Health Insurance Participants Research Articles

A tale of two markets—would housing appreciation prompt insurance participation? Evidence from China’s urban elderly

This paper investigates how housing wealth affects urban elderly’s commercial health insurance participation by using the discontinuity along housing size formed by China’s housing policies. The empirical results reveal a positive effect of housing wealth on urbanites’ enrolment in commercial health insurance, with elderly previously or currently working in non-public sectors, only having one child, and not having a son exhibiting higher responsiveness to unexpected gains in housing wealth. Moreover, the bumper housing wealth-induced insurance purchasing only takes effect for urban elderly having full homeownership, whereas those with partial ownership and tenants hardly react to housing policies.

Health Insurance for Universal Health Coverage in India

The role of health insurance in expanding Universal Health Coverage is to ease the access to healthcare services and reduce the risk of unexpected health expenditure burden. In order to examine this role, this article assesses the contribution of enrolment in health insurance on the utilisation of healthcare services and out-of-pocket expenditure for working-age Indians. Investigation into these two issues, addressing the self-selection/endogeneity problem in buying health insurance, is uncommon in the literature. Against this end, the probability of utilising healthcare services and the incurred out-of-pocket expenditure has been estimated using National Sample Survey (2017–2018) data in India. Empirical findings reveal evidence of endogeneity in health insurance enrolment for hospitalisation, which indicates the presence of self-selection in health insurance enrolment. Addressing the endogeneity problem, this study has found a higher probability of utilising hospitalisation and lower out-of-pocket expenditure among insured individuals than others. Socio-economic and demographic variables like household income, education, gender, religion and state of residence are important to determine the utilisation of healthcare facilities. On the other hand, while out-of-pocket expenditure incurred for hospitalisation significantly varies with age, gender, social caste, religion, working status, state of residence, nature of ailment and type of hospital, household income and health status have no significant effect on out-of-pocket expenditure. Poor people are less likely to be hospitalised, and compared to males, females have a higher probability of utilising healthcare services at their reproductive age. State-level health policies and health insurance schemes play a crucial role in determining health insurance participation and utilisation of health services. JEL: C13, C21, C25, I10, I11, I13, I14, I18

Determinants of Willingness to Pay for Community-Based Health Insurance in Ethiopia: National Household Survey

The existing evidence on households' participation in Ethiopia's community-based health insurance (CBHI) scheme is limited, lacks representativeness, and lacks disaggregation. Thus, this study aims to assess households' willingness to pay (WTP) for CBHI membership and identify the factors that influence their decision to enroll. From February to May 2020, a nationwide cross-sectional household survey was conducted involving CBHI member and non-member households. The primary theories that informed this study were utility theory, social capital theory, and the health belief model. Sample included 5,976 households from 166 EAs—118 in CBHI regions and 48 in non-CBHI regions. A two-stage stratified cluster sampling used to select enumeration areas (EAs) and households from within these areas. The maximum amount of money at which participants responded "yes" in the bidding game exercise was used to measure WTP. Data were analyzed using STATA Version 16. Household expenditure was adjusted for key factors. Analyses explored WTP for CBHI by region, membership, and livelihood, with WTP based on mean maximum values. Linear regression identified influencing factors. The findings reveal that 30.9% of participants were active CBHI members. The average WTP increased with each additional family member, both in rural (AMD = 9.3 [6.8, 11.9]) and urban areas (AMD = 7.2 [1.0, 13.4]). In urban areas, WTP was also positively associated with the ability to pay (ATP) for CBHI (AMD = 64.1 [6.3, 121.8]). Male respondents and those who were literate in urban areas had higher mean WTP values of AMD = 39.8 [13.1, 66.4] and AMD = 56.8 [26.1, 87.4], respectively. Additionally, holding leadership positions in health and women's development initiatives positively influenced WTP. The study found that 30.9% of participants were active CBHI members. WTP for CBHI was higher among larger families. In urban areas, WTP was positively associated with the ability to pay (ATP) for CBHI, particularly among male and literate respondents. Community leadership roles in health and women's development also positively influenced WTP. To improve the CBHI scheme, adjustments should be made to premiums based on households' ability to pay. Community engagement should be strengthened, service quality enhanced, regional disparities addressed, and performance regularly monitored.

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.

Impact of Direct Health Facility Financing on Health Insurance Enrollment and Service Quality in Dodoma Region, Tanzania

The National Health Insurance Fund (NHIF) and the Improved Community Health Fund (iCHF) are pre-payment schemes in Tanzania designed to achieve universal health coverage (UHC). Despite these efforts, public health facilities have historically struggled with poor-quality care. In response, the Direct Health Facility Financing (DHFF) mechanism was introduced in 2017, enabling health facilities to procure medicines and equipment directly from approved vendors when out-of-stock notifications are received from the Medical Store Department (MSD). This study evaluates the impact of DHFF on health insurance enrollment and service quality in the Dodoma Region. Utilizing a mixed-methods approach with an explanatory sequential design, a total of 35 respondents were involved in the proposed study, of which 30 were obtained from health insurance beneficiaries and 5 were from key informants. Results revealed increased health insurance enrollment for both NHIF and iCHF from 2018–2019 to 2019–2020, attributed to enhanced medicine availability, community education, and sensitization efforts. Beneficiaries reported significant improvements in health facilities, including better medicine availability, upgraded infrastructure, and improved attitudes from healthcare providers. Healthcare providers and authorities also noted improved service quality since DHFF's introduction. However, challenges remain, particularly with MSD's rigidity in notifying health facilities about out-of-stock items. Recommendations include enhancing the MSD's supply chain management to ensure timely notifications and deliveries. Future research should expand to multiple regions to account for cultural variations and additional factors influencing health insurance participation, enrollment, and service quality.

The impact of digital finance on young People's health insurance participation decisions in China.

The digital finance era has reshaped young people's lifestyles, risk perceptions and insurance participation decisions. Modern youth have to constantly seek for rational social security support and construct individual protection barriers to adapt to new lifestyles and social structures. China's multi-tiered, universal health insurance system is urgently needed to satisfy young people's flexible needs and rational decision-making. Based on the micro data from 2011 ~ 2021 Chinese General Social Survey (CGSS), this paper uses macro data from Digital Inclusive Finance Index (DIFI) matching to construct probit and m-logit model to assess the impact of the development of digital finance on Chinese youth whether or not to participate in health insurance, and how they choose the concrete type of health insurance. (1) Baseline regression results shows that digital finance has a significant positive effect on Chinese youth's health insurance participation decisions, and has different effects on choices within health insurance types. Strong support for the conclusions is provided by endogeneity and robustness tests. (2) The results of the heterogeneity analysis reveal that the marginal effect of digital finance on young people's health insurance decisions shows urban-rural differences, divergence in levels of self-rated health. (3) The mechanism analysis results suggest that there are two mechanism paths of digital finance on youth health insurance decisions: the household income effect and the subjective well-being effect, and two moderating effects: employment type and family structure. Highlighting the positive value that digital finance brings to the perception of youth insurance participation and the construction of social security systems, it needs to pay close attention to the dynamic changes in employment security and family structure through data, and explore the socio-psychological fluctuation and demand for social security among modern youth. To provide a way forward to achieve the integration of the health insurance system in China and solve the current problem of health insurance equity.

The Role of Online Queues as a Moderator Between Service Quality and Patient Satisfaction for National Health Insurance's Participants

This study aims to provide new insight and fill the gap of previous research by adding online queues to moderate the effect of perceived service quality and the organization’s image on perceived satisfaction. Data were collected from 120 respondents who are members of National Health Insurance (JKN) who became patients at Prof. dr. I Goesti Ngoerah Gde Ngoerah Hospital Denpasar. Partial Least Square Structural Equation Modeling (PLSSEM) was used to analyze and test hypotheses. This research applied quantitative approach using a preexisting measurement scale. The results of this study prove that service quality has a positive and significant effect on customer satisfaction. Another finding from this study is that an organization's image does not significantly affect customer satisfaction. Online queues could not moderate the relationship between service quality and the organization's image on customer satisfaction. The practical implication of this research is that hospitals must continue to improve the quality of their services to increase patient satisfaction with the hospital

The Effect of Pandawa Service Quality and Switching Cost on Loyalty of National Health Insurance Participants

The Effect of Pandawa Service Quality and Switching Cost on Loyalty of National Health Insurance Participants

Analysis of Factors Related to National Health Insurance Participation in Rungan Barat District

Target of the 2020-2024 RPJMN is targeting NHI membership of 98%. The data shows that West Rungan District is the area with the lowest coverage in Gunung Mas Regency as 36.35% in 2022. The study purposed to analyze the factors related to National Health Insurance membership in West Rungan District. The study used an analytic survey method with a cross sectional design. The population of this research is the people who live in West Rungan District, Gunung Mas Regency with a sample of 109 people who were determined using non-probability sampling with accidental sampling technique. Data were taken from primary data using a questionnaire. Data were analyzed by chi square test and multiple logistic regression. The chi square test shows the p-value between family income (p=0.001 < α 0.05), level of knowledge (p=0.323 >α 0.05), level of education (p=0.062 >α 0.05), number of family members (p=0.751 >α 0.05) and registration procedures (p=1,000 >α 0.05) with JKN participation. The conclusion was that there was a relationship between family income and NHI membership in West Rungan District. There was no significant relationship between family income, level of knowledge, level of education, number of family members, and registration procedures and NHI membership. Logistic Regression Test shows that family income is the most dominant factor (OR=6.536) related to JKN participation in West Rungan District.

The impact of the implementation of hierarchical medical system on population health: evidence from China

IntroductionThe implementation of a hierarchical medical system holds significant practical importance in advancing the Healthy China strategy and elevating the overall health status of the population of China.MethodsThis article empirically examines the influence of the implementation of a hierarchical medical system on the health of the population using the latest 2020 China Family Panel Studies database. Furthermore, it investigates the variability of this impact across distinct health insurance participation statuses and literacy groups.ResultsThe findings of the study demonstrate that the implementation of the hierarchical medical system substantially enhances the health of the population, not only in terms of self-assessed health but also through a notable positive effect on alleviating chronic diseases. These results maintain their validity even after conducting robustness tests utilizing a replacement estimation model. Heterogeneity analysis reveals that the impact of the hierarchical medical system on the population’s health status exhibits significant variation concerning health insurance participation and literacy. Specifically, regarding health insurance participation, the hierarchical medical system effectively improves both self-assessed health and chronic disease status among the insured population. However, for those not enrolled in health insurance, the hierarchical medical system only demonstrates improvement in chronic disease status, with insignificant results observed in enhancing self-assessed health status. Moreover, propensity score matching (PSM) was also used to address endogeneity problems resulting from sample selectivity bias. The findings demonstrate that endogeneity issues can be suitably addressed by the PSM model. Additionally, they point out that an overestimation of the impact of the hierarchical medical system on the population’s self-assessed health state would result from failing to take sample selectivity bias into account. On the other hand, it will lead to the underestimation of the effect of the hierarchical medical system on the status of chronic diseases.DiscussionMoving forward, steadfast efforts should be directed toward further enhancing the implementation of the hierarchical medical system. This includes the comprehensive promotion and using the pivotal role of the hierarchical medical system in improving the health of the population.

The Influence of National Health Insurance Participant Satisfaction in Mediating the Relationship of Service Quality and Brand Image Towards Participant Loyalty at RSU Balimed Denpasar

The irregularity of participants in paying National Health Insurance contributions shows that participants lack loyalty in paying contributions which are their routine obligations as participants in the National Health Insurance program. The aim of this research is to reveal the mediating impact of satisfaction on service quality and brand image on loyalty. This research is quantitative research conducted using a survey, using data samples from National Health Insurance participants with active membership and receiving services at the Bali Med Denpasar General Hospital, totaling 82 people with PLS-based SEM analysis. The research results showed that service quality had a positive and significant effect on satisfaction, brand image had no significant effect on satisfaction, service quality and brand image had a positive and significant effect on loyalty, and patient satisfaction was able to mediate the effect of service quality and brand image on patient loyalty. It is hoped that the results of the research can provide advice to related parties to improve the quality of health services, such as how to respond to existing complaints and communicate well with patients and this is expected to have a positive impact on the quality of services

Does health insurance participation matter in shaping African immigrants' physical health in Guangzhou, China? The role of mental health

AbstractChina is a burgeoning immigrant‐receiving country, and policies on immigration are just beginning to be developed. While African immigration to China was uncommon 30 years ago, China has gradually become a major destination for African immigrants due to its robust economy, welcoming universities, and low cost of living. Currently, there are increasing numbers of African students and professionals who are migrating to China to study or work. The health status of African migrants in China shapes their wellbeing, which plays a key role in strengthening long‐term cooperative relations between China and African countries. Although previous literature has examined the socioeconomic status of these African immigrants, the role of health insurance participation in shaping the health status of African immigrants remains obscure in China. Using data from the 2019 questionnaire‐survey in Guangzhou, China, this paper investigates the underlying mechanism driving African immigrants' health insurance participation as critical to their physical and mental health. Our results demonstrate that health insurance participation is a pivotal factor in the overall health of African immigrants; specifically, purchasing health insurance and one's mental and physical health can be characterised as a feedback loop. Purchasing health insurance can positively impact mental health, and consequently, better mental health can improve physical health. Good physical health also tends to bolster mental health. Therefore, policies aimed at improving African immigrants' mental and physical health are expected to encourage them to purchase health insurance above their present low level of insurance participation. The proposal here is that health policymaking for immigrants should include the interaction mechanism between physical and mental health rather than focus only on physical health conditions.

Effect of Marketing Strategy Implementation and Customer Behavior on Satisfaction and Trust and Its Implication on Loyalty in Non Recipient Health Insurance Participants

Purpose – The purpose of this study was to find out, study and analyze the implementation of marketing strategies and customer behavior on satisfaction and trust and their implications for the loyalty of BPJS Kesehatan participants who are not recipients of contribution assistance. Methodology/approach – The research method used is a survey method with quantitative research type, descriptive-verification research nature. The research sample was 400 BPJS Health participants who did not receive contribution assistance, this study used purposive and proportional clustered random sampling methods. In addition, the analysis method used is Structural Equation Modelling (SEM) analysis. Findings – The results of the study concluded that there was a significant influence from the implementation of marketing strategies and customer behavior on satisfaction by 76.15 percent, and there was a significant effect from the implementation of marketing strategies and customer behavior on trust by 78.24 percent, and there was a significant effect from satisfaction and trust in loyalty of 82.78 percent. Novelty/value – Marketing strategy consisting of target market and marketing mix, combined with consumer behaviour consisting of customer characteristics and customer psychology will have an impact on satisfaction and trust and have implications for loyalty.

Impact Of The Covid-19 Pandemic On Glycemic Control In Childhood Type 1 DM Patients

There has been an increase in cases of diabetic ketoacidosis in children aged 1-14 years from 73% in 2019 to 83% in 2020 during the COVID-19 pandemic. An increase in acute complications of type-1 DM can occur due to lack of compliance with glycemic control and activity restrictions which have the impact of reducing the level of glycemic control in children with type-1 DM. Based on these findings, researchers wanted to know the impact of restrictions on community activities during pandemic on the glycemic control of children with type 1 DM. The aims of this study is to determine the impact of the COVID-19 pandemic on glycemic control through HbA1c parameters in children with type 1 DM. Methods of this research is a cross sectional study with a sample size of 26 patients. Results are The average age of respondents was 15.58 years. More than half of respondents were female (73.1%). The average duration of suffering from type 1 DM was 4.77 years. More than half of the respondents had a history of diabetic ketoacidosis, 53.8%, and all respondents were Health Insurance (BPJS) participants (100%). There was a decrease in HbA1c levels during the pandemic compared to before the pandemic, namely 12.17 ± 2.60 to 10.32 ± 2.21. Statistically, this decrease means that there is an impact of the COVID-19 pandemic on glycemic control through the HbA1c parameter in children with type 1 DM (p<0.05). There was a decrease in HbA1c levels during the pandemic compared to before the pandemic.

Risk preference and relative poverty: An analysis based on the data of China Family Panel Studies

It is posited that solving the problem of relative poverty (RP) first requires the identification of its cause. We use data from China Family Panel Studies to examine the impact of risk preference on RP of urban and rural families in China and the underlying mechanism. This paper contributes to the existing body of evidence on the determinants of RP. The results show that a high degree of risk preference is conducive to alleviating families' RP. The effect is still significant after dealing with potential endogeneity through instrumental variables. Furthermore, the effect is more obvious among health insurance participation families, endowment insurance participation families, families with low life satisfaction, non-poor families, especially middle-income families, urban families, male-headed families and families in the West in China. Further analysis suggests that risk preference affects RP by promoting entrepreneurship and credit in urban and rural families. Families with a higher risk preference are more likely to engage in entrepreneurship and utilize credit, which in turn helps alleviate their RP. Overall, this paper provides new empirical evidence for understanding the mechanism of risk preference influencing RP.

The impact of basic health insurance participation characteristics on the health of mobile populations: the mediating role of health service utilization behavior.

It is a pivotal element of China's health system reform to improve the health security of health insurance for the mobile population. Achieving this objective is integral to the success of the reform. The aim of this study was to analyze the impact of different enrollment characteristics of basic health insurance on the health of the mobile population and to investigate the mediating role of health service utilization behavior. This cross-sectional study included 135,372 migrants who participated in the 2018 China Migrants Dynamic Survey (CMDS). Two indicators were employed in this study to assess the characteristics of the mobile population's involvement in basic health insurance-namely, whether or not they participated in local health insurance and the type of health insurance in which they participated. The health status of the mobile population was measured using self-assessed health. Health service utilization behavior was divided into public health service utilization and medical service utilization. Multivariate ordered logistic regression was employed to examine the effect of health insurance on the health of the mobile population. Subsequently, the Bootstrap method was applied to analyze the mediating effect of health service utilization behavior in the relationship between health insurance and the health of the mobile population. Health insurance had a positive impact on health, public health services, and health service utilization among the mobile population. However, enrollment in local health insurance (OR = 1.088, 95% CI = 1.043-1.134) and enrollment in Basic Medical Insurance for Urban Employees (OR = 1.178, 95% CI = 1.090-1.273) were more likely to be associated with higher levels of health and a greater likelihood of receiving health service utilization. The results of the mediating mechanism analysis indicated that health education, health records, family doctor contracting, receiving inpatient services, and being hospitalized locally all played a partially mediating role in the impact of the place of enrollment on health. Regarding the effect of the type of enrollment on health, three types of services-namely, health education, health records, and contracting with a family doctor-played a partially mediating role, while receiving inpatient services and being hospitalized locally did not exhibit a mediating effect. The effect of the type of participation on health is partially mediated. Based on the impact of the different enrolment characteristics of basic health insurance on the health of the mobile population and the mediating role of health service utilization in this impact, furthermore, improvement of health insurance coverage for the mobile population should focus on improving the accessibility of health services, increasing the level of health insurance coverage, mitigating differences in treatment between the different insurance systems, and simplifying the process of transferring the health insurance relationships.

Sustaining Universal Health Coverage in Vietnam: Expanding Health Coverage for Informal Economy Workers

As of 2022, Vietnam's health insurance coverage has reached approximately 91% of the population. However, over 5.4 million informal workers have not participated in health insurance due to limited access to health services, insufficient information about health insurance, loose labor contracts, and low income. This article presents solutions to expand health insurance coverage for informal workers and achieve the goal of maintaining universal health coverage. The proposed solution groups: Solution groups for access to medical services, include: Increasing access to high-quality medical examinations and treatments; Enhancing access through investment and upgrading of grassroots healthcare; and reforming payment methods for medical costs. State management solution group, including: Strengthening law enforcement in signing labor contracts; Strengthening propaganda work; Encouraging participation in health insurance by households; Strengthening inspection and supervision of health insurance participation in salaried groups and individual production and business households. Solution group strengthens public policy and supports vocational training, including: Strengthening linkage policies in local economic development; Strengthening training to improve skills for informal workers; and strengthening public policies to increase income for informal workers.

Determinants of Behavioral Compliance in Coronary Heart Disease Therapy Among Patients at Bandung Heart Clinic

Background: Coronary heart disease (CHD) ranks seventh among non-communicable diseases (NCDs) in Indonesia, with a projected increase in mortality by 2030 to approximately 23,6 million. The rehabilitation of CHD, which constitutes long-term treatment, significantly depends on patient adherence. Objective: This study aims to investigate the determinants of patient adherence behavior at the Bandung Heart Clinic. Methods: It employed a cross-sectional research design, gathering data from 471 CHD patients with a history of atherosclerosis at the clinic between January and October 2022. The minimum sample size of 80 respondents, calculated using the Lemeshow formula, was increased to 150 to mitigate potential dropouts. The research instrument used was a questionnaire that had been validated and deemed reliable, except for one question regarding family support. Sampling was conducted using accidental sampling and involved interview data collection. Results: Bivariate data analysis, using the chi-square test, indicated significant associations between gender (p=0.09), employment status (p=0.01), health insurance participation (p=0.012), healthcare accessibility (p=0.022), family support (p=0.006), and treatment motivation (p=0.22) with patient adherence behavior. Additionally, female patients (OR=3,316) patients who are members of a health insurance (OR=2,617), patients with high treatment motivation (OR=1,983), patients who receive support from their families (OR=2,476) are more likely to exhibit adherence behavior compared to those who are not. Conclusion: In summary, it can be concluded that gender, employment status, health insurance participation, family support, and treatment motivation have significant correlations with patient adherence behavior in the context of CHD at the Bandung Heart Clinic.

Legal protection for patients using health social security agency

The purpose of this research is to find out and regulate the legal protection and responsibilities of health insurance institutions toward health insurance participants. The research method used is the normative research method. Using a legal and analytical approach. The legal material used was tracked using literary techniques. The outcome of this writing is that, given the many cases of discrimination against patients by health insurance agencies, legal protection is necessary to protect the rights of patients from social health insurance agents. Moreover, the responsibility of the health administration and social security institutions is also imperative for patients from the social security administration bodies because the health services provided are not in accordance with the regulations in force. This liability can arise from the receipt of discriminatory complaints from participants in the health insurance organization. Disputes may be settled through mediation or dispute settlement with the state administration, according to the area of residence.

Private health insurance incentives and passive adverse selection: is Lifetime Health Cover responsible for the excess ageing of Australia's hospital cover risk pool?

Objective Lifetime Health Cover (LHC) was introduced in mid-2000 to increase participation in private health insurance that includes hospital cover (PHI-HC) and improve the risk profile of PHI-HC participants. It initially achieved both objectives, but since 2001 the PHI-HC population has aged faster than the general population. The aim of this study was to determine if the excess ageing of the PHI-HC risk pool has been due to passive age-based adverse selection, an inherent risk of LHC. This study has potential implications for the retention of LHC. Methods A descriptive population-level analysis of publicly available administrative datasets was performed. Data relating to PHI-HC were obtained from the Australian Prudential Regulatory Authority. National population data were obtained from the Australian Bureau of Statistics. Trends in demography, PHI-HC participation rates and LHC loading payments were analysed. Results By 2021, age-based adverse selection had returned to the pre-LHC level. Based on the available data, this was due to passive age-based adverse selection not active age-based adverse selection. Specifically, it reflected the combination of an avoidable unintended consequence of the introduction of LHC (the over-representation, in 2001, of individuals aged 45-59) and one of LHC's intended effects (incentivisation of insured individuals to retain PHI-HC). Conclusions This study supports the retention of LHC. Nonetheless, it highlights the risk of passive age-based adverse selection created by incentivising insured individuals to retain PHI-HC in the presence of distortions in the age distribution of the PHI-HC risk pool. Early targeted interventions are required when such distortions arise.