Social Health Insurance System Research Articles

Factors influencing the reimbursement of cancer drugs in Europe: A scoping review.

Reimbursement process of oncology drugs in Europe occurs within a complex decision-making process that varies between Member States. Distinctions between the States trigger societal debates since it is necessary to balance access to medicines and health systems sustainability. We aimed to review the evidence concerning factors associated with the reimbursement decision or Health Technology Agency recommendation of oncology drugs in Europe. A systematic literature search was performed in two databases from inception to august 2023. Screening and data extraction were performed by pairs. Thirteen articles were included and encompassed data from 11 nations. Seven articles showed that cost-effective (C-E) drugs and lower Incremental Cost-Effectiveness Ratios (ICERs) had higher likelihood of reimbursement. Disease severity might influence the reimbursement decision with financial agreements. Improvement in clinical outcomes, substantial clinical benefit (p < 0.01) or overall survival gains (p < 0.05) were positively associated. Orphan drug designation impact varies between countries but positive decisions are usually achieved under specific conditions. Clinical and C-E uncertainty frequently led to reimbursement with financial agreements or outcomes-based conditions. Sociodemographic factors as: social health insurance system, higher Gross Domestic Product and larger elderly population were positively associated with reimbursement (p < 0.01). There is a need for further research into key determinants of reimbursement decisions in Europe and the development of drug access models that can effectively address and overcome costs and effectiveness uncertainties.

Belief in Religion or Participation in Insurance? The Impact of Religious Beliefs on the Decision to Participate in Social Health Insurance in China

Investigating the factors that influence individual decisions to participate in social health insurance is an essential component of constructing a multi-tiered, comprehensive social health insurance system, and religious beliefs may constitute an important potential factor. Utilising data from the China General Social Survey (CGSS), this study has developed a comprehensive explanatory framework encompassing both macro- and micro-level analyses to ascertain the impact of religious beliefs on individual decisions to participate in social health insurance through quantitative methods. The findings indicate that religious beliefs significantly diminish the likelihood of individuals participating in social health insurance, and the influence varies among different types of religions; endogeneity and robustness tests offer robust support for these conclusions. With respect to heterogeneity, the influence of religious beliefs on the decision to participate in social health insurance exhibits differentiation across dimensions such as educational attainment, social trust levels, income levels, and self-rated health statuses. Furthermore, the social interaction effect and the employment opportunity effect are identified as potential mechanisms driving this influence.

The roads to managed competition for mixed public-private health systems: a conceptual framework.

Health systems' insurance/funding can be organised in several ways. Some countries have adopted systems with a mixture of public-private involvement (e.g. Australia, Chile, Ireland, South Africa, New Zealand) which creates two-tier health systems, allowing consumers (groups) to have preferential access to the basic standard of care (e.g. skipping waiting times). The degree to which efficiency and equity are achieved in these types of systems is questioned. In this paper, we consider integration of the two tiers by means of a managed competition model, which underpins Social Health Insurance (SHI) systems. We elaborate a two-part conceptual framework, where, first, we review and update the existing pre-requisites for the model of managed competition to fit a broader definition of health systems, and second, we typologise possible roadmaps to achieve that model in terms of the insurance function, and focus on the consequences on providers and governance/stewardship.

Value-based pricing of cognitive behavioral therapy for depression in primary care: an economic evaluation

ObjectivesValue-based pricing (VBP) determines product prices based on their perceived benefits. In healthcare, VBP prices medical technologies considering health outcomes and other relevant factors. This study applies VBP using economic evaluation to provider-patient communication, taking cognitive behavioral therapy (CBT) for adult primary care patients with depressive disorders as a case study.MethodsA 12-week decision-tree model was developed from the German social health insurance system’s perspective, comparing CBT against the standard of care. The influence of an extended time horizon on VBP was assessed using a theoretical model and long-term data spanning 46 months.ResultsUsing a willingness-to-pay threshold of €88,000 per quality-adjusted life year gained, the base-case 50-minute compensation rate for CBT was €45. Assuming long-term effects of CBT significantly affected the value-based compensation, increasing it to €226.ConclusionsThis study showcases the potential of applying VBP to CBT. However, significant price variability is highlighted, contingent upon assumptions regarding CBT’s long-term impacts.

Enhancing Patient Satisfaction in Cross-Regional Healthcare: a Cross-Sectional Study in the Knowledge-Based Healthcare Landscape

AbstractIn the wake of China’s monumental achievement in establishing the world’s most extensive social health insurance system, encompassing 1.4 billion individuals, a unique challenge known as the “siphoning effect” has emerged. This effect involves insured individuals seeking medical care predominantly in major urban centers, straining resources and hindering local healthcare service development. A policy innovation of cross-regional direct settlement of medical outpatient expenses has been implemented nationwide to address this. However, increased population mobility and urbanization have introduced new complexities, prompting insured individuals to seek healthcare beyond their home regions. This study explores the determinants of patient satisfaction in the context of cross-regional medical treatment, adopting a comprehensive approach across six independent dimensions. Findings indicate a 70% satisfaction rate, emphasizing room for improvement, particularly in communication and service efficiency. The study reaffirms the significance of medical competence and professionalism as primary determinants of patient satisfaction, highlighting their robustness in diverse healthcare contexts. Sociodemographic factors also play a crucial role, emphasizing the need for tailored services. Also, accessible information within hospital settings proves vital in enhancing patient satisfaction. This research calls for prioritizing investments in enhancing medical competence and professionalism among healthcare staff. It underscores the importance of adapting services to cater to specific patient groups’ characteristics and the need for standardization in medical insurance policies. A patient-centered approach is crucial to ensure comprehensive and easily understandable information, ultimately enhancing overall patient satisfaction in cross-regional medical treatment within China’s evolving healthcare system. These insights contribute to a broader understanding of healthcare management and services.

Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria

Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients’ (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool.

Welfare state regimes and social policy resistance to fiscal consolidations

AbstractWe study how welfare states regimes influence the effect of episodes of fiscal consolidations on the four main components of the welfare state: social investment, pensions, healthcare and labour market insurance. Welfare state regimes are associated with distinct social policy legacies that feedback into political competition by shaping the size and influence of different coalitions of constituents. Using data from 1980 to 2014 in 16 OECD countries, we find that labour market insurance is more vulnerable to consolidations in Liberal regimes, while social investments are more resistant to consolidations in Nordic regimes. In the Continental regime, which overlaps with Social Health Insurance systems, healthcare is more resistant to consolidations. Finally, pensions are more resistant to consolidations in the Southern regime. These findings contribute to the study of the comparative political economy of welfare state retrenchment.

Policy interplay among social health insurance system, pension system, delayed retirement initiative and implications for the self-rated health status of older workers.

Delayed retirement initiative proposed in China attaches greater importance to the sustainability of pension systems and the labour shortage, but less to the health status of older people. The existing social health insurance and pension system are not well established to match this initiative. This study investigates the policy mix of delayed retirement, employment-based social health insurance, social pension participation for health status of older people. Results of the data from the China Health and Retirement Longitudinal Study (CHARLS-2018) show that late retirement could benefit health status among older adults. Moreover, such effect of late retirement appears more salient for those uninsured by employment-based social health insurance and those still in the pension contribution phase upon reaching the statutory retirement age. Hence, in countries with inadequate health insurance and pension systems, such as China, delayed retirement may serve as an important alternative to social security for the health of older people.

An Analytical Data Model to Improve Benefits of the Comprehensive Health Insurance System By Data Mining Techniques

Health insurance represents a crucial safeguard against the myriad risks associated with individual health conditions, covering expenses related to examinations, diagnosis and treatment, as well as providing psychological and physical support. Until mid-2019, Egypt implemented a social health insurance system, and then moved to a renewed framework known as the comprehensive health insurance system in the latter half of 2019. The research at hand focuses on exploring a new mechanism through develop a new model, it can be help the General Authority for Health Insurance to attainment of maximum benefits, whether in terms of individuals medical services or the enhancement of the nation's overall income return.&#x0D; The researcher depends on using the data mining technique to conduct specialized analyzes of big data for the new model, to offer the numerous advantages, including empowering decision-makers to make accurate decisions based on reliable information and proficient data analysis, Based on the new model for the health insurance system that was prepared and implemented using the Weka program, version 3.8.6, through the classifier scheme (classifiers.trees.J48 algorithm), the applied pattern was used:&#x0D; (Scheme:weka.classifiers.misc.InputMappedClassifier -I -trim -Wweka.classifiers.trees.J48 -- -C 0.25 -M 2), Through the Weka program, a new model was designed that contains two parts. The first part is to classify the insured into insurance categories according to their monthly salaries, and the second part is to predict the classification and distribution of employees among insurance packages according to the new health insurance model. The model was prepared using Weka.classifiers.trees.J48. software to analysis the dataset of 2781 employees.&#x0D; One of the significant outcomes that the researcher emphasizes from implementing the new model is the attainment of maximum benefits, whether in terms of individual medical services or the enhancement of the nation's overall income return. Under the existing health insurance law in Egypt, the monthly subscription fee is a flat 1% for all employees, without accounting for other factors. The results of applying the new model showed the effectiveness of the model through a comparison between the current subscription fees and the new health insurance model, developed using the same dataset of 2781 employees, reveals that the total monthly subscription fees under the current health insurance system amount to 153057.97 Egyptian Pounds (L.E.), whereas the total subscription fees under the new health insurance system model reach 365998.91 L.E., The financial benefits realized from the new model amount to 212940.94 L.E., representing a percentage increase of up to 139.12%. This demonstrates a considerable improvement in financial outcomes, and the potential advantages of transitioning to the new health insurance model.

The Health Insurance Fund Participates in Controlling the Epidemic: Insights from German Experience in Dealing with the COVID-19 Pandemic.

To reveal the importance of the participation of the health insurance fund in the prevention and control of serious infectious diseases, this research retrospectively analyzed the case of the German statutory health insurance fund in response to the COVID-19 epidemic. Based on Germany's practical experience, this research offers a strategy idea for other countries with a social health insurance system, aiming to ensure that the health care system does not collapse rapidly due to medical resource shortage in the event of a pandemic. Firstly, this research conducted a documentary analysis to systematically collate the temporary and additional coverage measures provided by the health insurance fund from January to the end of July 2020, which sheds light on the pivotal role of these funds in epidemic prevention and control. Secondly, this research used comparative analysis to examine the time sequence of implementing these different types of coverage measures in the progression of the epidemic to illustrate how the health insurance fund adjusted its response measures. The health insurance fund was actively involved in the development of core strategies for combating the epidemic when it broke out, by taking part in joint multisectoral consultations. By using payment instruments flexibly, the fund led the implementation of epidemic prevention and control measures, as it could allocate health resources quickly and efficiently in emergencies. Furthermore, the health insurance fund played a critical role in transmitting information on the epidemic and guiding the insured to take appropriate protective measures. By fulfilling its role in health promotion, particularly in the area of health education, the fund provided important complementary and synergistic contributions to the prevention and control of the spread of infectious diseases. In summary, this research provides a new model for other countries for mobilizing a multi-sectoral response to infectious disease prevention and control, and emphasises the key role of the health insurance fund in responding to major public health crises.

Effects of healthcare financing policy tools on health system efficiency: Evidence from sub-Saharan Africa

BackgroundEvidence shows high levels of catastrophic and impoverishing healthcare expenditure among households in sub-Saharan Africa (SSA). The way healthcare is financed has an impact on how well a health system performs its functions and achieves its objectives. This study aims to examine the effect of healthcare financing policy tools on health system efficiency. MethodThe study classifies 46 sub-Saharan African (SSA) countries into four groups of health systems sharing similar healthcare financing strategies. A two-stage and one-stage stochastic frontier analysis (SFA) and Tobit regression techniques were employed to assess the impact of healthcare financing policy variables on health system efficiency. Data from the selected 46 SSA countries from 2000 to 2019 was investigated. ResultsThe results revealed that prepayment healthcare financing arrangements, social health insurance, mixed- and external-financing healthcare systems significantly enhance health system efficiency. Reliance on a single source for financing healthcare, particularly private out-of-pocket payment reduces health system efficiency. ConclusionFor policy-making purposes, health care systems financed through a mix of financing arrangements comprising social health insurance, private, and public funding improve health system efficiency in delivering better health outcomes as opposed to depending on one major source of financing, particularly, private out-of-pocket payments.

Changing roles of health insurers in France, Germany, and the Netherlands: any lessons to learn from Bismarckian systems?

Bismarckian health systems are mainly governed by social health insurers, but their role, status, and power vary across countries and over time. We compare the role of health insurers in three distinct social health insurance systems in improving health systems' efficiency. In France, insurers work together as a single payer within a highly regulated context. Although this gives insurers substantial bargaining power, collective negotiations with providers are highly political and do not provide appropriate incentives for efficiency. Both Germany and the Netherlands have introduced competition among insurers to foster efficiency. However, the rationale of insurer competition in Germany is unclear because contracts are mostly concluded at a collective level and individual insurers have little power to influence health system efficiency. In the Netherlands, insurer competition is substantially more effective, but primarily focused on price and cost containment. In all three countries, the role of insurers has been transforming slowly to respond to common challenges of assuring care quality and continuity for an ageing population. To assure sustainability, they need to ensure that care providers cooperate with the same quality and efficiency objectives, but their capacity to do so has been limited by insufficient support to enforce public information on provider quality.

Problems and Prospects in Medical Insurance System Development

China has experienced remarkable economic growth since its reform and opening-up; the gross domestic product and residents' disposable income have both increased, and the disparity in income distribution has also come to light and become a common concern for all facets of Chinese society. China has already surpassed low-income nations in terms of income level. The level of national welfare should be raised even when the economy is expanding with excellent quality. This essay talks about how China's health insurance system has evolved and how it might be improved to better the lives of its citizens. This paper compiles and analyses the development process and policies of health insurance reform. The effectiveness of the program is assessed by examining if it has raised inhabitants' quality of life and reduced the disparity in income. Moreover, The divergence of economic and policy development between urban and rural areas, and, additionally, the government management fragmentation, are two primary challenges encountered in the implementation of the program. These issues are brought on by the economy's stage of development and the long-standing customs of the policy-making process. The social health insurance system must precisely assist special groups, expand fund investment, enhance social security mechanisms, and foster harmony between urban and rural areas in order to fulfill its mission of fostering social fairness.

Willingness to Pay for Social Health Insurance Among Health Care Professionals in North Wollo Zone, Amhara Region, Ethiopia: Mixed Method Study.

Ethiopia introduced a social health insurance (SHI) scheme for the formal sector that will cost 3% of the monthly salary as a premium and provide universal health coverage. Since health care professionals (HCP) are the primary front-line service providers, their willingness to pay (WTP) for SHI may have a direct or indirect impact on how the programme is implemented. However, little is known about WTP for SHI among HCP. To assess WTP for SHI and associated factors among government employee HCP in the North Wollo Zone, Northeast Ethiopia. Using the contingent valuation method, a mixed approach and cross-sectional study design were applied. For the qualitative study design, in-depth interviews were performed with focal persons and officers of health insurance. Multistage systematic random sampling was used to select 636 healthcare professionals. Logistic regression analysis was used to determine independent predictors of WTP for SHI. Qualitative data were analyzed using thematic analysis. A response rate of 92.45% was achieved among the 636 participants, with 588 healthcare professionals completing the interview. The majority (61.7%) of participants were willing to joinand pay the suggested SHI premium. Participants' WTP was significantly positively associated with the presence of under five years of children but their willingness to pay was significantly negatively associated with the female gender and increasing monthly salary. On the other hand, on the qualitative side, the amount of premium contribution, benefits package, and quality of service were the major factors affecting their WTP. The majority of healthcare professionals were willing to pay for the SHI scheme, almost as much as the premium set by the government. This suggests proof that healthcare financing reform is feasible, particularly for the implementation of the SHI system.

How Delayed Retirement Initiatives and Social Health Insurance System Affect China's Elderly

The challenges brought by global aging make countries begin to pay attention to and pay attention to the role of deferred retirement initiatives. At present, China's social medical insurance system has not been reformed, and the retirement age policy formulated in the 1950s obviously does not meet the needs of China's economic development. China is in urgent need of a new delayed retirement policy. In this paper, using 2014 CLHLS data, the study found that working age affects the health of the elderly, and there is a negative correlation between age and health. According to the findings, the social medical insurance system has a favourable impact on the health of the elderly, and there is no direct evidence that it can reduce the mortality rate. The social health insurance system and the proposal to postpone retirement interact with one another

How Delayed Retirement Initiatives and Social Health Insurance System Affect China's Elderly

How Delayed Retirement Initiatives and Social Health Insurance System Affect China's Elderly

Objective assessment of nasal obstruction.

There are many methods and types of equipment for measuring the nasal airway, but there is no consensus regarding the results of various clinical studies on nasal obstruction. In this review, we discuss the two major methods of objectively assessing the nasal airway: rhinomanometry and acoustic rhinometry. The Japanese standard of rhinomanometry in Japanese adults and children was established by the Japanese Standardization Committee on Rhinomanometry in 2001 and 2018, respectively. However, the International Standardization Committee has proposed different standards because of differences in race, equipment, and social health insurance systems. The standardization of acoustic rhinometry in Japanese adults is making progress in several Japanese institutes, but the international standardization of acoustic rhinometry has not yet begun. Rhinomanometry is the physiological expression of nasal airway breathing, whereas acoustic rhinometry is the anatomic expression. In this review, we introduce the history and methods of the objective assessment of nasal patency and the physiological and pathological issues regarding nasal obstruction.

The Social Health Insurance (BPJS) Patient Satisfaction at Hermina Daan Mogot and Pasar Minggu Hospitals, Indonesia

Objective: The purpose of this study is to investigate the function of the Indonesian Social Health Insurance (BPJS) system for the provision of medical services, and to examine the differences and similarities between the public and private hospitals in Jakarta, Indonesia. Theoretical framework: Service quality in BPJS is a public service that can be classified as all different kinds of goods and services as well. This means that the Indonesian government is responsible for all of the actions that take place within the organisation. Method: The population of the study will primarily consist of patients who are treated at Hermina Daan Mogot, a private hospital, and Pasar Minggu Public Hospital. Path analysis is being used in this study, which is a quantitative descriptive research approach. The goal of the study is to meet the research objectives by evaluating a set of hypotheses. The data collection is carried out through the use of a hardcopy questionnaire, and the primary data is gathered from four hundred patients spread across Jakarta's two hospitals. Results and conclusion: The outcomes of the research show that there is a favourable association between the BPJS and the level of satisfaction experienced by patients. In addition, the level of contentment expressed by patients regarding the quality of the treatment. Implications of the research: The findings suggest that Cost does not influence Service Quality because it possessed a significant value of t-count greater than 0.05 for both Hermina Daan Mogot Private Hospital and Pasar MInggu Public Hospital. Originality/value: The government regulated and established the financing, facility procurement, the source of the workforce, and the quality standard of the service, so that almost all dimensions of service can meet the desire and satisfaction of patients.

Predictable profits and losses in a health insurance market with risk equalization: A multiple-contract period perspective

Many social health insurance systems rely on ‘regulated competition’ among insurers to improve efficiency. In the presence of community-rated premiums, risk equalization is an important regulatory feature to mitigate risk-selection incentives in such systems. Empirical studies evaluating selection incentives have typically quantified group-level (un)profitability for one contract period. However, due to switching barriers, a multiple contract period perspective might be more relevant. In this paper, using data from a large health survey (N≈380k) we identify subgroups of chronically ill and healthy individuals in year t and follow these groups over three consecutive years. Using administrative data covering the entire Dutch population (N≈17m), we then simulate the mean per person predictable profits and losses (i.e. spending predicted by a sophisticated risk-equalization model minus actual spending) of these groups over the three follow-up years. We find that most of the groups of chronically ill are persistently unprofitable on average, while the healthy group is persistently profitable. This implies that selection incentives might be stronger than initially thought, underscoring the necessity of eliminating predictable profits and losses for the adequate functioning of competitive social health insurance markets.

카자흐스탄 의무의료보험제도 도입 과정 연구

In November 2015, Kazakhstan introduced the “Compulsory Social Health Insurance System (the System) in the social insurance format,” first among the Central Asian countries, including Russia. By introducing the system, the country shifted from the previous government-led medical insurance system that had originated from the era of the former Soviet Union to that in the “social insurance format.” Under the new system, every citizen pays health insurance premiums and bears the collective responsibility for public health. The process of introducing the System was quite abrupt, which was possible because Kazakhstan is an authoritative nation where the president of the country exerts enormous power. In this regard, this study alters and modifies Kingdon's multiple streams framework model, which is useful for analyzing such an abrupt process of policy change by period, and applies the revised version as the analysis framework. The analysis period was classified into three periods based on the national mood, the presence and direction of policies, etc. In addition, the intensity of the three streams(problems, politics and policies), and the extent of the policy entrepreneur’s role were set as the specific components of the analytical framework. As a result of the analysis, the policy change succeeds in the third period(Jan. 2014-Jan.2020). The results confirmed that when the aforementioned model is applied, policy entrepreneurs played the most important role in the policy change process in Kazakhstan for the introduction of the compulsory social health insurance system. Nazarbayev, a policy entrepreneur, first recognized the necessity of improving the public health budget indicators, which had been deteriorating since 2010, from the perspective of the flow of policy problems. Based on his realization, Nazarbayev tried to strengthen the country's financial soundness by resolving the identified policy problems and further, he intended to achieve the advancement and modernization of the country. Aggressive and enthusiastic efforts and firm and decisive willingness of the policy entrepreneur finally led to the successful policy change. Consequently, the System was established and implemented nationwide in Kazakhstan from January 2020, starting with partial implementation in July 2017.