groups. The policy change might have conveyed educational messages regarding the benefits of early treatment. Trial registration number not applicable

Drivers of Customer Loyalty in the Downstream Petroleum Sub-Sector in Nigeria

The downstream petroleum sub-sector in Nigeria has remained highly competitive since the partial subsidy removal era. Operators now adopt various marketing efforts to attract and retain customers. While several models have been used to examine the drivers of customer loyalty in the petroleum industry, no study is known that applies the 7Ps model. This study, attempts to close this gap. Data was generated from petroleum products customers in the Southeast region of Nigeria, and analyzed with the SPSS 23.0 multiple regression analysis. Findings reveal that all the 7Ps variables – product, price, place, promotion, people, process and physical evidence are significant drivers of customer loyalty. The study recommends appropriate blending of the mix elements for more positive outcomes.

Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis

BackgroundUnder-five malaria in Nigeria is a leading cause of global child mortality, accounting for 95,000 annual child deaths. High out-of-pocket medical expenditure contributes to under-five malaria mortality by discouraging care-seeking and use of effective anti-malarials in the poorest households. The significant inequity in child health outcomes in Nigeria stresses the need to evaluate the outcomes of potential interventions across socioeconomic lines.MethodsUsing a decision tree model, an extended cost-effectiveness analysis was done to determine the effects of subsidies covering the direct and indirect costs of case management of under-five malaria in Nigeria. This analysis estimates the number of child deaths averted, out-of-pocket (OOP) expenditure averted, cases of catastrophic health expenditure (CHE) averted, and cost of implementation. An optimization analysis was also done to determine how to optimally allocate money across wealth groups using different combinations of interventions.ResultsFully subsidizing direct medical, non-medical, and indirect costs could annually avert over 19,000 under-five deaths, 8600 cases of CHE, and US$187 million in OOP spending. Per US$1 million invested, this corresponds to an annual reduction of 76 under-five deaths, 34 cases of CHE, and over US$730,000 in OOP expenditure. Due to low initial treatment coverage in poorer socioeconomic groups, health and financial-risk protection benefits would be pro-poor, with the poorest 40% of Nigerians accounting for 72% of all deaths averted, 55% of all OOP expenditure averted, and 74% of all cases of CHE averted. Subsidies targeted to the poor would see greater benefits per dollar spent than broad, non-targeted subsidies. In an optimization scenario, the strategy of fully subsidizing direct medical costs would be dominated by a partial subsidy of direct medical costs as well as a full subsidy of direct medical, nonmedical, and indirect costs.ConclusionSubsidizing case management of under-five malaria for the poorest and most vulnerable would reduce illness-related impoverishment and child mortality in Nigeria while preserving limited financial resources. This study is an example of how focusing a targeted policy-intervention on a single, high-burden disease can yield large health and financial-risk protection benefits in a low and middle-income country context and address equity consideration in evidence-informed policymaking.

Pricing research for automotive supply chains considering low-carbon consumer preferences under a dual policy

PurposeThe promotion of new energy vehicles (EVs) is an effective way to achieve low carbon emission reduction. This paper aims to investigate the optimal pricing of automotive supply chain members in the context of dual policy implementation while considering consumers' low-carbon preferences.Design/methodology/approachThis article takes manufacturers, retailers and consumers in a main three-level supply chain as the research object. Stackelberg game theory is used as the theoretical guidance. A game model in which the manufacturer is the leader and the retailer is the follower is established. The author also considered the impact of carbon tax policies, subsidy policies and consumer preferences on the results. Furthermore, the author investigates the optimal decision-making problem under the profit maximization model.FindingsThrough model solving, it is found that the pricing of EVs is positively correlated with the unit price of carbon and the amount of subsidies. The following conclusions can be obtained by numerical analysis of each parameter. Changes in carbon prices have a greater impact on conventional gasoline vehicles. Based on the numerical analysis of parameter β, it is also found that when the government subsidizes consumers, supply chain members will increase their prices to obtain partial subsidies. Compared with retailers, low-carbon preferences have a greater impact on manufacturers.Research limitations/implicationsThe new energy automobile industry involves many policies, including tax cuts, tax exemptions and subsidies. The policy environment faced by the members of a supply chain is complex and diverse. Therefore, the analysis in this article is based only on partial policies.Originality/valueThe authors innovatively combine the three factors of subsidy policy, carbon tax policy and consumer low-carbon preference, with research on the pricing of EVs. The influence of policy factors and consumer preferences on the pricing of EVs is studied.

Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from A Field Experiment in Ghana

We conduct a randomized experiment that varies one-time health insurance subsidy amounts (partial and full) in Ghana to study the impacts of subsidies on insurance enrollment and health care utilization. We find that both partial and full subsidies promote insurance enrollment in the long run, even after the subsidies expired. Although the long run enrollment rate and selective enrollment do not differ by subsidy level, long run health care utilization increased only for the partial subsidy group. We show that this can plausibly be explained by stronger learning-through-experience behavior in the partial than in the full subsidy group.

Attaining herd immunity to a new infectious disease through multi-stage policies incentivising voluntary vaccination

Vaccine hesitancy, as well as propensity to free-ride, can pose serious challenges to mass vaccination schemes aimed at controlling spread of infectious diseases. If vaccination is not mandatory, the individuals decide whether to vaccinate, or not, comparing their expected utilities, net of costs, from the respective options. In our proposed model, to encourage and incentivise vaccination, the government launches a 4-stage policy implementation plan, involving awareness building, vaccine distribution intensification, subsidising the vaccine, and offering free-vaccination along with a reward for getting vaccinated. While the government distributes and subsidises one vaccine, it decides whether to approve private distribution of another vaccine. Modelling the scenario as a population game, wherein the individuals may want to free-ride by avoiding vaccine while others get vaccinated, we determine the vaccine coverage in the Markov perfect equilibrium (MPE) of the game at each stage. Through a detailed numerical simulation, we observe the effects of exogenous variables, policy variables and efficiency parameters, on coverage. Our results indicate that the government should approve the other vaccine and focus on intensifying vaccine distribution. The impact of awareness development is limited. If the partial subsidy in the penultimate stage is higher, a smaller fraction of the population needs to be covered under the rewarded free-vaccination scheme. However, the high partial subsidy in the penultimate stage may come at an additional cost burden on the government, and hence a trade-off may be necessary.

Green retrofit of existing residential buildings in China: An investigation on residents’ perceptions

Green retrofit of existing residential buildings is a sustainable way to improve the energy efficiency. However, such implementation faces some challenges due to the different willingness of residents involved. There is a lack of comparative study on residents’ preceptions of green retrofit in China, which is of great concern to the government. Therefore, this study investigates residents’ housing conditions and their perceptions of a green retrofit, based on the feedbacks from 9936 questionnaires which are collected from urban and rural residents throughout China. The Chi-squared test is employed to identify the key influencing factors, including demographic and housing characteristics. The results show that more than 90% of the respondents are willing to adopt retrofit, and installing a zoned temperature control system of individual rooms is a generally acceptable measure. The retrofit subsidy is a topic of high concern, and the respondents are more likely to undertake unified free retrofit, compared with separate retrofit supported by a partial subsidy. Besides, household income, city of residence, housing type and housing problems will cause significant differences in residents’ perceptions. After evaluating the retrofit potential of different resident groups, some suggestions are proposed for policymakers. The findings from this study can help develop differentiated strategies for residents, to promote green retrofit of existing residential buildings in China.

Partial Fuel Subsidy Removal in Nigeria

The ripple effects of the petrol crisis on the Nigerian economy is multi-faceted: price distortions, volatilities, dutch-disease, corruption, and inefficiencies. This study assessed the effects of partial fuel subsidy removal on agricultural sector and Nigerian economy. The study made use of secondary data obtained from Central Bank of Nigeria Statistical Bulletins, Petroleum Product Price Regulatory Agency (PPPRA), National Bureau of Statistics, Benue State Agricultural and Rural Development Authority (BNARDA), and FAO. Johansen co-integration model and t-test were the analytical tools used. After appropriate robustness checks and ensuring data stationarity, the study found that partial fuel subsidy removal had significant positive influence on the country's GDP, significantly reduced inflation rate, and also reduced life expectancy of Nigerians. Specifically, a percentage increase in petrol price significantly increases GDP by 9.8%; a percentage increase in petrol price increases the prices of rice and maize by 0.75% and 1.50% respectively. The study concludes that increased petrol price had positive effects on GDP and adverse effects on the prices of crop produce. Government should diversify and develop other economies and provide adequate infrastuctural facilities to cushion the effects of subsidy removal. Organic and low-input methods of farming should be adopted to reduce the need for fuel inputs to the food system at all levels.

Acceptance and willingness to pay for a hypothetical vaccine against monkeypox viral infection among frontline physicians: A cross-sectional study in Indonesia

BackgroundA clinical trial is ongoing to evaluate the safety and efficacy of a monkeypox vaccine among healthcare workers (HCWs). The critical question that needs to be addressed is whether HCWs are willing to accept and purchase this vaccine. The objective of this study was to evaluate the acceptance and willingness to pay (WTP) for the vaccine among HCWs. MethodsFrom May to July 2019, a cross-sectional study was conducted among registered general practitioners (GPs) in Indonesia. A contingent valuation method was employed to evaluate the WTP. Besides acceptance and WTP, various explanatory variables were also collected and assessed. A logistic regression and a multivariable linear regression were used to explore the explanatory variables influencing acceptance and WTP, respectively. ResultsAmong 407 respondents, 391 (96.0%) expressed acceptance of a free vaccination. The mean and median WTP was US$ 37.0(95%CI:US$ 32.76–US$ 41.23) and US$ 17.90(95%CI:US$ 17.90–US$ 17.90), respectively. In an unadjusted analysis, those 30 years old or younger had 2.94 times greater odds of vaccine acceptance compared to those who were older (95%CI: 1.07–8.08). Location of alma mater, type of workplace, length of individual medical experience, and monthly income of GPs were all significantly associated with WTP. ConclusionAlthough the vast majority of GPs would accept a freely provided vaccine, they were also somewhat price sensitive. This finding indicates that partial subsidy maybe required to achieve high vaccine coverage, particularly among GPs at community health centres or those with a shorter duration of medical practice.

Sex differences in the risk of diabetes mellitus among individuals with psoriasis: A retrospective cohort study in Québec, Canada

Sex differences in the risk of diabetes mellitus among individuals with psoriasis: A retrospective cohort study in Québec, Canada

Association between insurance cost-sharing subsidy and postoperative opioid prescription refills among Medicare patients

BackgroundModels of health care coverage with varying degrees of patient cost-sharing have been shown to influence health care behaviors for chronic conditions including medication adherence. The effect of insurance cost-sharing subsidies on the probability of postoperative opioid refill, however, is unclear. MethodsThis retrospective cohort study examined 100% Medicare claims data among patients (N = 21,781) ages 65 and older undergoing orthopedic procedures in Michigan between January 2013 and September 2016. Patients were classified based on the presence of low-income subsidy and on prior opioid exposure using Medicare Part D prescription files of drug events. We investigated the association of these factors with the probability of both initial and second postoperative opioid fill within 90 days from the date of discharge. ResultsIn this cohort, 84.6% of patients filled an initial opioid prescription, and 66.4% refilled an opioid prescription. Patients with a full low-income subsidy had greater odds of refill within the postoperative 90 days compared with those patients without a low-income subsidy (odds ratio 1.38, 95% confidence interval 1.18–1.60). Among opioid naïve patients with a full low-income subsidy, the adjusted refill rate was 61.3% (95% confidence interval 58.0–64.7%) compared with 57.6% (95% confidence interval 51.4–63.7%) among those with partial low-income subsidy and 54.2% (95% confidence interval 52.8–55.6%) among patients without low-income subsidy. ConclusionAmong Medicare patients undergoing orthopedic procedures, a full medication subsidy is associated with an increased probability of opioid refill when compared with no subsidy. Going forward, it is critical to lessen financial barriers to ensure all patients have equitable access to postoperative analgesia, including both opioid and nonopioid analgesics by decreasing the patient burden of cost-sharing.

Sustainable Policy for Water Pricing in Kuwait

This research investigates consumer willingness to pay (WTP) for water in Kuwait as a foundation for policy decisions on reducing water subsidies. Heavy subsidies have encouraged unsustainable very high consumption, but efforts to cut subsidies can generate strong political opposition. A survey (n = 443) indicates that WTP is greater at lower prices, but resistance is not purely about price. The presence of a continued partial water subsidy for basic household use slightly increases WTP, probably mainly from perceptions of fairness. Information about Kuwait’s water scarcity also has a small impact. All of these effect sizes are small, so we discuss these issues using a nudge framework from behavioral economics. A number of policies can foster small shifts in WTP; collectively they may have larger impact and make subsidy reduction relatively painless.

Loan and Grant Support for Students in the Context of the Diversification of Funding Sources for Higher Education

[full article and abstract in English]&#x0D; This paper considers the mechanism of direct state support for students in European countries using loans and grants: their functions, forms, schemes, and conditions for provision. The peculiarities of the state preferential educational loan in Ukraine and the reasons for its curtailment since 2011 are determined. Nowadays, it is established that the main form of state support for Ukrainian students who receive higher education in public procurement comes with academic and social scholarships, whereas students who receive higher education under a contract of preferential state lending yet after the curtailment of the program are deprived of any state support. The necessity of restoring the program of preferential state lending for students and the directions of its improvement, such as the establishment of an interest rate on a loan based on the level of inflation, the establishment of a minimum amount of annual payments on a loan as a percentage of the minimum salary, the distribution of the risk of non-repayment of a loan between the state, the borrower and his parent, are all substantiated. This is done taking into account the financial capabilities of the Ukrainian state and the high levels of hidden income. We consider the establishment of conditions needed for the development of a system of commercial educational loans, by providing for the provision of a state guarantee on it and partial state subsidy of interest rates. We consider the areas of improvement of scholarship support of students and substantiate the necessity of introducing education at least for orphans, children deprived of parental care, and disabled children.

Family-Based Health Insurance for Informal Sector Workers in Vietnam: Why Does Enrolment Remain Low?

Providing financial protection to the whole population is a top health policy priority of many countries. However, expanding social health insurance coverage to the "informal sector worker" is a challenge in many developing countries. This study analyzed the reasons for the limited coverage of health insurance for informal sector workers. Direct interviews were carried out with 391 uninsured households in Vietnam, followed by in-depth interviews with 11 key stakeholders. The study offers several possible explanations for the low enrollment in family-based health insurance scheme at both the demand and supply sides, such as inability to pay the premium, lack of information, perceived poor quality of primary health care services, and complicated enrollment procedures. The study suggests that a partial government subsidy and improvement in the quality of primary health care are crucial strategies for health insurance expansion for the informal sector workers and their families.