Private Insurance Schemes Research Articles

Health Insurance Utilization and Financial Behaviour: A Study of Rashtriya Swasthya Bima Yojana (RSBY) in Kerala

This paper examines the health behaviour and health insurance landscape in Kerala, India, with a focus on the impact of the Rashtriya Swasthya Bima Yojana (RSBY) on healthcare utilization and financial behaviour. Using primary data collected from Mukkam municipality in Kozhikode district, Kerala, the study analyses the demographic profile of respondents, their health insurance status, and satisfaction levels with the RSBY scheme. The findings indicate a fairly balanced preference between government and private insurance schemes among households, with a significant majority possessing an insurance card. The RSBY scheme has been successful in enrolling a large proportion of households and providing satisfactory coverage at both government and private hospitals. However, there are variations in insurance coverage and satisfaction levels among different demographic subgroups, highlighting the need for targeted interventions and policy measures to improve access to healthcare and financial security among vulnerable populations.

Optimizing Real-World Evidence Framework for Oncology: Challenges, Opportunities, and Way Forward for India

Given the increasing prevalence of rare and metastatic cancers, the utilization of real-world evidence (RWE) has become imperative. RWE plays a crucial role in generating oncology data that aids healthcare providers in their routine clinical practice and, more importantly, informs policymaking decisions. Pfizer and IQVIA joined forces to convene a ground breaking round table discussion involving stakeholders from both private and public organizations. The primary objective of this collaborative initiative was to explore the current state of the real-world evidence (RWE) framework in India, particularly within the realm of oncology. By assessing recent changes in the healthcare landscape, the discussion aimed to identify opportunities for government initiatives, acknowledge associated challenges, and chart a path forward for optimizing oncology clinical decision-making. Several key outcomes emerged from this pioneering endeavour. Firstly, there was a strong emphasis on the significance of public-private partnerships in generating real-world data (RWD) within the Indian context. Specifically, the integration of electronic health records (EHRs) and cancer registries was highlighted as crucial for enhancing the quality and accessibility of RWD. Secondly, the discussion underscored the importance of harnessing real-world claims data obtained from both private and government insurance schemes to advance health outcome research. This data source holds immense potential for informing evidence-based decision-making in the field of oncology. Additionally, the round table meeting facilitated the generation of longitudinal RWD through government-led initiatives, opening avenues for comprehensive and long-term data analysis. Lastly, the exploration of utilizing RWE in reimbursement decisions and potential expansion of indications emerged as a significant area of focus. The insights and conclusions derived from this round table meeting serve as a foundation for continued discussions. The diverse and extensive collection of RWD pertaining to oncology therapeutics holds immense potential to guide decision-making not only within India but also across other Asia-Pacific countries Keywords: Real-world evidence, policymaking, oncology

Future Directions in Endodontics

Headlines Dental practitioners should have better communication with the patients about treatment goals and prognosis or refer to a specialist at the appropriate time without delays to achieve optimal treatment outcome. Research must not only concentrate on innovations which may interest stakeholders with short-term benefits but on randomized studies, to compare with existing materials, to prove their superiority in clinical outcomes. We need better knowledge to understand dental pain mechanisms, management of pain sensation, control and eradicate infection. Recruitment of students with outstanding performances by educational institutions in a competitive job market is a challenge that needs to be addressed. The cost of dental treatment, including endodontics, may call for increased third-party payment by government or private insurance schemes. By studying the cost-effectiveness of treatment, current systems may need to be reviewed.

Build Back Better and Long-Term Housing Recovery: Assessing Community Housing Resilience and the Role of Insurance Post Disaster

The purpose of this research is to better understand community housing resilience and the role of insurance using a Build Back Better Long-term Recovery Housing framework to analyze approaches and effects on long-term housing rebuilding and recovery. A comparative case study approach is taken to assess insurance policies and outcomes following Hurricane Katrina in New Orleans and the Canterbury earthquake sequence in Christchurch, New Zealand, both affluent urban communities with strong insurance markets. Framed within the context of “Build Back Better”, the community housing and insurance resilience assessment is based on five key indicators; governance, community resources, risk reduction, housing rebuilding funding (funding and speed of funding), and time compression (built environment and periods of recovery time). Public and private insurance schemes for both case studies are identified and are considered together with analysis of insurance claims and other sources of financial support. The findings and results show that recovery is the result of highly interdependent Build Back Better processes. The data suggests that insurance and governance systems greatly influences the onset and overall speed of recovery (time compression), thereby performing a major role in long-term recovery. This research provides an original contribution to disaster recovery knowledge by analyzing insurance claims from two well-documented natural disasters. Additionally, the paper proposes for the singular definition of community housing resilience.

Public financing for primary health care is the key to universal health coverage and strengthening health security

Public financing for primary health care is the key to universal health coverage and strengthening health security

Healthcare Cost Reduction and Health Insurance Policy Improvement

ObjectivesReducing healthcare costs is a constant endeavor of all healthcare organizations, governments, policy makers, and individuals. A comparative study of available healthcare policies from the patient’s perspective is not available. Furthermore, an analysis of how the various components of these policies affect the healthcare cost of a patient is required. MethodsData were collected from 150 hospitalized patients in India regarding their views on 7 healthcare cost categories covering 22 cost components. These are statistically analyzed under 4 commonly used health insurance policies (2 government insurance schemes: ex-servicemen contributory health scheme and employee state insurance; private insurance schemes; and self-financing—ie, no insurance) to assess which healthcare cost component is more important under which policy option. ResultsUnder 7 healthcare cost categories, 22 cost components were studied, and out of these 22, 16 were found statistically significant. Results revealed that the treatment of all 16 significant cost components under the 4 health insurance policy options was statistically different. ConclusionsPatients covered under government sector health insurance policies were found to be less concerned about healthcare costs, whereas those covered under private health insurance policies were found to be more cost-conscious. Access to healthcare or transportation costs to the healthcare facility is a key concern area for self-financed patients.

Avoiding material hardship: The buffer function of wealth

We assess how a variety of disruptive life-course events impact the economic wellbeing of US households and trace the importance of household wealth in helping families who experience these events avoid entering a spell of material hardship. Using longitudinal data from two panels of the Survey of Income and Program Participation (SIPP), we draw on direct measures of material hardship, disruptive events and household assets. Our analyses reveal that the relationship between disruptive events and the likelihood of experiencing a new spell of material hardship strongly varies across the wealth distribution, suggesting that high household wealth provides an effective private safety net. By distinguishing different types of disruptive events, we demonstrate that divorce, disability and income loss entail a risk of material hardship but also that this risk is effectively buffered by substantial wealth. Different types of hardship – namely, financial, food and medical hardship – respond in similar ways. Like public insurance schemes, wealth insurance helps buffer the effects of disruptive events on material hardship, but unlike public insurance schemes, reliance on private wealth further stratifies the economic wellbeing of households. Policy options for addressing this highly stratified private insurance scheme include disposing of the need for it by funding more robust public insurance, for instance through wealth taxation.

Ayushman Bharat: An Ethical Analysis of the World’s Biggest Health Scheme

An affordable health scheme has been always required by the Indian people. Even after passing74 years of Indian independence, quality healthcare has not been accessible to the Indian people. The data have shown out of the vast population of India only 25 percent of people are insured under the private and government insurance scheme. To overcome this problem Indian government has launched the Ayushman Bharat scheme on 25 December 2018 on the occasion of the birth anniversary of Pt. Deen Dayal Upadhyaya. The Ayushman Bharat is the Hindi translation of “India blessed with long life”. This scheme is the biggest health care scheme in the world which covers the huge population of India and the covered population under this scheme is more than 100 million. The scheme has categories into the primary, secondary, and tertiary care domain to address the health-related problems of the people and the most important and fascinating feature of the scheme is that a beneficiary avails the facilities in government hospital along with private hospitals. The present study reviews different aspects of the scheme in relevance to the helath sector to provide better perpective towards Indian health care systems.

BİRLEŞİK KRALLIK VE AMERİKA BİRLEŞİK DEVLETLERİNDE SAĞLIK HARCAMALARININ ANALİZİ

In the light of Welfare State Literature, both the United Kingdom (UK) and the United States of America (USA) are categorized as Liberal Welfare Regime by Esping-Andersen, whose classification is widely accepted in the literature, and other researchers. But as a significant difference, whereas the UK has a universal free healthcare system contrary to typical Liberal Welfare State Regime, the US doesn’t have a universal healthcare system and furthermore, the healthcare system is mostly based on private insurance schemes. Moving from that point, health expenditures in the UK and the US has been compared and analyzed since the conditions create a significant comparing chance. This study’s main argument is based on the claim of even though the US health expenditures are about two times higher than the UK (per capita and as a rate of GDP) health system in the UK is financially more efficient than the US in terms of better public health outcomes and quality. In order to do so, the study analyzes the quantity and quality of healthcare expenditures in both countries by using literature, World Health Organization and different rating systems and furthermore both systems are discussed by 8 selected public health outcomes. The study concludes that the UK’s National Health Service (NHS) is giving better quality of service with almost two times lesser financial resources in terms of public health outcomes and some policy recommendations have been made.

Customer Satisfaction in Health Insurance: Evidence from India

Health care is a universally considered as a merit good sector as most countries either have a universal health care system or a universal insurance system. India has been following a hybrid system where predominantly the health logistics and health care have been provided by the State and Central government. From a fledgling beginning with Employees' State Insurance Corporate (ESIC) (1952) and Central Government health Scheme (CGHS) (1954), India has come a long way where it has witnessed a plethora of health insurance programs. The latest addition has been the Ayushman Bharat Health Insurance Scheme, which promises to cover 10 crore families with an insurance coverage of 5 lakh. This study tries to compare the Customer Satisfaction Index (CSI) of Government Sponsored Health Insurance scheme with Private Health Insurance alternatives. It has studied two cities (Bhubaneswar and Cuttack) of Odisha, by taking a sample of 400. The Composite Satisfaction Index has taken four parameters viz. value for money (VFM), affordability, claim settlement process and claim settlement amount, to have a comparative picture of the overall satisfaction level. The broad findings are that the overall satisfaction level of government sponsored schemes is significantly higher than the private schemes; largely due to the higher cost of the private insurance scheme. The study does not take into account variables like age, number of dependents, education etc. for arriving the satisfaction index. All the same, it shows broad trends as to how due to high cost of premium and processing hassles, the private insurance schemes have not been able to become the preferred option for those below poverty line and low income groups.

Harnessing the private health sector by using prices as a policy instrument: Lessons learned from South Africa

Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the country’s spending on health care, despite only serving 16% of the population with the capacity to pay. Following years of consolidation among private hospital groups and insurance schemes, and after successive failures at establishing credible price benchmarks, South Africa’s private hospitals charge prices comparable with countries that are considerably richer. This compromises the affordability of a broad-based expansion in health care for the population. The South African example demonstrates that prices can be part of a structure that perpetuates inequalities in access to health care resources. The lesson for other countries is the importance of norms and institutions that uphold price schedules in high-income countries. Efforts to compromise or liberalize price setting should be undertaken with a healthy degree of caution.

Progress on catastrophic health spending in 133 countries: a retrospective observational study.

The goal of universal health coverage (UHC) requires inter alia that families who get needed health care do not suffer undue financial hardship as a result. This can be measured by the percentage of people in households whose out-of-pocket health expenditures are large relative to their income or consumption. We aimed to estimate the global incidence of catastrophic health spending, trends between 2000 and 2010, and associations between catastrophic health spending and macroeconomic and health system variables at the country level. We did a retrospective observational study of health spending using data obtained from household surveys. Of 1566 potentially suitable household surveys, 553 passed quality checks, covering 133 countries between 1984 and 2015. We defined health spending as catastrophic when it exceeded 10% or 25% of household consumption. We estimated global incidence by aggregating up from every country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We used multiple regression to explore the relation between a country's incidence of catastrophic spending and gross domestic product (GDP) per person, the Gini coefficient for income inequality, and the share of total health expenditure spent by social security funds, other government agencies, private insurance schemes, and non-profit institutions. The global incidence of catastrophic spending at the 10% threshold was estimated as 9·7% in 2000, 11·4% in 2005, and 11·7% in 2010. Globally, 808 million people in 2010 incurred catastrophic health spending. Across 94 countries with two or more survey datapoints, the population-weighted median annual rate of change of catastrophic payment incidence was positive whatever catastrophic payment incidence measure was used. Incidence of catastrophic payments was correlated positively with GDP per person and the share of GDP spent on health, and incidence correlated negatively with the share of total health spending channelled through social security funds and other government agencies. The proportion of the population that is supposed to be covered by health insurance schemes or by national or subnational health services is a poor indicator of financial protection. Increasing the share of GDP spent on health is not sufficient to reduce catastrophic payment incidence; rather, what is required is increasing the share of total health expenditure that is prepaid, particularly through taxes and mandatory contributions. Rockefeller Foundation, Ministry of Health of Japan, UK Department for International Development (DFID).

Comparing Strategies for Providing Child and Youth Mental Health Care Services in Canada, the United States, and The Netherlands.

This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services. We outline reforms to the organization of health care that have been introduced in recent years, and the basket of services covered by public and private insurance schemes. We conclude with a discussion of country-level opportunities to enhance access to child and youth mental health services using existing health policy levers in Canada, the United States and the Netherlands.

Hospital Contracting Reforms: The Lebanese Ministry of Public Health Experience

—Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provision of curative care. As an “insurer of last resort,” the MoPH plays an important role in providing hospital coverage to 53% of the population who lack coverage by private or public insurance schemes, through contractual arrangements with the private sector. Historically, the MoPH used hospital accreditation as the basis for contracting and for determining the reimbursement rate. However, recent studies by the MoPH showed that reimbursing hospitals solely on accreditation results was not appropriate and led to an unfair and inefficient reimbursement system. The reform program included the development of several components, in particular, an automated billing system, a utilization review function, standardized admission criteria, and a hospital case mix index that accounts for case complexity. In 2014, the MoPH started implementing a new mixed-model contracting system with private and public hospitals. Preliminary evaluation of the new model suggests that the system incentivized hospitals to admit fewer inappropriate cases and more cases that are more complex/serious. This article shares one experience of how to introduce a merit-based system to face the common practice of political clientelism and confessional/religious-based favoritism in Lebanon. It highlights the importance of stakeholder engagement in a framework of networking and participatory governance that proved to be a key element behind the resilience of a diversified health system.

健康水平平等追求與中國綱常倫理——基於中國醫療衛生體制改革進程的思考

LANGUAGE NOTE | Document text in Chinese; abstract also in English.中國傳統綱常蘊含著深刻的生命道德原則，發掘、認識和理解這一傳統倫理文化的核心內容，對認識和審視當代中國以追求社會健康水準平等為目的的醫療衛生體制改革具有重要的道德價值。如果說綱常倫理是根基，而與綱常倫理一脈相承的儒家生命倫理思想，則能夠為認識和解決醫療衛生體制改革的具體問題提供理論支援和邏輯分析框架。用“差等之愛”的思想分析醫保籌資制度便是例證。中國醫改八年成就斐然，社會健康水準平等應當成為醫改的目標指向，中國傳統綱常中保障生命安全和提供生命基本供養的思想，能夠成為醫改的道德原則和倫理智慧，而儒家生命倫理學則能夠將綱常倫理思想轉化為實在的方法與路徑。Traditional Chinese ethics contain profound bioethical teachings and principles. For the purpose of understanding and reflecting on the ongoing health care system reform in mainland China in recent years, it is important to rediscover, recognize and understand the central teachings of traditional Chinese ethics, especially the cardinal Confucian virtues in Chinese traditions. It is implausible to pursue health equality for everyone, as individuals inevitably exhibit differences in their health conditions no matter what kind of health care system is maintained. However, it is plausible to accomplish health equality in the sense that everyone in society enjoys a similar public health care system. With the great achievements made during the eight-year process of health care system reform in China, health equality has rightly become the target of reform and been significantly improved. Following the cardinal Chinese ethical virtues and principles that advocate for both universal and differentiated/graded love, the Chinese reform should not only pursue health equality, but also allow individuals to pursue private insurance schemes for themselves and their family members to practice differentiated/graded love. The government should not only ensure equality of public insurance for everyone in Chinese society, but also leave sufficient room for individuals to purchase private insurance for better or quicker health care.DOWNLOAD HISTORY | This article has been downloaded 142 times in Digital Commons before migrating into this platform.

Mobile Populations in Immobile Welfare Systems: A Typology of Institutions Providing Social Welfare and Protection Within a Mobility Framework

The economic benefits of migration for developing countries through remittance-sending practices have been extensively researched on the migration-development nexus. Remittances are used not only for productive investments, but also to ensure social protection for migrants and their families, locally and transnationally, through complex formal and informal provisions. This is necessary because migrant-sending countries often have limited formal social protection institutions, whereas formal institutions in receiving countries are based on sedentary models, excluding many migrants. By reviewing literature on social protection and migration from a transnational lens and providing examples mainly from a labour migration context from the global-south towards the global-north, we offer a comprehensive typology of institutions providing social protection to migrants and their families back home. The paper advances an emerging semi-formal social protection system, which combines informal elements migrants known from their origin countries, with private insurance schemes. This analysis contributes to re-thinking the development of an inclusive global social protection system for mobile populations.

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper.

Dr Putin or how I learnt to stop whining and love the NHS.

Before medical school, I studied Russian at university. After a year of lectures on obscure grammatical points, I was dispatched to an industrial town north of Moscow to study at the local university. Two months into the course, I fell ill. A couple of days’ rest and I’d be fine, I thought. How wrong I was. A week later, I felt more feverish, my throat was achingly swollen. I needed to see a doctor. Russia has two health systems: a state funded system and a variety of private insurance schemes. My Russian professor suggested I see a doctor privately, but I insisted on going to the local poliklinika, which is similar to a general practitioner walk-in clinic in the United Kingdom. During my three hour stay in the packed waiting room, I noticed that several of the windows were smashed, with bin bags taped over to keep out the −20oC temperatures. To add insult, quite literally, to injury, the outpatient orthopaedic clinic was up three flights of stairs with no lift. The experience left me feeling like a character …

Preventing Obesity in the USA: Impact on Health Service Utilization and Costs.

With more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to 'bend the curve' of rising healthcare costs is still an object of debate. This study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA. The study was carried out as a retrospective evaluation of alternative scenarios compared with a 'business as usual' scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997-2010). In 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to $US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits. Prevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

Lessons Learned From National Health Accounts in Iran: Highlighted Evidence for Policymakers

Context: National Health Account (NHA) is an accepted tool for tracing the flow of health resources at country level. As policy makers concern about the effective allocation of scarce resources, thus NHA can play a dominant role in evidence-based decision making. Reevaluation of last NHA in Iran is required for helpful highlights. Evidence Acquisition: We reviewed last NHA documents in Iran which was performed in 2008 to highlight a good evidence for policy makers and compared it with other national and international available data. Results: Reevaluation of data highlighted some issues, which were compared with the national and international available data and useful evidences for policy makers were extracted. These evidences are mentioned in following part. Conclusions: The issues highlighted in last NHA in Iran were: changes in the health insurance system, adopting approaches for increasing an insurance coverage in noninsured population, informing the population about insurance scheme, private insurance scheme according to indigenous conditions, applying a concerted national effort towards controlling the high cost of medicine alongside concerning about equity and coverage, and applying effective indigenous strategies for decreasing out-of-pocket health care expenditures.