Social Health Insurance Funds Research Articles

Benefit equity of social health insurance in China and its provinces (2014–2020): implications for universal health coverage

IntroductionChina has increased fiscal input into social health insurance (SHI) schemes to achieve universal health coverage. Our study aimed to examine the equity of SHI benefits in the country and...

Governing health service purchasing agencies: Comparative study of national purchasing agencies in 10 countries in eastern Europe and central Asia

This study discusses findings from comparative case studies of the governance of health services purchasing agencies in 10 eastern European and central Asian countries established over the past 30 years, and the relationship between governance attributes, institutional development, and the progress made in strategic purchasing. The feasibility and effectiveness of implementing international recommendations from the health sector and wider public sector governance literature and practice are also discussed. The study finds that only those countries that have transitioned from middle to high-income status during the study period have been successful in comprehensively and consistently implementing internationally recommended practices. Moreover, these countries have made varying progress in developing capable purchasers with technical and operational independence, as well as advancing strategic purchasing. However, the current middle-income countries (MICs) in the study have implemented only certain elements of recommended governance practices, often superficially. Notably, the study reveals that some international recommendations, particularly those related to higher degrees of purchaser autonomy and the associated governance structures observed in western European social health insurance funds, have proven challenging to implement effectively or sustain in the MICs. None of the MICs succeeded in strategic purchasing beyond a limited agenda or scale, and even then, only implementing and sustaining them during favorable conditions. Difficulties in maintaining these achievements can be attributed, in part, to governance deficiencies. However, setbacks are commonly linked to periods of political and economic instability, which in turn lead to fluctuations in policy priorities, institutional instability, and inadequacies in health budgets. The study findings point to some actions related to civil society and stakeholder engagement, accountability frameworks, and digitalization in MICs that can facilitate continuity in health reforms and the functioning of purchasing institutions despite these challenges. The findings of the study provide important lessons for countries designing or newly implementing health purchasing agencies and for countries reviewing the performance and governance of their health purchasing agencies with a view to developing or strengthening strategic purchasing.

The impact of the Public Pension Program on the elderly’s medical expenditures: a regression discontinuity approach

ABSTRACT The surge in aging societies has increased the relevance of retirement as a research topic. Utilizing the public data obtained from the China Family Panel Studies, this paper applies a regression discontinuity approach to assess the impact of China’s current Public Pension Program on the medical expenditures of the elderly. The results reveal that the Public Pension Program increases out-of-pocket medical expenditures, hospitalization expenditures, and other injury and illness expenses. The results also report that being insured by Basic Social Health Insurance has a mitigating effect on the medical expenditures of the elderly; furthermore, there are significant differences in the use of medical resources between regions and urban and rural areas in China. Therefore, ensuring the sustainability of pension funds and social health insurance funds and developing customized private insurance according to areas can play a positive role in improving the use of medical resources and relieving the medical burden on the elderly population.

Sustainability of Healthcare Financing in Greece: A Relation Between Public and Social Insurance Contributions and Delivery Expenditures.

The economic crisis in Greece, which began in 2010 and lasted for 10 years, highlighted the serious problems and challenges of the Greek Social Health Insurance system. The reforms that mainly took place during the crisis provided a temporary solution. They focused on establishing a new National Organization for Healthcare Services (named EOPYY) and merging all the old insurance funds. This paper aims to examine whether this social health insurance fund has been sustainable in the long run. An actuarial model was created to project future expenses and revenues. Demographic and economic trends were considered, while it was assumed that medical technology remains unaltered. The assessment of the system solvency was based on the ratio (Revenue/Liabilities) calculated for each year, from 2020 to 2050. The results led to deficits, the amount and the time point in which they appear depends on how optimistic or pessimistic demographic and economic assumptions were. A new financial flow model was proposed to address the deficits. The results show that under the new model, the system remains solvent until 2050. The state subsidy amount on the employees’ health insurance premium was estimated as a percentage of the employees’ wage.

Social Health Insurance country responses to the COVID-19 pandemic

Abstract Background Pandemic response is largely also driven by organization and governance of health systems. In countries with social health insurance (SHI) systems, pluralism of actors and decentralisation may represent a particular challenge in crisis times. Objectives We aim to present a comprehensive analysis of the health system responses during the COVID-19 pandemic of eight SHI countries: Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland. The question at the centre of the analysis is how SHI funds and defining characteristics of SHI systems have shaped pandemic response and which lessons to draw from the experiences of the first wave (spring to autumn 2020). Results Our analysis highlights key characteristics driving pandemic response common across SHI countries, particular the level of (de)centralization of responsibilities and providers and the role of SHI funds (compared to other actors). Five key themes emerged: governance, SHI fund sustainability, the role of GPs, surveillance strategies and (essential) health service provision. We found that SHI funds were not represented in crisis management teams during the pandemic in the majority of countries analysed. Responsibility partly shifted towards central government and away from the SHI funds. Conclusions Decentralization may pose significant challenges among local authorities with regard to the coordination of policies and information system flows. At the same time, decentralized pandemic management may be favourable as it supports bottom-up self-organization of ambulatory care providers. In fact, coordinated ambulatory care often helped avoid overburdening hospitals in the countries analysed.

The Influence of China's COVID-19 Treatment Policy on the Sustainability of Its Social Health Insurance System.

BackgroundWhile past experiences show that a health system financing mechanism can support resilience to shocks, the impact on the sustainability of the financing system is exceptionally important considering the magnitude of the COVID-19 pandemic. The role of Social Health Insurance (SHI) in responding to the pandemic brings about an influence on insurance system sustainability. This study investigates the impact of China’s COVID-19 treatment policy on the sustainability of its SHI system, explores influences of the policy on Wuhan’s system, and discusses the effects of an assumed equivalent emergency on SHI funds for five other provincial capital cities in China.MethodsThe study was conducted using pay-as-you-go actuarial models of Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) funds, which constitute China’s basic health insurance system. Current and accumulated balances of the funds in 2020 are predicted and utilized to measure the sustainability of health insurance funds during emergencies.ResultsThe findings suggest a disparity in the capacities of insurance schemes and localities. If the surplus before 2018 is not considered, it is likely that the URRBMI fund of Wuhan would suffer a deficit, whereas the UEBMI would retain a considerable surplus. To maintain the current actuarial balance of the URRBMI fund, coverage for ordinary inpatient and outpatient expenses would have to be significantly reduced in Wuhan, potentially affecting enrollees’ wellbeing. A similar situation may occur in three other cities, some with underdeveloped economies and lower per capita income are likely to be encountered with worse situation than Wuhan.ConclusionConcerning fragmentation of China’s SHI system, to strengthen longer-term preparedness to manage future emergencies, this study suggests the integration of insurance schemes and provincial pooling, fund balance adjusting and an emergency safety net are also advised. All options call for more public health investments.

Tackling the COVID-19 pandemic: Initial responses in 2020 in selected social health insurance countries in Europe

Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Europe (Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland). Data collection and analysis builds on the methodology and content in the COVID-19 Health System Response Monitor (HSRM) up to November 2020. We find that SHI funds were, in general, neither foreseen as major stakeholders in crisis management, nor were they represented in crisis management teams. Further, responsibilities in some countries shifted from SHI funds to federal governments. The overall organisation and governance of SHI systems shaped how countries responded to the challenges of the pandemic. For instance, coordinated ambulatory care often helped avoid overburdening hospitals. Decentralisation among local authorities may however represent challenges with the coordination of policies, i.e. coordination costs. At the same time, bottom-up self-organisation of ambulatory care providers is supported by decentralised structures. Providers also increasingly used teleconsultations, which may remain part of standard practice. It is recommended to involve SHI funds actively in crisis management and in preparing for future crisis to increase health system resilience.

COST-CONTAINMENT MECHANISMS FOR PUBLIC PHARMACEUTICAL SPENDING

Pharmaceutical spending continues to ascend. Very expensive pharmaceutical products have been introduced on the market in recent years, thus increasing decision makers’ concerns regarding the patient access to innovative treatments, and sustainability of their reimbursement systems. Despite the multitude of tools for containing public pharmaceutical spending, solutions have to take into account many factors in order to ensure both equitable access for consumers, and an acceptable budgetary balance. In Romania, public expenditures for compensated drugs were between 15% up to 25% of the National Social Health Insurance Fund during las decade, while medicines reached 26% of total health expenditures (according to OECD data). In order to cover the patient needs and face considerable challenges and pressure of pharmaceutic industry, comprehensive knowledge and rationally selection of those tools are needed to limit public pharmaceutical spending within available funds without obstructing the access to innovation. Key words: pharmaceutical spending, EU, public health policies, sustainability. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:8.0pt; mso-para-margin-left:0cm; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-ansi-language:EN-US; mso-fareast-language:EN-US;}

Analysis of the Management System of the Social Health Insurance Fund of the Republic of Kazakhstan

The aim of the study: to assess the concept of restructuring the organizational structure of the management of the Social Health Insurance Fund of the Republic of Kazakhstan.Methods. In this research were used mixed methods of analysis, SWOT analysis, data grouping, and a systematic approach. To study the opinions of the participants in the process regarding the improvement of the organizational structure and ongoing business processes, an anonymous survey was conducted among the employees of the Social Health Insurance Fund.Results. There are certain advantages in the existing system of the Social Health Insurance Fund, such as clearly defined goals and objectives, as well as an organized system. However, there are several shortcomings in building the organizational structure of the Social Health Insurance Fund, which should be revised for more effective implementation. Moreover, temporary organizational structures should be applied to solve complex problems.Conclusions. In order to further improve the management system of the Social Health Insurance Fund, it is necessary to work out issues on further optimization of the levels of management of the organizational structure. Nevertheless, the Social Health Insurance Fund is already working to optimize the organizational structure.Key words: social health insurance, social health insurance fund, management system, organizational structure, business process.Corresponding author: Talgat Turmaganbet, Deputy Director of the Department of Strategy and Project Management, Social Health Insurance Fund, Nur-Sultan, Kazakhstan.Postal code: Z05B9K3Address: Kazakhstan, Nur-Sultan city, st. Dostyk 13/3.Phone: +7 707 107 09 83E-mail: t.turmaganbet@fms.kzJ Health Dev 2021; 3 (43): 41-47Recieved: 21-07-2021Accepted: 11-08-2021 This work is licensed under a Creative Commons Attribution 4.0 International License

Анализ текущей ситуации после внедрения системы обязательного социального медицинского страхования Республики Казахстан

The aim of the study: To assess the current state, the balance of functions and development trends of Social Health Insurance Fund NJSC. Methods. In order to study the level of awareness of the population about the implementation of the compulsory social health insurance system (CSHI), a mass survey was conducted twice during 2019 (in May and September) with a total sample of 2,150 respondents, including all regions of Kazakhstan. Also, within the framework of the study, such indicators of the activity of the Social Health Insurance Fund as the availability of funding for 2019-2020, the amount of funding by service providers, and coverage of the population were analyzed. Results. There is a positive trend in the compulsory health insurance system: awareness of the population is growing; the population positively assesses the changes in the provision of health services; there is a twofold increase in PHC visits; the share of private spending on health is twice the ceiling recommended by WHO; the level of coverage of the population with the compulsory health insurance system is quite high - 84%. However, about 3 million of the country's citizens remain uncovered. Conclusions. It is necessary to create a system for monitoring the effectiveness of the implementation of compulsory health insurance on the basis of information systems with the further adoption of managerial decisions both at the regional level and at the republican level. The introduction of mechanisms for proactive monitoring of the quality of medical care will protect the rights of patients, as well as improve feedback with them. Key words: Compulsory social health insurance, Medical services, Health care financing, Kazakhstan

Inflammatory Bowel Disease: A Nationwide Study of Hip Fracture and Mortality Risk After Hip Fracture

With rising rates of inflammatory bowel diseases [IBD] in older adults, management of comorbidities such as osteoporosis is becoming increasingly important. Hip fracture [HF] is the most serious consequence of low bone mineral quality and is associated with excess risk of mortality. For older IBD patients, there are only limited data available. Therefore, we aimed to assess the association of IBD with HF, and all-cause mortality risk after HF, among IBD patients older than 50 years. In a national database-registered case-control study, 56 821 HF cases aged ≥50 years, and 113 718 age-, sex- and region-matched non-hip-fracture controls, were analysed between 2012 and 2016. A history of IBD was assessed from data from Austrian social health insurance funds. Logistic regression and Cox proportional multivariate models were used to test the association of IBD with HF and post-hip fracture mortality risk. A total of 531 patients were identified with IBD (25.0% men, mean age 81.2 years, standard deviation [SD] 9.7). Analysis, adjusted for anti-osteoporotic treatment, use of glucocorticoids, and selected medications, showed that IBD patients had an increased odds of HF (odds ratio [[OR] 2.22, 95% confidence interval [CI] 1.86-2.64). Patients with Crohn's disease [CD] revealed a higher HF odds in contrast to patients with ulcerative colitis [OR 2.91, 95% CI 2.17-3.89 and OR 1.89, 95% CI 1.52-2.35, respectively]. Overall mortality risk after HF was higher among female CD patients [HR 1.75, 95% CI 1.28-2.41] than in the general population. IBD was strongly associated with HF in older patients. Post-hip fracture mortality risk was elevated particularly in women with CD.

Constructing a value-based healthcare system for hypertensive patients through changing payment mode: evidence from a comparative study in rural China

Objective: To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio.Methods: This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes.Results: In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p > .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (–40.7%) yuan and 394.2 (–27.7%) yuan, respectively (p < .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (–28.5%) yuan (p < .05), and the per capita annual total out-of-pocket expenditure by 201.9 (–29.9%) yuan (p < .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p < .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p > .05).Conclusion: Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.

Gemeinschaftliche Selbsthilfe und Patientenbeteiligung: aktuelle Entwicklungen in Österreich

In Austria, health-related self-help groups and organisations have been growing continuously over the past decades. They are increasingly demanding to be accepted as partners of the professional health system and to be involved in health policy decisions.Practice shows that "self-help friendly hospitals" are widespread in Austria. Although some self-help groups/organisations have gained access to health policy committees, research indicates that they find the system unresponsive to their interests. Public support for self-help organisations is particularly lacking at the national level as are conducive conditions for collective patient participation.Arecent initiative by the Social Health Insurance Funds, the Ministry of Health and the National Health Promotion Agency seeks to tackle these problems. Aplan for public support of self-help groups/organisations, primarily those operating at the national level, has been developed in collaboration with representatives of self-help organisations. It provides financial support for the activities of indication-specific self-help organisations at regional and national levels aiming at strengthening their autonomy. In addition, two institutions were founded: an umbrella organisation of indication-specific self-help organisations and aprofessional national support agency. The implementation of the new concept offers opportunities for closer cooperation between system stakeholders and self-help groups/organisations, and anew stimulus for patient participation is expected from these two new institutions.

Stakeholders analysis of merging social health insurance funds in Iran: what kind of interests they may gain or lose?

Iran passed a Law in 2010 to merge all existing health insurance funds physically together. This stakeholder analysis aimed at revealing that what benefits the stakeholders might lose or gain as a result of merging health insurance schemes in Iran, which make them to oppose or support it. This was a qualitative study conducted in 2014. Sixty semi-structured face-to-face interviews were conducted. Purposive and snowball samplings with maximum heterogeneity samples were used for selecting interviewees. Government is not willing to undertake more financial commitment. Existing health insurance schemes like Social Security Organization and minor well-resourced health insurance funds and also worker unions are unwilling to lose their financial and organizational autonomy, to share their benefits with other less privileged groups, or face likely financial challenges in running their health facilities like hospitals. Top managers and workforces are worried to lose their job, salary, or organizational positions. Ministry of Cooperation, Labour, and Social Welfare does not want to lose its control on health insurance schemes. Ministry of Health and Medical Education and Iran Health Insurance Organization are among actors that support the insurance funds merging policy. Successful implementing of consolidation requires taking into account the interests of different stakeholders.

Improving the performance of social health insurance system through increasing outpatient expenditure reimbursement ratio: a quasi-experimental evaluation study from rural China

BackgroundChina has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance.MethodsTwo comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes.ResultsOne thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (− 60.0%) times (P < 0.05), and to increase the per capita total medical service utilization frequency by 3.225 (76.8%) times (P < 0.05). The per capita total medical expenditure decreased 394.2 (− 27.7%) yuan. The SHI reimbursed 90.3 yuan more per capita for the outpatient spending, but the per capita inpatient expenditure reimbursement and per capita total medical expenditure reimbursement decreased significantly by 282.6 (− 44.0%) yuan and 192.3 (− 28.5%) yuan, respectively (P < 0.05). The intervention reduced the per capita inpatient out-of-pocket expenditure and the per capita total out-of-pocket expenditure by 192.8 (− 36.7%) yuan and 201.9 (− 29.9%) yuan, respectively (P < 0.05). The intervention significantly decreased the diastolic blood pressure of the intervention group by 2.9 mmHg (P < 0.05) but had no significant impact on the systolic blood pressure (− 7.9 mmHg, P > 0.05).ConclusionFor China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.

The right to choose health insurer: A comparative review of the EU Member States’ experiences

Introduction: The monopoly status of the National Health Insurance Fund in Bulgaria is considered to be a major problem of the healthcare system in the country. The absence of a right by the citizens to choose a fund for social health insurance (SHI) is perceived as a weakness of the system itself. Taking this into account, all major political parties prioritize the demonopolisation of the NHIF. The aim of this study is to address the question whether the absence of a free choice of a SHI fund could be a shortcoming of the healthcare system. Material and methods: A comparative analysis of the SHI systems across Europe has been performed. Based on information from the European Observatory on Health Systems and Policies, countries are classified into two groups: 1. countries with an absence of a free choice of a SHI fund, and 2. countries where people are free to choose the insurer. Data on countries` population, health expenditure, and citizens satisfaction with the health systems is extracted from the Eurostat Database and the Health Consumer Powerhouse index for 2017. Results: Sixteen EU countries have a SHI system. Citizens have no right to choose a SHI fund in 11 of them (group 1). Eight of the group 1 countries and one of the group 2 countries have a population under 10 million. In 2015, health expenditure per capita varied between 865 PPP€ (in Romania) and 4 131 PPP€ (in France) in the 1st group and between 1612 PPP€ (Slovakia) and 4 113 PPP€ (Germany) in the second group. SHI expenditure as a share of total health expenditure varies widely within the two groups as well. In both groups, there are highly ranged health systems according to the European Health Consumer Index for 2017 with a total score above 700. Conclusion: The free choice of a SHI fund does not seem to influence either the health expenditure size and structure or citizens satisfaction with the health system. The monopoly status of the NHIF in Bulgaria cannot be perceived as an immediate and ultimate shortcoming of the healthcare system and the search for the causes of ineffectiveness and poor performance of the system should take a more complex approach.

VECTOR FOR THE DEVELOPMENT OF MEDICAL INSURANCE IN THE CONTEXT OF MODERN MEDICAL REFORM IN UKRAINE

Introduction. The current practice of functioning of the medical sector shows the existence of problems that impede the introduction of compulsory health insurance in Ukraine, the effective development of its voluntary form. At the same time, the problems of development of medical insurance under the influence of crisis phenomena of the national economy are deepening. The purpose of the article is to develop recommendations for improving medical reform in Ukraine. Results. The most controversial moment in the reform of health care was the rejection of free medicine, the right to which is enshrined in the Constitution of Ukraine. However, budget medicine in Ukraine will still remain, however, in what volumes and at what stages of provision of medical services or medical care is not yet defined in the Ministry of Health of Ukraine. The negative trend of the contracted health model is the creation of an authorized body that will not only implement health policy but, in fact, formulate this policy: to define state guarantees, needs for medical services and to check the quality of these services. And this is a huge threat, because Ukrainian medicine will be in a worse situation than it is now. We believe that the policy-making function should remain under the Ministry of Health of Ukraine. The negative aspect of modern medical reform in Ukraine is the lack of requirements for the formation of medical treatment protocols. This can be explained by the fact that patients will continue to prescribe treatment that is untrue. Instead, for the health insurance, the insurance company would monitor costs and control the appointment of treatment for the patient, the price of medical services. In this context, we propose to adopt the Law of Ukraine “On Compulsory Health Insurance”, which stipulates and clearly defines the rights and obligations of the insurer, the insurer, the list of services, their price, a single register of insured persons, the formation of the Social Health Insurance Fund and a differentiated approach to categories of the population. Conclusions. The experience of developed countries of the world proves that achieving this goal is possible through the introduction of insurance medicine. Insurance medicine is a real alternative to budget financing, which is no longer capable of ensuring the constitutional right of citizens to receive unpaid health care. The development of health insurance is an objective need, which is dictated by the need to ensure that healthcare receives funds. At the moment, the study of the question of the necessity of introducing compulsory health insurance is probably very relevant to all. Successful market reforms in Ukraine are impossible without the formation of an effectively organized health insurance market that can guarantee the preservation and strengthening of human health, improving the quality of medical services and the level of human life.

Effectiveness and cost-effectiveness of an integrated care program for schizophrenia: an analysis of routine data.

In Germany, a regional social health insurance fund provides an integrated care program for patients with schizophrenia (IVS). Based on routine data of the social health insurance, this evaluation examined the effectiveness and cost-effectiveness of the IVS compared to the standard care (control group, CG). The primary outcome was the reduction of psychiatric inpatient treatment (days in hospital), and secondary outcomes were schizophrenia-related inpatient treatment, readmission rates, and costs. To reduce selection bias, a propensity score matching was performed. The matched sample included 752 patients. Mean number of psychiatric and schizophrenia-related hospital days of patients receiving IVS (2.3±6.5, 1.7±5.0) per quarter was reduced, but did not differ statistically significantly from CG (2.7±7.6, 1.9±6.2; p=0.772, p=0.352). Statistically significant between-group differences were found in costs per quarter per person caused by outpatient treatment by office-based psychiatrists (IVS: €74.18±42.30, CG: €53.20±47.96; p<0.001), by psychiatric institutional outpatient departments (IVS: €4.83±29.57, CG: €27.35±76.48; p<0.001), by medication (IVS: €471.75±493.09, CG: €429.45±532.73; p=0.015), and by psychiatric outpatient nursing (IVS: €3.52±23.83, CG: €12.67±57.86, p=0.045). Mean total psychiatric costs per quarter per person in IVS (€1117.49±1662.73) were not significantly lower than in CG (€1180.09±1948.24; p=0.150). No statistically significant differences in total schizophrenia-related costs per quarter per person were detected between IVS (€979.46±1358.79) and CG (€989.45±1611.47; p=0.084). The cost-effectiveness analysis showed cost savings of €148.59 per reduced psychiatric and €305.40 per reduced schizophrenia-related hospital day. However, limitations, especially non-inclusion of costs related to management of the IVS and additional home treatment within the IVS, restrict the interpretation of the results. Therefore, the long-term impact of this IVS deserves further evaluation.

The Politics of Scaling Up Social Protection in Kenya

This paper discusses the role of Kenya’s political settlement in the adoption and promotion of social protection, which has expanded significantly since 2003. Analysis focuses on the interplay between the domestic political settlement and external factors in shaping the social protection discourse and policy and provisioning outcomes. Successive regimes in Kenya since 2003 supported social protection as part of their framing of the development discourse. There has been significant progress in developing the legislative and policy structures to support cash transfer provision, including a commitment in the 2010 constitution, together with an increasing fiscal commitment, largely donor supported, and a rapid expansion of cash transfer coverage. However, where the realisation of constitutional or legislative commitments would have a cost to the political settlement, disturbing clientelist relationships, less progress has taken place, as illustrated by the failure of the proposed National Social Health Insurance Fund. Implementation of social protection policy and provision has been managed in such a way that the clientelism at the centre of the political settlement is not disturbed. The extent to which the political settlement ultimately shapes social protection outcomes is also a function of the preferences and incentives of the donor community and it is the convergence of the requirements of the political settlement with donor interests that has driven the successful provision of social assistance, whereas the lack of convergence has hindered the development of social health insurance. Initially a donor-led agenda, cash transfer provision has become increasingly popular politically, as politicians have realised its potential as an additional constituency-level patronage resource, which they have successfully co-opted in recent years, resulting in the paradox that improved, and largely externally financed, social protection performance is intrinsically linked to the entrenchment of the existing political settlement. The paper concludes that the social protection agenda in Kenya is defined by the extent of accommodation between the underlying clientelist interests of political actors and the aspirations of external actors.

Should acupuncture play a greater role in healthcare?

s / European Journal of Integrative Medicine 7 (2015) 432–438 437 back pain. Available evidence may not facilitate guideline development for integration into best clinical practice. Practitioner perception of the evidence base is equally important. TCM practitioners in the EU and China vary in their perceived need for research evidence, and the evidence gaps. The complexity and plurality of traditional Chinese medicine theory and practice, informed by comparative effectiveness studies, personalized medicine and TCM pattern differentiation should be incorporated into future research if it is to be effectively integrated into health care provision. Steps are needed to promote the development and implementation of academic training and research programs that support progress in this direction. It is vitally important that competent professionals, both clinically skilled and trained in research are involved in the development of the evidence base to ensure that it is appropriate and ongoing. Otherwise studies will be designed and conducted by researchers who do not understand traditional systems of medicine or by practitioners who do not fully understand research practices. If this persists, good quality effectiveness data will continue to be lacking and compromise integration into any healthcare system. With advances in biomedical, chemical and computational technology, plenty of opportunities exist to provide multidisciplinary approaches to investigate evidence-based aspects of TCM practice. An integrative approach is crucial to connect the multiplicity of expertise, scientific innovation and investigations. http://dx.doi.org/10.1016/j.eujim.2015.07.039 Acupuncture as part of the health care system: Some key facts from European and a national point of view Wolfgang Weidenhammer 1,∗, Dieter Melchart 1,2 1 Competence Centre for Complementary Medicine and Naturopathy, Klinikum rechts der Isar, Technische Universitat Munchen, Munich, Germany 2 Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland E-mail address:wolfgang.weidenhammer@lrz.tu-muenchen.de (W. Weidenhammer). The presentation will follow two approaches to give some insight into the situation of medical acupuncture as applied by doctors in Europe and specifically in Germany. The current status as well as the development over the previous years will be demonstrated. Between 2001 and 2006, three groups of German statutory sickness organizations funded three large reimbursement and research programs on acupuncture. One of them was conceptualized and conducted by the Competence Centre for Complementary Medicine and Naturopathy at TU Munich. Apart from the well-known controlled trials to investigate the specific effects of acupuncture the program also includes a description of routine care and therapeutic safety. Between June 2001 and November 2005, approximately one million patients insured by the participating sickness funds received acupuncture with systematic documentation. Data of about 450,000 patients were analyzed complemented by a more detailed longitudinal dataset from a subsample of about 5000 patients. Moreover, a survey on the participating acupuncturists enabled the analysis of relations between indicators of therapist’s qualification and the outcome of the treatment. As a result of the acupuncture research programs the German health authorities decided in 2006 to restrict the reimbursement by social health insurance funds to low back pain and osteoarthritis of the knee. Additionally, the conditions for certified physicians changed. The consequences of these decisions for the routine medical care with acupuncture were far-reaching. Although not focused on any specific CAM modality, the EU-funded project CAMbrella (2010–2012) could reveal some key points for acupuncture. In Europe, acupuncture is mostly regulated as a treatment that may or may not be provided by regulated health professionals or other CAM practitioners. 25 countries have acupuncture treatment regulations while 12 have no specific acupuncture regulations. A systematic analysis of the provision of CAM in Europe showed that approx. 305,000 registered CAM providers (47% are medical practitioners) can be identified in the EU. Acupuncture is reported as the most available therapeutic method for both, medical (80,000) and nonmedical providers (16,380). Beyond acupuncture, the presentation will end with a brief detour on research in CAM in Europe, with the focus on research promotion by the European Commission. Possibilities for the field of CAM and issues will be demonstrated, exemplified by the Horizon 2020 program. http://dx.doi.org/10.1016/j.eujim.2015.07.040 The cost-effectiveness of acupuncture