Social Health Insurance Scheme Research Articles

Out-of-Pocket Expenditure in Patients admitted to Cardiology Department under ABPMJAY scheme in a Tertiary Care Hospital in Delhi: A Cross-Sectional Study

Introduction: The recent National Health Accounts 2019-20 data reveals that Out-of-Pocket Expenditure (OOPE) as a percent of Total Health Expenditure is more than 47% which is still higher compared to out-of-pocket health spending in other developing nations. Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), the world’s largest public-funded social health insurance scheme is a by-product of National Health Policy 2017 recommendations to achieve Universal Health Coverage and reduce OOPE in health. The present study was conducted to know the OOPE among the patients admitted to the Cardiology department under AB-PMJAY scheme in a tertiary care hospital in New Delhi. Methods: A descriptive cross-sectional study was carried out from January 2021 to April 2022 among the patients admitted under the PMJAY scheme in the Cardiology Department of Tertiary Care Hospital in New Delhi. A total of 320 patients were interviewed using a structured questionnaire divided into eight sections. The collected data was tabulated in Microsoft Excel and analyzed. Results: The study investigated out-of-pocket expenditure (OOPE) for patients, finding the scheme covered doctor consultations, bed charges, physiotherapy, implants, and oxygen, but some patients still faced OOPE for diagnostics (15%), medicines (22.5%), blood transfusions (8.75%), and ambulance with an average direct medical expenditure of approximately Rs. 1511 during the hospital stay at the current hospital. Compared to previous hospitalizations, OOPE for diagnostics, medicines, and blood transfusions significantly decreased under PMJAY. Overall, 60.3% of respondents were satisfied with the PMJAY scheme. Conclusion: The PMJAY scheme helped the beneficiaries to reduce the financial burden of health to a great extent. However, few of the beneficiaries continued to make some payments from their pockets for diagnosis, medication, etc. The main reason for this was a lack of knowledge and awareness about the scheme among the beneficiary population.

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...

Collaborative governance of an integrated system for collecting contributions for social health insurance, pension, and taxes from the informal sector: a synthesis of stakeholder perspectives

BackgroundMany low-and middle-income countries have adopted social health insurance schemes. However, the collection of contributions from the large informal sector of these economies poses a significant challenge. Employing an integrated system of contribution collection from all relevant institutions may be cost-effective. We used the integrative framework for collaborative governance, to explore and explain factors that may shape the governance of an integrated system for collecting contributions for social health insurance, pension, and taxes from the informal sector in Zambia.MethodsWe undertook a qualitative case study involving 25 key informants drawn from government ministries and institutions, cooperating partners, non-governmental organizations, and association representatives in the informal sector. Data were analyzed thematically using Emerson’s integrative framework for collaborative governance.ResultsThe main drivers of collaboration included a need for comprehensive policies and legislation to oversee the integrated system for contribution collection, prevent redundancy, reduce costs, and enhance organizational effectiveness. However, challenges such as leadership issues and coordination complexities were noted. Factors affecting principled engagement within the collaborative regime consisted of communication gaps, organizational structure disparities, and the adoption of appropriate strategies to engage the informal sector. Additionally, factors influencing shared motivation involved concerns about power dynamics, self-interests, trust issues, corruption, and a lack of common understanding of the informal sector.ConclusionThis study sheds light on a multitude of factors that may shape collaborative governance of an integrated system for contribution collection for social health insurance, pension, and taxes from the informal sector, providing valuable insights for policymakers and implementers alike. Expanding social health insurance coverage to the large but often excluded informal sector will require leveraging factors identified in this study to enhance collaboration with pension and tax subsystems.

Optimising availability and geographical accessibility to emergency obstetric care within a sub-national social health insurance scheme in Nigeria.

Health insurance is a key instrument for a health system on its path to achieving universal health coverage (UHC) and protects individuals from catastrophic health expenditures, especially in health emergencies. However, there are other dimensions to care access beyond financial accessibility. In this study, we assess the geographical accessibility of comprehensive emergency obstetric care (CEmOC) within the Lagos State Health Insurance Scheme. We geocoded functional public and private CEmOC facilities, established facilities registered on the insurance panel as of December 2022, and assembled population distribution for women of childbearing age. We used Google Maps Platform's internal directions application programming interface to obtain driving times to facilities. State- and local government area (LGA)-level median travel time (MTT) and a number of CEmOC facilities reachable within 30 min were obtained for peak travel hours. Across Lagos State, MTT to the nearest public CEmOC was 25 min, reduced to 17 min with private facilities added to the insurance panel. MTT to the nearest public facility in LGAs ranged from 9 min (Lagos Island) to 51 min (Ojo) (median = 25 min). With private facilities added, MTT ranged from 5 min (Agege and Ajeromi-Ifelodun) to 36 min (Ibeju-Lekki) (median = 13 min). On average, no public CEmOC facility was reachable within 30 min of driving for women living in 6 of 20 LGAs. With private facilities included in the scheme, reachable facilities within 30 min remained zero in one LGA (Ibeju-Lekki). Our innovative approach offers policy-relevant evidence to optimise insurance coverage, support efforts in advancing UHC, ensure coverage for CEmOC, and improve health system performance.

Budget impact analysis of high-priced orphan medicinal products intended for the treatment of rare diseases in China: evidence from a densely populated metropolis of Chengdu

BackgroundAn increasing number of orphan medicinal products (OMPs) are being included in social health insurance schemes, significantly improving access to medicines for patients with rare diseases. However, high-priced OMPs are still not covered, primarily due to health equity controversies and inadequate data systems required for economic evaluation. The aim of this study was to estimate the burden of drug expenditures and the size of the reimbursement budget required for high-priced OMPs from the perspectives of society and healthcare payers.MethodsThe study performed a budget impact analysis using data from multiple sources to estimate the reimbursement budget for high-priced OMPs in Chengdu, a densely populated metropolis in China. The budget analysis consisted of three main elements: the number of patients, the price of drugs, and the simulated policy scenario. By adjusting the combinations of these elements, the budget fluctuations for payers were estimated. Furthermore, the study predicted the budget trend for the next three years to validate its sustainability.ResultsThe analysis indicated that 98 rare disease patients in Chengdu required high-priced OMPs in 2019. This suggested a projected budget of CNY 179 million for these patients without reimbursement policies, from a societal perspective. Under six assumed policy scenarios, this budget ranged from CNY 32 million to CNY 156 million. Over the next three years, the annual budget was estimated to range from CNY 200 million to CNY 1.303 billion.ConclusionIntegration of multi-source data helps to obtain more scientifically reliable results on budget impacts. The study found that the budgetary impacts of high-priced OMPs on society and payers are relatively limited. Health policymakers can choose appropriate reimbursement strategies based on financial affordability among a diverse mix of elements. The results of related studies provided insights for optimizing the allocation of health resources and improving patient access to medications.

Follow-up Performance assessment of a Social Health Insurance Scheme in a southwest Nigeria state

Aims: Social health insurance and other forms of prepayment health schemes are effective approaches to enhancing access to available healthcare services. While prepayment schemes are generally common and well established in developed countries, they are relatively new and in the early stages of development in sub-Saharan countries, including Nigeria. Social health insurance in Nigeria, hitherto centralized, has devolved to the subnational state levels. The Oyo State Health Insurance Scheme, which is managed by the Oyo State Health Insurance Agency (OYSHIA), is one of the subnational schemes. The present study is a follow-up on the first three-year performance assessment of OYSHIA. The aim is also to assess the performance of the scheme and, most importantly, whether the recommendations made in the first study were used and if these recommendations have had a desirable impact on the scheme. Methods: Secondary data on enrolment in the social health insurance scheme of Oyo State between July 2020 and June 2023 were downloaded from the server of OYSHIA. The data were collated and analyzed. Data extraction, cleaning, and analysis covered a period of one and a half months (February–AApril, 2024). Excel software was used to analyze the data. Descriptive statistics were used to summarize the data. Population coverage distributions were expressed as frequencies and percentages. Frequency tables and graphs were generated to disaggregate the findings. Results: Although population coverage was still generally low, as it was in the first three-year performance assessment of the scheme, However, the present study shows that population coverage in the informal sector is very encouraging. Conclusions: In the absence of external limitations, the Oyo State social health insurance scheme has the potential to perform and achieve universal health coverage. Acknowledgements: The authors wish to acknowledge the Oyo State Health Insurance Agency for their permission to make use of the data and to submit the manuscript for publication. All enrollees are also appreciated. Contributions: David Adewole conceived and designed the study. Sola Akande, Boluwatito Orimadegun, and Ganiyu Owolabi were responsible for the data collection and analysis. Adewole, Akande, Orimadegun, Osungbade, and Owolabi contributed equally to the manuscript write-up. All authors read through the manuscript draft a second time. All authors agreed to the final manuscript.

Client satisfaction with health services provided under Social Health Insurance Scheme in selected wards of Banepa municipality, Nepal

Client satisfaction with health services provided under Social Health Insurance Scheme in selected wards of Banepa municipality, Nepal

Does supplemental private health insurance impact health care utilization and seeking behavior of residents covered by social health insurance? Evidence from China National Health Services Survey

BackgroundSupplemental private health insurance (PHI) plays a crucial role in complementing China’s social health insurance (SHI). However, the effectiveness of incorporating PHI as supplementary coverage lacks conclusive evidence regarding its impact on healthcare utilization and seeking behavior among SHI-covered individuals. Therefore, investigating the effects of supplementary PHI on health care utilization and seeking behavior of residents covered by social health insurance is essential to provide empirical evidence for informed decision-making within the Chinese healthcare system.MethodsData from the 2018 China National Health Services Survey were analyzed to compare outpatient and inpatient healthcare utilization and choices between PHI purchasers and non-purchasers across three SHI schemes: urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), and the new rural cooperative medical scheme (NRCMS). Using the Andersen Healthcare Services Utilization Behavior Model as the theoretical framework,binary logistic regression and multinomial logistic regression (MNL) models were employed to assess the impact of PHI on healthcare utilization and provider preferences.ResultsAmong UEBMI, URBMI, and NRCMS participants with PHI, outpatient visit rates were 17.9, 19.8, and 21.7%, and inpatient admission rates were 12.4, 9.9, and 12.9%, respectively. Participants without PHI exhibited higher rates for outpatient visits (23.6, 24.3, and 25.6%) and inpatient admissions (15.2, 12.8, and 14.5%). Binomial logistic regression analyses revealed a higher probability of outpatient visits and inpatient admissions among UEBMI participants with PHI (p < 0.05). NRCMS participants with PHI showed a lower probability of outpatient visits but a higher probability of inpatient admissions (p < 0.05). Multinomial logistic regression indicated that NRCMS participants with PHI were more likely to choose higher-level hospitals, with a 17% increase for county hospitals and 27% for provincial or higher-level hospitals compared to primary care facilities.ConclusionThe findings indicate that the possession of PHI correlated with increased utilization of outpatient and inpatient healthcare services among participants covered by UEBMI. Moreover, for participants under the NRCMS, the presence of PHI is linked to a proclivity for seeking outpatient care at higher-level hospitals and heightened utilization of inpatient services. These results underscore the nuanced influence of supplementary PHI on healthcare-seeking behavior, emphasizing variations across individuals covered by distinct SHI schemes.

Re-envisioning contributory health schemes to achieve equity in the design of financial protection mechanisms in low- and middle-income countries.

Universal health coverage has emerged as a global health priority, requiring that financing strategies that ensure low-income and medically and financially at-risk individuals can access health services without the threat of financial catastrophe. Contributory financing schemes and social health insurance (SHI) schemes, in particular, predominate in low- and middle-income countries (LMICs), despite evidence that suggests the most vulnerable remain excluded from such schemes. In this commentary, we discuss the need to re-envision schemes to prioritize equity, offering 3 concrete recommendations: adopt participatory designs for the co-design of schemes with beneficiaries, establish linkages between contributory financial protection schemes with economic empowerment initiatives, and prioritize the needs and preferences of beneficiaries over political expediency. Co-design alone does not necessarily translate into more equitable schemes, underscoring the need for greater monitoring and evaluation of these schemes that consider differential impacts across contexts and subgroups. In doing so, SHI schemes can be both attractive and accessible to populations that have long been excluded from financial protections in LMICs, acting as 1 channel in a broader financing strategy to achieve universal health coverage.

Towards universal health coverage in Vietnam: a mixed-method case study of enrolling people with tuberculosis into social health insurance

BackgroundVietnam’s primary mechanism of achieving sustainable funding for universal health coverage (UHC) and financial protection has been through its social health insurance (SHI) scheme. Steady progress towards access has been made and by 2020, over 90% of the population were enrolled in SHI. In 2022, as part of a larger transition towards the increased domestic financing of healthcare, tuberculosis (TB) services were integrated into SHI. This change required people with TB to use SHI for treatment at district-level facilities or to pay out of pocket for services. This study was conducted in preparation for this transition. It aimed to understand more about uninsured people with TB, assess the feasibility of enrolling them into SHI, and identify the barriers they faced in this process.MethodsA mixed-method case study was conducted using a convergent parallel design between November 2018 and January 2022 in ten districts of Hanoi and Ho Chi Minh City, Vietnam. Quantitative data were collected through a pilot intervention that aimed to facilitate SHI enrollment for uninsured individuals with TB. Descriptive statistics were calculated. Qualitative interviews were conducted with 34 participants, who were purposively sampled for maximum variation. Qualitative data were analyzed through an inductive approach and themes were identified through framework analysis. Quantitative and qualitative data sources were triangulated.ResultsWe attempted to enroll 115 uninsured people with TB into SHI; 76.5% were able to enroll. On average, it took 34.5 days to obtain a SHI card and it cost USD 66 per household. The themes indicated that a lack of knowledge, high costs for annual premiums, and the household-based registration requirement were barriers to SHI enrollment. Participants indicated that alternative enrolment mechanisms and greater procedural flexibility, particularly for undocumented people, is required to achieve full population coverage with SHI in urban centers.ConclusionsSignificant addressable barriers to SHI enrolment for people affected by TB were identified. A quarter of individuals remained unable to enroll after receiving enhanced support due to lack of required documentation. The experience gained during this health financing transition is relevant for other middle-income countries as they address the provision of financial protection for the treatment of infectious diseases.

Morbidity Cost and Willingness to Pay for Healthcare Insurance among Wheat Farmers in Jigawa State of Nigeria

The study determined the costs of morbidity and farmers&amp;apos; willingness to pay for health insurance in the Jigawa State of Nigeria using a cross-sectional data collected from 284 farmers through a multi-stage sampling technique. Using an easy-route cost approach, a well-structured questionnaire coupled with interview schedule was used for data collection. Besides, the collected data was then analysed using both descriptive and inferential statistics. Empirically, the majority of farmers utilised an accumulation strategy for livelihood sustenance, alongside enterprise diversification – which acted as a catalyst in increasing their stocks and consumption outcomes, thus smoothing their income and consumption. However, financial and, at worst, physical livelihood capitals posed challenges that affected farmers&amp;apos; livelihood assets in the study area. Furthermore, malaria emerged as the major health issue affecting livelihoods; consequently, slightly over half of the sampled population agreed to the notion of a social health insurance scheme for a healthy livelihood. However, this inclination was largely influenced by the overlooked or nearly neglected social learning aspect of extension service delivery. Therefore, as a method to reduce public capital expenditure on healthcare for livelihoods in the study area, the study recommends that policymakers expand the healthcare scheme to include the farming community, going beyond formal organisations, thereby enhancing farm family livelihoods specifically and overall economic growth and development in general. Nonetheless, enhance institutional factors, alongside social extension, financial and infrastructural facilities are recommended.

Public expenditure on health care and the incidence of non-communicable diseases (NCDs) in China from 2008 to 2018

ObjectivesThis study investigates whether differences in individual-level and provincial-level health funding could explain or mitigate health inequalities among older people in terms of non-communicable diseases within a population served by fragmented health insurance schemes. Study designA national repeated cross-sectional analysis was done of the 2008, 2011, 2014, and 2018 Chinese Longitudinal Healthy Longevity Surveys. These provided a total of 44,623 persons aged 60 and over. Main outcome measuresRespondents were asked whether they had been diagnosed with any types of non-communicable diseases by doctors. A dichotomous outcome variable was constructed to indicate whether older people had any diagnosed non-communicable diseases. ResultsCompared with uninsured older persons, those who were enrolled in social health insurance schemes designed for civil servants as cadres, urban employees and urban residents were more likely to report a higher incidence of non-communicable diseases. There were no significant differences in the prevalence of non-communicable diseases between uninsured older people and those in the New Rural Cooperative Medical Scheme. Although the incidence of non-communicable diseases among older persons increased over the study period, greater health expenditure was significantly associated with a lower risk of non-communicable diseases. The interaction results between individual social health insurance schemes and public health expenditure indicate that disparities in the incidence of non-communicable diseases among different health insurance schemes diminish as public health expenditure increases. Older individuals with Public Free Medical Services benefited the most in provinces with higher public health expenditure compared with other health insurance schemes. ConclusionsGiven the evidence of the beneficial effects of universal health coverage on non-communicable diseases among older persons, these results should encourage policy makers to increase public health funding and to raise the overall benefit packages for social health insurance schemes.

Willingness to pay for Social Health Insurance and associated factors among Public Civil Servants in Ethiopia: A systematic review and meta-analysis.

The provision of equitable and accessible healthcare is one of the goals of universal health coverage. However, due to high out-of-pocket payments, people in the world lack sufficient health services, especially in developing countries. Thus, many low and middle-income countries introduced different prepayment mechanisms to reduce large out-of-pocket payments and overcome financial barriers to accessing health care. Though many studies were conducted on willingness to pay for social health insurance in Ethiopia, there is no aggregated data at the national level. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of willingness to pay for social health insurance and its associated factors among public servants in Ethiopia. Studies conducted before June 1, 2022, were retrieved from electronic databases (PubMed/Medline, Science Direct, African Journals Online, Google Scholar, and Web of Science) as well as from Universities' digital repositories. Data were extracted using a data extraction format prepared in Microsoft Excel and the analysis was performed using STATA 16 statistical software. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for cross-sectional studies. To evaluate publication bias, a funnel plot, and Egger's regression test were utilized. The study's heterogeneity was determined using Cochrane Q test statistics and the I2 test. To determine the pooled effect size, odds ratio, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region, sample size, and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. To estimate the pooled magnitude of willingness to pay for the Social Health insurance scheme in Ethiopia, twenty articles with a total of 8744 participants were included in the review. The pooled magnitude of willingness to pay for Social Health Insurance in Ethiopia was 49.62% (95% CI: 36.41-62.82). Monthly salary (OR = 6.52; 95% CI:3.67,11.58), having the degree and above educational status (OR = 5.52; 95%CI:4.42,7.17), large family size(OR = 3.69; 95% CI:1.10,12.36), having the difficulty of paying the bill(OR = 3.24; 95%CI: 1.51, 6.96), good quality of services(OR = 4.20; 95%CI:1.97, 8.95), having favourable attitude (OR = 5.28; 95%CI:1.45, 19.18) and awareness of social health insurance scheme (OR = 3.09;95% CI:2.12,4.48) were statistically associated with willingness to pay for Social health insurance scheme. In this review, the magnitude of willingness to pay for Social Health insurance was low among public Civil servants in Ethiopia. Willingness to pay for Social Health Insurance was significantly associated with monthly salary, educational status, family size, the difficulty of paying medical bills, quality of healthcare services, awareness, and attitude towards the Social Health Insurance program. Hence, it's recommended to conduct awareness creation through on-the-job training about Social Health Insurance benefit packages and principles to improve the willingness to pay among public servants.

A qualitative assessment on the acceptability of providing cash transfers and social health insurance for tuberculosis-affected families in Ho Chi Minh City, Vietnam.

To achieve the Sustainable Development Goal's targets of universal health coverage (UHC) and poverty reduction, interventions are required that strengthen and harmonize both UHC and social protection. Vietnam is committed to achieving financial protection and over 90% of the general population has enrolled in its social health insurance (SHI) scheme. However, an estimated 63% of tuberculosis (TB)-affected households in Vietnam still face catastrophic costs and little is known about the optimal strategies to mitigate the costs of TB care for vulnerable families. This study assessed the acceptability of a social protection package containing cash transfers and SHI using individual interviews (n = 19) and focus group discussions (n = 3 groups). Interviews were analyzed through framework analysis. The study's main finding indicated that both conditional and unconditional cash transfers paired with SHI were acceptable, across six dimensions of acceptability. Cash transfers were considered beneficial for mitigating out-of-pocket expenditure, increasing TB treatment adherence, and improving mental health and general well-being, but the value provided was inadequate to fully alleviate the economic burden of the illness. The conditionality of the cash transfers was not viewed by participants as inappropriate, but it increased the workload of the TB program, which brought into question the feasibility of scale-up. SHI was viewed as a necessity by almost all participants, but people with TB questioned the quality of care received when utilizing it for auxiliary TB services. Access to multiple sources of social protection was deemed necessary to fully offset the costs of TB care. Additional research is needed to assess the impact of cash transfer interventions on health and economic outcomes in order to create an enabling policy environment for scale-up.

Enrollees’ satisfaction with health service provision under the formal sector Social Health Insurance Scheme in South Eastern Nigeria

Introduction : Healthcare financing is a critical global issue, particularly in low and middle-income countries (LMICs) grappling with underfunded health systems. Various financing approaches, such as fee-for-service, private insurance, general taxation, social insurance, community financing, loans, and grants, have been explored to bridge the funding gap. Health insurance, a mechanism involving resource pooling and risk sharing, plays a pivotal role in achieving Universal Health Coverage (UHC) and delivering quality healthcare. This study aimed to assess enrollees' satisfaction with the Formal Sector Social Health Insurance Scheme (FSSHIS) at the University of Nigeria Teaching Hospital (UNTH), with a focus on the registration process, waiting time, drug availability, and willingness to continue using the scheme.&#x0D; Methods : A descriptive cross-sectional study was conducted at UNTH, Enugu, involving 470 enrollees. Data were collected using a pretested Patient Satisfaction Survey Questionnaire and analyzed using descriptive statistics. Enrollees' satisfaction was assessed on a 5-point Likert scale, a score of ≥ 3 signified enrollees’ satisfaction.&#x0D; Results : Respondents were satisfied with the processes of registration (4.10±0.95), getting an identity card (3.50±0.72) and interest shown by the providers (3.80±0.83). They were dissatisfied with the referral process (2.7±0.41), level of their involvement in decision making (2.8±0.44), long waiting time (2.5±0.45), non-availability of drugs (1.8±0.24) and diagnostic facilities (1.5±0.22). The overall satisfaction was poor (43%) while 59% would not recommend a health insurance scheme in the facility for family or friends.&#x0D; Conclusions : Enrollees' dissatisfaction with the FSSHIS suggests a need for immediate intervention and improvement in healthcare service delivery. Addressing these concerns can foster increased utilization of health services and contribute to the scheme's success in achieving its objectives.

Laos’ Social Health Insurance (SHI) program’s impact on older people’s accessibility and financial security against catastrophic health expense

Laos has introduced various SHI schemes for multiple groups of the population, such as government officials and other population groups under the NHI schemes. There is no specific health insurance policy for this group of people who need special health services and may have a higher possibility of entering financial catastrophe. This study aims to assess the impact of SHI schemes on accessibility and financial catastrophe against catastrophic health expenditures for older people in Laos. A structured questionnaire has been used to retrieve information from 400 older people across 39 villages in Kaysone Phomvihane District, Savannakhet province, the largest province in Laos. In the analytical process, this study used a cross-sectional study design and binary logistic regression models to predict the likelihood of accessing health facilities and experiencing financial catastrophe. The study outcome shows that the increase in age, occupation, number of older people within a household, and presence of chronic conditions increase the likelihood of using health services. Despite the existence of various SHI schemes, this study found that 74 out of 165 households reported using health services experienced catastrophic health expenditure. Several characteristics are associated with catastrophic health expenditure: age, income level, and gender are prone to suffer from catastrophic health expenditure. The difficult problems stem from the absence of comprehensive legislation regarding the older population. Recommendations for policymakers in various timeframes have been made, which cover short- and long-term policy proposals, including providing a specialized lane or fast-track for an older population, building health facilities exclusively for older people, and providing transportation services for older individuals living alone.

Health Financing Options for Sri Lanka: What, and Why?

The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka's aspirational goal of achieving Universal Health Coverage (UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.

Health financing options for Sri Lanka

The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka’s aspirational goal of achieving Universal Health Coverage(UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.

The impact of health insurance enrollment on health outcomes in Kenya

BackgroundThe achievement of the global agenda on universal health coverage (UHC) is pivotal in ensuring healthy lives and promoting the well-being of all. However, achieving healthy lives and wellbeing of all has been hampered by the challenge of health care financing. As such, healthcare financing, through health insurance is gaining popularity in developing countries such as Kenya, in their pursuit to achieve universal health coverage. The primary purpose of health insurance and delivery is to improve health. However, there is a paucity of evidence on the effectiveness of health insurance in improving the health outcomes and health status of the Kenyan population. Therefore, this study aimed to analyze the impact of health insurance on health outcomes in Kenya.MethodsThe study utilized the most recent nationally representative Kenya Integrated Household Budget Survey (KIHBS) 2015/16 dataset in order to analyze the impact of health insurance on health outcomes. The instrumental variable 2-stage least squares (IV 2SLS) and control function approach (CFA) estimation techniques were used to cater for potential endogeneity and heterogeneity biases present in ordinary least squares (OLS) estimators.ResultsHealth insurance enrolment leads to a reduction in mortality, thereby improving the health status of the Kenyan population, despite low levels of insurance uptake. However, the insured population experienced higher chronic illnesses and out-of-pocket (OOP) expenditures raising concerns about financial risk protection. The fact that health insurance is linked to chronic illnesses not only reinforces the reverse causality of health insurance and health status, but also that the effects of potential adverse selection strongly drive the strength and direction of this impact.ConclusionsWe conclude that health insurance enrolment reduces mortality and hence has a beneficial impact in promoting health. Health insurance coverage therefore, should be promoted through the restructuring of the National Hospital Insurance Fund (NHIF) fragmented schemes and by consolidating the different insurance schemes to serve different population groups more effectively and equitably. The government should revisit the implementation of a universal social health insurance scheme, as a necessary step towards UHC, while continuing to offer subsidies in the form of health insurance to the marginalized, vulnerable and poor populations.

SOURCES OF HEALTH CARE FINANCING AMONG SURGICAL PATIENTS SEEN AT THE DALHATU ARAF SPECIALIST HOSPITAL LAFIA NASARAWA STATE NIGERIA

Sources of healthcare financing especially among surgical patients in Nasarawa state is presently unknown. Sub-Saharan African countries have introduced a number of methods to funding healthcare system. The Nigerian government commenced implementation of a social health insurance scheme (National Health Insurance Scheme; NHIS) so as to improve on healthcare funding for its citizens. This study determined the sources of financing surgical cases, type of surgeries and compared the cost of treatment among patients attending the Dalhatu Araf Specialist Hospital and other Health Centers in Nasarawa State. It was a hospital based cross-sectional descriptive study among 420 adults aged 18 years to 75 years in a study that lasted for two years. The data collected was analyzed using Statistical package for the Social Science (SPSS) version 20.0. Significant p was &lt; 0.05. The average age of patient was 28.6 ± 11.9 years. There were more females (75.5%) with most (73.8) of our participants living in rural areas. Majority (60.0%) had Caesarean Section and one-sixth had exploratory laparotomy respectively. Most spending for healthcare needs was Out-Of-Pocket (OOP) with only a handful (6.7%) enjoying insurance coverage. The average cost of surgery was 41,337.73 Naira and 28,426.47 Naira among the low and high socio-economic class respectively. Most of the participants in this study were on Out-Of[1]Pocket healthcare financing with only one out of fifteen having health insurance coverage of the NHIS. Most of the surgical patients are from the rural areas, are females, do not attend tertiary level of education and are of low socio-economic status. Caesarean section and exploratory laparatomy were the predominant indications for surgeries. Those from the lower socio-economic status pay more for surgeries even though they earn less. We recommended that the state consider State health insurance agency and this should cater for people in both the formal ana the non-formal sectors. In addition, rural dwellers and surgeries such as caesarean section and emergency laparatomies should not be left out.