WorldWideScience

Sample records for universal coverage health

  1. Providing Universal Health Insurance Coverage in Nigeria.

    Science.gov (United States)

    Okebukola, Peter O; Brieger, William R

    2016-07-07

    Despite a stated goal of achieving universal coverage, the National Health Insurance Scheme of Nigeria had achieved only 4% coverage 12 years after it was launched. This study assessed the plans of the National Health Insurance Scheme to achieve universal health insurance coverage in Nigeria by 2015 and discusses the challenges facing the scheme in achieving insurance coverage. In-depth interviews from various levels of the health-care system in the country, including providers, were conducted. The results of the analysis suggest that challenges to extending coverage include the difficulty in convincing autonomous state governments to buy into the scheme and an inadequate health workforce that might not be able to meet increased demand. Recommendations for increasing the scheme's coverage include increasing decentralization and strengthening human resources for health in the service delivery systems. Strong political will is needed as a catalyst to achieving these goals. © The Author(s) 2016.

  2. Monitoring intervention coverage in the context of universal health coverage.

    Directory of Open Access Journals (Sweden)

    Ties Boerma

    2014-09-01

    Full Text Available Monitoring universal health coverage (UHC focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the

  3. Realizing right to health through universal health coverage

    Directory of Open Access Journals (Sweden)

    ANJALI Singh

    2014-07-01

    Full Text Available Recognition of right to health is an essential step to work towards improvement of public health and to attain highest standard of physical and mental health of the people. Right to health in India is implicit part of right to life under Article 19 mentioned in the Constitution of India but is not recognized per se. Universal Health Coverage adopts rights based approach and principles of universality, equity, empowerment and comprehensiveness of care. The Universal Coverage Report of India makes recommendations in six identified areas to revamp the health systems in order to ensure right to health of Indians. These areas are: health financing and financial protection; health service norms; human resources for health; community participation and citizen engagement; access to medicines, vaccines and techno- logy; management and institutional reforms. This paper attempts to determine the ways inwhich Universal Health Coverage can make a contribution in realizing right to health and thus human rights in developing countries.

  4. [Universal coverage of health services in Mexico].

    Science.gov (United States)

    2013-01-01

    The reforms made in recent years to the Mexican Health System have reduced inequities in the health care of the population, but have been insufficient to solve all the problems of the MHS. In order to make the right to health protection established in the Constitution a reality for every citizen, Mexico must warrant effective universal access to health services. This paper outlines a long-term reform for the consolidation of a health system that is akin to international standards and which may establish the structural conditions to reduce coverage inequity. This reform is based on a "structured pluralism" intended to avoid both a monopoly exercised within the public sector and fragmentation in the private sector, and to prevent falling into the extremes of authoritarian procedures or an absence of regulation. This involves the replacement of the present vertical integration and segregation of social groups by a horizontal organization with separation of duties. This also entails legal and fiscal reforms, the reinforcement of the MHS, the reorganization of health institutions, and the formulation of regulatory, technical and financial instruments to operationalize the proposed scheme with the objective of rendering the human right to health fully effective for the Mexican people.

  5. Progress toward universal health coverage in ASEAN.

    Science.gov (United States)

    Van Minh, Hoang; Pocock, Nicola Suyin; Chaiyakunapruk, Nathorn; Chhorvann, Chhea; Duc, Ha Anh; Hanvoravongchai, Piya; Lim, Jeremy; Lucero-Prisno, Don Eliseo; Ng, Nawi; Phaholyothin, Natalie; Phonvisay, Alay; Soe, Kyaw Min; Sychareun, Vanphanom

    2014-01-01

    The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC. Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and 'snowball' further data. We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate

  6. Progress toward universal health coverage in ASEAN

    Directory of Open Access Journals (Sweden)

    Hoang Van Minh

    2014-12-01

    Full Text Available Background: The Association of Southeast Asian Nations (ASEAN is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC. Design: Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and ‘snowball’ further data. Results: We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1 financial constraints, including low levels of overall and government spending on health; 2 supply side constraints, including inadequate numbers and densities of health workers; and 3 the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should

  7. Technical support for universal health coverage pilots in Karnataka ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Technical support for universal health coverage pilots in Karnataka and Kerala. This project will provide evidence-based support to implement universal health coverage (UHC) pilot activities in two Indian states: Kerala and Karnataka. The project team will provide technical assistance to these early adopter states to assist ...

  8. Universal Health Coverage for Schizophrenia: A Global Mental Health Priority

    OpenAIRE

    Patel, Vikram

    2015-01-01

    The growing momentum towards a global consensus on universal health coverage, alongside an acknowledgment of the urgency and importance of a comprehensive mental health action plan, offers a unique opportunity for a substantial scale-up of evidence-based interventions and packages of care for a range of mental disorders in all countries. There is a robust evidence base testifying to the effectiveness of drug and psychosocial interventions for people with schizophrenia and to the feasibility, ...

  9. Expanding the universe of universal coverage: the population health argument for increasing coverage for immigrants.

    Science.gov (United States)

    Nandi, Arijit; Loue, Sana; Galea, Sandro

    2009-12-01

    As the US recession deepens, furthering the debate about healthcare reform is now even more important than ever. Few plans aimed at facilitating universal coverage make any mention of increasing access for uninsured non-citizens living in the US, many of whom are legally restricted from certain types of coverage. We conducted a critical review of the public health literature concerning the health status and access to health services among immigrant populations in the US. Using examples from infectious and chronic disease epidemiology, we argue that access to health services is at the intersection of the health of uninsured immigrants and the general population and that extending access to healthcare to all residents of the US, including undocumented immigrants, is beneficial from a population health perspective. Furthermore, from a health economics perspective, increasing access to care for immigrant populations may actually reduce net costs by increasing primary prevention and reducing the emphasis on emergency care for preventable conditions. It is unlikely that proposals for universal coverage will accomplish their objectives of improving population health and reducing social disparities in health if they do not address the substantial proportion of uninsured non-citizens living in the US.

  10. Enhancing Political Will for Universal Health Coverage in Nigeria.

    Science.gov (United States)

    Aregbeshola, Bolaji S

    2017-01-01

    Universal health coverage aims to increase equity in access to quality health care services and to reduce financial risk due to health care costs. It is a key component of international health agenda and has been a subject of worldwide debate. Despite differing views on its scope and pathways to reach it, there is a global consensus that all countries should work toward universal health coverage. The goal remains distant for many African countries, including Nigeria. This is mostly due to lack of political will and commitment among political actors and policymakers. Evidence from countries such as Ghana, Chile, Mexico, China, Thailand, Turkey, Rwanda, Vietnam and Indonesia, which have introduced at least some form of universal health coverage scheme, shows that political will and commitment are key to the adoption of new laws and regulations for reforming coverage. For Nigeria to improve people's health, reduce poverty and achieve prosperity, universal health coverage must be vigorously pursued at all levels. Political will and commitment to these goals must be expressed in legal mandates and be translated into policies that ensure increased public health care financing for the benefit of all Nigerians. Nigeria, as part of a global system, cannot afford to lag behind in striving for this overarching health goal.

  11. Nursing challenges for universal health coverage: a systematic review

    Directory of Open Access Journals (Sweden)

    Mariana Cabral Schveitzer

    2016-01-01

    Full Text Available Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage.

  12. Universal Health Coverage for Schizophrenia: A Global Mental Health Priority.

    Science.gov (United States)

    Patel, Vikram

    2016-07-01

    The growing momentum towards a global consensus on universal health coverage, alongside an acknowledgment of the urgency and importance of a comprehensive mental health action plan, offers a unique opportunity for a substantial scale-up of evidence-based interventions and packages of care for a range of mental disorders in all countries. There is a robust evidence base testifying to the effectiveness of drug and psychosocial interventions for people with schizophrenia and to the feasibility, acceptability and cost-effectiveness of the delivery of these interventions through a collaborative care model in low resource settings. While there are a number of barriers to scaling up this evidence, for eg, the finances needed to train and deploy community based workers and the lack of agency for people with schizophrenia, the experiences of some upper middle income countries show that sustained political commitment, allocation of transitional financial resources to develop community services, a commitment to an integrated approach with a strong role for community based institutions and providers, and a progressive realization of coverage are the key ingredients for scale up of services for schizophrenia. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

  13. Universal health coverage in Turkey: enhancement of equity.

    Science.gov (United States)

    Atun, Rifat; Aydın, Sabahattin; Chakraborty, Sarbani; Sümer, Safir; Aran, Meltem; Gürol, Ipek; Nazlıoğlu, Serpil; Ozgülcü, Senay; Aydoğan, Ulger; Ayar, Banu; Dilmen, Uğur; Akdağ, Recep

    2013-07-06

    Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with

  14. BRICS countries and the global movement for universal health coverage

    NARCIS (Netherlands)

    Tediosi, Fabrizio; Finch, Aureliano; Procacci, Christina; Marten, Robert; Missoni, Eduardo

    2016-01-01

    This article explores BRICS' engagement in the global movement for Universal Health Coverage (UHC) and the implications for global health governance. It is based on primary data collected from 43 key informant interviews, complemented by a review of BRICS' global commitments supporting UHC.

  15. Is universal coverage via social health insurance financially feasible ...

    African Journals Online (AJOL)

    SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based ...

  16. Minding the gaps: health financing, universal health coverage and gender.

    Science.gov (United States)

    Witter, Sophie; Govender, Veloshnee; Ravindran, T K Sundari; Yates, Robert

    2017-12-01

    In a webinar in 2015 on health financing and gender, the question was raised why we need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage (UHC) will automatically be equitable and gender balanced. This article provides a reflection on this question from a panel of health financing and gender experts.We trace the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. We find that unless explicit attention is paid to gender and its intersectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations (e.g. poor women, unemployed men, female-headed households), movement towards UHC can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to UHC and the needs of less powerful groups, which can include women and children, are not necessarily given priority.We identify the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of UHC decisions, political economy as well as technical research should be prioritized.We conclude that countries should adopt an equitable approach towards achieving UHC and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children. This constitutes the 'progressive universalism' advocated for by the 2013 Lancet Commission on Investing in Health. © The Author 2017. Published by Oxford University Press in association with The

  17. Universal Health Coverage: A burning need for developing countries

    OpenAIRE

    Zaman, Sojib Bin; Hossain, Naznin

    2017-01-01

    The term of universal health coverage (UHC) are getting popularity among the countries who have not yet attained it. Majority of the developing countries are planning to implement the UHC to protect the vulnerable citizen who cannot afford to buy the health services. Poor people living in developing countries, where there is no UHC, are bereft of getting equal health care. They have to bear a significant amount of health cost in buying different services which often causes catastrophic expend...

  18. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    Directory of Open Access Journals (Sweden)

    Denise Bryant-Lukosius

    Full Text Available ABSTRACT Objective: to examine advanced practice nursing (APN roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.

  19. Indonesia's road to universal health coverage: a political journey.

    Science.gov (United States)

    Pisani, Elizabeth; Olivier Kok, Maarten; Nugroho, Kharisma

    2017-03-01

    In 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. This paper explores Indonesia's journey towards universal health coverage (UHC) from independence to the launch of a comprehensive health insurance scheme in January 2014. We find that Indonesia's path has been determined largely by domestic political concerns – different groups obtained access to healthcare as their socio-political importance grew. A major inflection point occurred following the Asian financial crisis of 1997. To stave off social unrest, the government provided health coverage for the poor for the first time, creating a path dependency that influenced later policy choices. The end of this programme coincided with decentralisation, leading to experimentation with several different models of health provision at the local level. When direct elections for local leaders were introduced in 2005, popular health schemes led to success at the polls. UHC became an electoral asset, moving up the political agenda. It also became contested, with national policy-makers appropriating health insurance programmes that were first developed locally, and taking credit for them. The Indonesian experience underlines the value of policy experimentation, and of a close understanding of the contextual and political factors that drive successful UHC models at the local level. Specific drivers of success and failure should be taken into account when scaling UHC to the national level. In the Indonesian example, UHC became possible when the interests of politically and economically influential groups were either satisfied or neutralised. While technical considerations took a back seat to political priorities in developing the structures for health coverage nationally, they will have to be addressed going forward

  20. Universal health coverage in Rwanda: dream or reality.

    Science.gov (United States)

    Nyandekwe, Médard; Nzayirambaho, Manassé; Baptiste Kakoma, Jean

    2014-01-01

    Universal Health Coverage (UHC) has been a global concern for a long time and even more nowadays. While a number of publications are almost unanimous that Rwanda is not far from UHC, very few have focused on its financial sustainability and on its extreme external financial dependency. The objectives of this study are: (i) To assess Rwanda UHC based mainly on Community-Based Health Insurance (CBHI) from 2000 to 2012; (ii) to inform policy makers about observed gaps for a better way forward. A retrospective (2000-2012) SWOT analysis was applied to six metrics as key indicators of UHC achievement related to WHO definition, i.e. (i) health insurance and access to care, (ii) equity, (iii) package of services, (iv) rights-based approach, (v) quality of health care, (vi) financial-risk protection, and (vii) CBHI self-financing capacity (SFC) was added by the authors. The first metric with 96,15% of overall health insurance coverage and 1.07 visit per capita per year versus 1 visit recommended by WHO, the second with 24,8% indigent people subsidized versus 24,1% living in extreme poverty, the third, the fourth, and the fifth metrics excellently performing, the sixth with 10.80% versus ≤40% as limit acceptable of catastrophic health spending level and lastly the CBHI SFC i.e. proper cost recovery estimated at 82.55% in 2011/2012, Rwanda UHC achievements are objectively convincing. Rwanda UHC is not a dream but a reality if we consider all convincing results issued of the seven metrics.

  1. [Using the concept of universal health coverage to promote the health system reform in China].

    Science.gov (United States)

    Hu, S L

    2016-11-06

    The paper is systematically explained the definition, contents of universal health coverage (UHC). Universal health coverage calls for all people to have access to quality health services they need without facing undue financial burden. The relationship between five main attributes, i.e., quality, efficiency, equity, accountability and resilience, and their 15 action plans has been explained. The nature of UHC is belonged to the State and government. The core function is commitment with equality. The whole-of-system method is used to promoting the health system reform. In China, the universal health coverage has been reached to the preliminary achievements, which include universal coverage of social medical insurance, basic medical services, basic public health services, and the provision of essential medicines. China has completed millennium development goals (MDG) and is being stepped to the sustainable development goals (SDG).

  2. BRICS countries and the global movement for universal health coverage.

    Science.gov (United States)

    Tediosi, Fabrizio; Finch, Aureliano; Procacci, Christina; Marten, Robert; Missoni, Eduardo

    2016-07-01

    This article explores BRICS' engagement in the global movement for Universal Health Coverage (UHC) and the implications for global health governance. It is based on primary data collected from 43 key informant interviews, complemented by a review of BRICS' global commitments supporting UHC. Interviews were conducted using a semi-structured questionnaire that included both closed- and open-ended questions. Question development was informed by insights from the literature on UHC, Cox's framework for action, and Kingdon's multiple-stream theory of policy formation. The closed questions were analysed with simple descriptive statistics and the open-ended questions using grounded theory approach. The analysis demonstrates that most BRICS countries implicitly supported the global movement for UHC, and that they share an active engagement in promoting UHC. However, only Brazil, China and to some extent South Africa, were recognized as proactively pushing UHC in the global agenda. In addition, despite some concerted actions, BRICS countries seem to act more as individual countries rather that as an allied group. These findings suggest that BRICS are unlikely to be a unified political block that will transform global health governance. Yet the documented involvement of BRICS in the global movement supporting UHC, and their focus on domestic challenges, shows that BRICS individually are increasingly influential players in global health. So if BRICS countries should probably not be portrayed as the centre of future political community that will transform global health governance, their individual involvement in global health, and their documented concerted actions, may give greater voice to low- and middle-income countries supporting the emergence of multiple centres of powers in global health. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  3. Universal health coverage in 'One ASEAN': are migrants included?

    Science.gov (United States)

    Guinto, Ramon Lorenzo Luis R; Curran, Ufara Zuwasti; Suphanchaimat, Rapeepong; Pocock, Nicola S

    2015-01-01

    As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of

  4. Universal Health Coverage - The Critical Importance of Global Solidarity and Good Governance Comment on "Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage".

    Science.gov (United States)

    Reis, Andreas A

    2016-06-07

    This article provides a commentary to Ole Norheim' s editorial entitled "Ethical perspective: Five unacceptable trade-offs on the path to universal health coverage." It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of universal health coverage (UHC). © 2016 by Kerman University of Medical Sciences.

  5. Health-system reform and universal health coverage in Latin America.

    Science.gov (United States)

    Atun, Rifat; de Andrade, Luiz Odorico Monteiro; Almeida, Gisele; Cotlear, Daniel; Dmytraczenko, T; Frenz, Patricia; Garcia, Patrícia; Gómez-Dantés, Octavio; Knaul, Felicia M; Muntaner, Carles; de Paula, Juliana Braga; Rígoli, Felix; Serrate, Pastor Castell-Florit; Wagstaff, Adam

    2015-03-28

    Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Health financing for universal coverage and health system performance: concepts and implications for policy.

    Science.gov (United States)

    Kutzin, Joseph

    2013-08-01

    Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

  7. EDITORIAL Universal health coverage: A re-emerging paradigm?

    African Journals Online (AJOL)

    admin

    of earlier initiatives in global health that include the basic health ... the availability, accessibility (geographic, economic, cultural) and appropriateness ... public good nature of health leading to new .... fragmentation and towards universal.

  8. Health status and health systems financing in the MENA region: roadmap to universal health coverage.

    Science.gov (United States)

    Asbu, Eyob Zere; Masri, Maysoun Dimachkie; Kaissi, Amer

    2017-01-01

    Since the declaration of the Millennium Development Goals (MDGs) in 1990, many countries of the Middle East and North Africa (MENA) region made some improvements in maternal and child health and in tackling communicable diseases. The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health, well-being, and universal health coverage. This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage. Time-series data on socioeconomics, health expenditures, and health outcomes were extracted from databases and reports of the World Health Organization, the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software. Countries were grouped according to the World Bank income categories. Descriptive statistics, tables and charts were used to analyze temporal changes and compare the key variables with global averages. Non-communicable diseases (NCDs) and injuries account for more than three quarters of the disability-adjusted life years in all but two lower middle-income countries (Sudan and Yemen). Prevalence of risk factors (raised blood glucose, raised blood pressure, obesity and smoking) is higher than global averages and counterparts by income group. Total health expenditure (THE) per capita in most of the countries falls short of global averages for countries under similar income category. Furthermore, growth rate of THE per capita has not kept pace with the growth rate of GDP per capita. Out-of-pocket spending (OOPS) in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care. The alarmingly high prevalence of NCDs and injuries and associated risk factors, health spending falling short of the GDP

  9. Experiences with Universal Health Coverage of Maternal Health ...

    African Journals Online (AJOL)

    USER

    services does not expose the user to financial hardship‖. This is based on the .... statements of the two hospitals at inception was ―to run integrated maternal and child .... consolidated revenue for primary health care which will essentially be ...

  10. Achieving and Sustaining Universal Health Coverage: Fiscal Reform of the National Health Insurance in Taiwan.

    Science.gov (United States)

    Lan, Jesse Yu-Chen

    2017-12-01

    The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.

  11. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health.

    Science.gov (United States)

    Bryant-Lukosius, Denise; Valaitis, Ruta; Martin-Misener, Ruth; Donald, Faith; Peña, Laura Morán; Brousseau, Linda

    2017-01-30

    to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. analisar o papel da enfermagem com prática avançada (EPA) a nível internacional para um relatório do seu desenvolvimento na América Latina e no Caribe, para apoiar a cobertura universal de saúde e o acesso universal à saúde. análise da bibliografia relacionada com os papéis da EPA, sua implantação no mundo e a eficácia da EPA em relação à cobertura universal de saúde e acesso à saúde. dada a evidência da sua eficácia em muitos países, as funções da EPA são ideais como parte de uma estratégia de recursos humanos de atenção primária de saúde na América Latina para melhorar a cobertura universal de saúde e o acesso à saúde. Brasil

  12. Medicalization of global health 4: The universal health coverage campaign and the medicalization of global health.

    Science.gov (United States)

    Clark, Jocalyn

    2014-01-01

    Universal health coverage (UHC) has emerged as the leading and recommended overarching health goal on the post-2015 development agenda, and is promoted with fervour. UHC has the backing of major medical and health institutions, and is designed to provide patients with universal access to needed health services without financial hardship, but is also projected to have 'a transformative effect on poverty, hunger, and disease'. Multiple reports and resolutions support UHC and few offer critical analyses; but among these are concerns with imprecise definitions and the ability to implement UHC at the country level. A medicalization lens enriches these early critiques and identifies concerns that the UHC campaign contributes to the medicalization of global health. UHC conflates health with health care, thus assigning undue importance to (biomedical) health services and downgrading the social and structural determinants of health. There is poor evidence that UHC or health care alone improves population health outcomes, and in fact health care may worsen inequities. UHC is reductionistic because it focuses on preventative and curative actions delivered at the individual level, and ignores the social and political determinants of health and right to health that have been supported by decades of international work and commitments. UHC risks commodifying health care, which threatens the underlying principles of UHC of equity in access and of health care as a collective good.

  13. Is universal health coverage the practical expression of the right to health care?

    OpenAIRE

    Ooms, Gorik; Latif, Laila A; Waris, Attiya; Brolan, Claire E; Hammonds, Rachel; Friedman, Eric A; Mulumba, Moses; Forman, Lisa

    2014-01-01

    The present Millennium Development Goals are set to expire in 2015 and their next iteration is now being discussed within the international community. With regards to health, the World Health Organization proposes universal health coverage as a 'single overarching health goal' for the next iteration of the Millennium Development Goals. The present Millennium Development Goals have been criticised for being 'duplicative' or even 'competing alternatives' to international human rights law. T...

  14. Mitigating India's health woes: Can health insurance be a remedy to achieve universal health coverage?

    Directory of Open Access Journals (Sweden)

    B Savitha

    2016-01-01

    Full Text Available A low level of public investments in preventive health facilities and medical care facilities and health professionals has given rise to poor health status for an average Indian. Insufficient government funding for health care, inadequate and ineffective health financing mechanisms, poor delivery of health care, especially in public facilities, and excessive reliance on unregulated high-cost private providers have contributed to the poor accomplishment of Millennium Development Goals, especially in the informal sector. Sustainable Development Goals (SDGs consider health to be one of the important objectives to be achieved by all the nations in the world. This paper reappraises the current status, unmet needs, challenges, and the way forward to implement and achieve universal health coverage (UHC in India by thrusting the focus on three elements (pillars of universal access to health services. Despite seven decades of independence, India does still face the formidable challenge of providing health services to its population at an affordable cost. One of the major obstacles in reaching universal coverage and universal health entitlement of every Indian citizen has been the absence of effective health financing mechanism that promotes affordable access to weaker and vulnerable sections of the society. In this respect, health insurance certainly does have the potential to expedite the process of UHC if various stakeholders work in cohesion under the government stewardship. In rural India, the health infrastructure and workforce are inadequate to serve the unserved and underserved population. Hence, the government should invest in public health facilities while promoting pan-India health insurance to ensure and guarantee easy access and affordability for its citizens. The way forward should not only be centered on financial protection, but also to have renewed emphasis on restructuring the health-care system, ensuring the adequate availability of

  15. Preparing States in India for Universal Health Coverage | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This expanded access has the potential to become a financial burden on households. This project aims to provide the evidence needed to support the rollout of universal health care in India. The Public Health Foundation of India, in collaboration with state-level institutions and decision-makers, will carry out the research.

  16. Social health insurance in Nepal: A health system departure toward the universal health coverage.

    Science.gov (United States)

    Pokharel, Rajani; Silwal, Pushkar Raj

    2018-04-10

    The World Health Organization has identified universal health coverage (UHC) as a key approach in reducing equity gaps in a country, and the social health insurance (SHI) has been recommended as an important strategy toward it. This article aims to analyze the design, expected benefits and challenges of realizing the goals of UHC through the recently launched SHI in Nepal. On top of the earlier free health-care policy and several other vertical schemes, the SHI scheme was implemented in 2016 and has reached population coverage of 5% in the implemented districts in just within a year of implementation. However, to achieve UHC in Nepal, in addition to operationalizing the scheme, several other requirements must be dealt simultaneously such as efficient health-care delivery system, adequate human resources for health, a strong information system, improved transparency and accountability, and a balanced mix of the preventive, health promotion, curative, and rehabilitative services including actions to address the social determinants of health. The article notes that strong political commitment and persistent efforts are the key lessons learnt from countries achieving progressive UHC through SHI. Copyright © 2018 John Wiley & Sons, Ltd.

  17. Performance of private sector health care: implications for universal health coverage

    OpenAIRE

    Morgan, R; Ensor, T; Waters, H

    2016-01-01

    Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combi...

  18. Seeking consensus on universal health coverage indicators in the sustainable development goals.

    Science.gov (United States)

    Reddock, Jennifer

    2017-01-01

    There is optimism that the inclusion of universal health coverage in the Sustainable Development Goals advances its prominence in global and national health policy. However, formulating indicators for Target 3.8 through the Inter-Agency Expert Group on Sustainable Development Indicators has been challenging. Achieving consensus on the conceptual and methodological aspects of universal health coverage is likely to take some time in multi-stakeholder fora compared with national efforts to select indicators.

  19. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016-40.

    Science.gov (United States)

    2018-05-05

    Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4-5·1) per year, followed by lower-middle-income countries (4·0%, 3·6-4·5) and low-income countries (2·2%, 1·7-2·8). Despite global growth, per capita health spending was projected to range from only $40 (24-65) to $413 (263-668) in 2040 in low-income countries, and from $140 (90-200) to $1699 (711-3423) in lower-middle-income countries. Globally, the share of health spending

  20. Universal Health Coverage – The Critical Importance of Global Solidarity and Good Governance

    Science.gov (United States)

    Reis, Andreas A.

    2016-01-01

    This article provides a commentary to Ole Norheim’ s editorial entitled "Ethical perspective: Five unacceptable trade-offs on the path to universal health coverage." It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of universal health coverage (UHC). PMID:27694683

  1. Policy Choices for Progressive Realization of Universal Health Coverage Comment on "Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage".

    Science.gov (United States)

    Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Panichkriangkrai, Warisa; Sommanustweechai, Angkana

    2016-07-31

    In responses to Norheim's editorial, this commentary offers reflections from Thailand, how the five unacceptable trade-offs were applied to the universal health coverage (UHC) reforms between 1975 and 2002 when the whole 64 million people were covered by one of the three public health insurance systems. This commentary aims to generate global discussions on how best UHC can be gradually achieved. Not only the proposed five discrete trade-offs within each dimension, there are also trade-offs between the three dimensions of UHC such as population coverage, service coverage and cost coverage. Findings from Thai UHC show that equity is applied for the population coverage extension, when the low income households and the informal sector were the priority population groups for coverage extension by different prepayment schemes in 1975 and 1984, respectively. With an exception of public sector employees who were historically covered as part of fringe benefits were covered well before the poor. The private sector employees were covered last in 1990. Historically, Thailand applied a comprehensive benefit package where a few items are excluded using the negative list; until there was improved capacities on technology assessment that cost-effectiveness are used for the inclusion of new interventions into the benefit package. Not only cost-effectiveness, but long term budget impact, equity and ethical considerations are taken into account. Cost coverage is mostly determined by the fiscal capacities. Close ended budget with mix of provider payment methods are used as a tool for trade-off service coverage and financial risk protection. Introducing copayment in the context of fee-for-service can be harmful to beneficiaries due to supplier induced demands, inefficiency and unpredictable out of pocket payment by households. UHC achieves favorable outcomes as it was implemented when there was a full geographical coverage of primary healthcare coverage in all districts and sub

  2. Universal health coverage in Latin American countries: how to improve solidarity-based schemes.

    Science.gov (United States)

    Titelman, Daniel; Cetrángolo, Oscar; Acosta, Olga Lucía

    2015-04-04

    In this Health Policy we examine the association between the financing structure of health systems and universal health coverage. Latin American health systems encompass a wide range of financial sources, which translate into different solidarity-based schemes that combine contributory (payroll taxes) and non-contributory (general taxes) sources of financing. To move towards universal health coverage, solidarity-based schemes must heavily rely on countries' capacity to increase public expenditure in health. Improvement of solidarity-based schemes will need the expansion of mandatory universal insurance systems and strengthening of the public sector including increased fiscal expenditure. These actions demand a new model to integrate different sources of health-sector financing, including general tax revenue, social security contributions, and private expenditure. The extent of integration achieved among these sources will be the main determinant of solidarity and universal health coverage. The basic challenges for improvement of universal health coverage are not only to spend more on health, but also to reduce the proportion of out-of-pocket spending, which will need increased fiscal resources. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Health care financing in Nigeria: Implications for achieving universal health coverage.

    Science.gov (United States)

    Uzochukwu, B S C; Ughasoro, M D; Etiaba, E; Okwuosa, C; Envuladu, E; Onwujekwe, O E

    2015-01-01

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

  4. Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage

    Directory of Open Access Journals (Sweden)

    Ole Frithjof Norheim

    2015-11-01

    Full Text Available This article discusses what ethicists have called “unacceptable trade-offs” in health policy choices related to universal health coverage (UHC. Since the fiscal space is constrained, trade-offs need to be made. But some trade-offs are unacceptable on the path to universal coverage. Unacceptable choices include, among other examples from low-income countries, to expand coverage for services with lower priority such as coronary bypass surgery before securing universal coverage for high-priority services such as skilled birth attendance and services for easily preventable or treatable fatal childhood diseases. Services of the latter kind include oral rehydration therapy for children with diarrhea and antibiotics for children with pneumonia. The article explains why such trade-offs are unfair and unacceptable even if political considerations may push in the opposite direction.

  5. Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health

    NARCIS (Netherlands)

    de Wolf, Antenor Hallo; Toebes, Brigit

    2016-01-01

    The goal of universal health coverage is to "ensure that all people obtain the health services they need without suffering financial hardship when paying for them." There are many connections between this goal and the state's legal obligation to realize the human right to health. In the context of

  6. From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

    Science.gov (United States)

    Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John G

    2017-01-01

    Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group. PMID:29177101

  7. From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

    Science.gov (United States)

    Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John

    2017-01-01

    Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group.

  8. The quest for universal health coverage: achieving social protection for all in Mexico.

    Science.gov (United States)

    Knaul, Felicia Marie; González-Pier, Eduardo; Gómez-Dantés, Octavio; García-Junco, David; Arreola-Ornelas, Héctor; Barraza-Lloréns, Mariana; Sandoval, Rosa; Caballero, Francisco; Hernández-Avila, Mauricio; Juan, Mercedes; Kershenobich, David; Nigenda, Gustavo; Ruelas, Enrique; Sepúlveda, Jaime; Tapia, Roberto; Soberón, Guillermo; Chertorivski, Salomón; Frenk, Julio

    2012-10-06

    Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries. Copyright

  9. Improving equity in health care financing in China during the progression towards Universal Health Coverage.

    Science.gov (United States)

    Chen, Mingsheng; Palmer, Andrew J; Si, Lei

    2017-12-29

    China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage. We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households. The overall Kakwani index (KI) of China's health care financing system is 0.0444. For general tax KI was -0.0241 (95% confidence interval (CI): -0.0315 to -0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident's Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), -0.1737 (95% CI: -0.2166 to -0.1308), and -0.5598 (95% CI: -0.5830 to -0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China's health care finance system. China's health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China's progression towards UHC.

  10. Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries.

    Science.gov (United States)

    de Andrade, Luiz Odorico Monteiro; Pellegrini Filho, Alberto; Solar, Orielle; Rígoli, Félix; de Salazar, Lígia Malagon; Serrate, Pastor Castell-Florit; Ribeiro, Kelen Gomes; Koller, Theadora Swift; Cruz, Fernanda Natasha Bravo; Atun, Rifat

    2015-04-04

    Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Towards Universal Health Coverage: Exploring the Determinants of ...

    African Journals Online (AJOL)

    WHO),. 2013). For example, Alatinga and Williams (2014) argue that health insurance improves the poor's access to health care and protects them against the costs of illness. With a view to reducing disparities in access to health care, in 2004 ...

  12. Macroeconomic impacts of Universal Health Coverage : Synthetic control evidence from Thailand

    NARCIS (Netherlands)

    M. Rieger (Matthias); N. Wagner (Natascha); A.S. Bedi (Arjun Singh)

    2015-01-01

    textabstractWe study the impact of Universal Health Coverage (UHC) on various macroeconomic outcomes in Thailand using synthetic control methods. Thailand is compared to a weighted average of control countries in terms of aggregate health and economic performance over the period 1995 to 2012. Our

  13. India's "tryst" with universal health coverage: reflections on ethnography in Indian health policymaking.

    Science.gov (United States)

    Nambiar, Devaki

    2013-12-01

    In 2011, India stood at the crossroads of potentially major health reform. A High Level Expert Group (HLEG) on universal health coverage (UHC), convened by the Indian Planning Commission, proposed major changes in the structure and functioning of the country's health system. This paper presents reflections on the role of ethnography in policy-based social change for health in India, drawing from year-long participation in the aforementioned policy development process. It theorizes that international discourses have been (re)appropriated in the Indian case by recourse to both experience and evidence, resulting in a plurality of concepts that could be prioritized for Indian health reform. This articulation involved HLEG members exerting para-ethnographic labour and paying close attention to context, suggesting that ethnographic sensibilities can reside within the interactive and knowledge production practices among experts oriented toward policy change. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Morocco's policy choices to achieve Universal health coverage ...

    African Journals Online (AJOL)

    Morocco's health system remains weak in spite of the improvement of other development indicators in the last ten years. Health remains one of the major challenges to lower the social disparities that are the priority for the authorities. Despite the goodwill of all stakeholders, significant reforms implemented respond only ...

  15. Los seguros de salud mexicanos: cobertura universal incierta Mexican health insurance: uncertain universal coverage

    Directory of Open Access Journals (Sweden)

    Asa Cristina Laurell

    2011-06-01

    Full Text Available El sistema de salud mexicano se compone de la Secretaría de Salud (rectora del sector y prestador de algunos servicios, la seguridad social laboral pública, y el sector privado. Transita por un proceso de reforma iniciado en 1995 para universalizar la cobertura y separar las funciones regulación-financiamiento-prestación de servicios; reforma que después de quince años sigue inacabada y problemática. Este texto analiza crítica- y propositivamente la problemática surgida a raíz de las sucesivas reformas. El énfasis se pone en su última etapa con la introducción del "Seguro Popular" para la población sin seguridad social laboral. El análisis concibe la reforma de salud como parte de la Reforma del Estado en el marco de la reorganización neoliberal de la sociedad. A diferencia de otros países latinoamericanos este proceso no pasó por una nueva Constitución. El análisis se basa en documentos oficiales y un seguimiento sistemático de la instrumentación del Sistema de Protección Social en Salud y su impacto sobre la cobertura y acceso a los servicios. Se concluye que es improbable que se universalice la cobertura poblacional y menos el acceso a los servicios. Empero las reformas están forzando la mercantilización del sistema aún en presencia de un sector privado débil.The Mexican health system is comprised of the Department of Health, state labor social security and the private sector. It is undergoing a reform process initiated in 1995 to achieve universal coverage and separate the regulation, financing and service functions; a reform that after fifteen years is incomplete and problematic. The scope of this paper is to assess the problems that underlie the successive reforms. Special emphasis is given to the last reform stage with the introduction of the "Insurance of the People" aimed at the population without labor social security. In the analysis, health reform is seen as part of the Reform of the State in the context of

  16. Understanding the impact of global trade liberalization on health systems pursuing universal health coverage.

    Science.gov (United States)

    Missoni, Eduardo

    2013-01-01

    In the context of reemerging universalistic approaches to health care, the objective of this article was to contribute to the discussion by highlighting the potential influence of global trade liberalization on the balance between health demand and the capacity of health systems pursuing universal health coverage (UHC) to supply adequate health care. Being identified as a defining feature of globalization affecting health, trade liberalization is analyzed as a complex and multidimensional influence on the implementation of UHC. The analysis adopts a systems-thinking approach and refers to the six building blocks of World Health Organization's current "framework for action," emphasizing their interconnectedness. While offering new opportunities to increase access to health information and care, in the absence of global governance mechanisms ensuring adequate health protection and promotion, global trade tends to have negative effects on health systems' capacity to ensure UHC, both by causing higher demand and by interfering with the interconnected functioning of health systems' building blocks. The prevention of such an impact and the effective implementation of UHC would highly benefit from a more consistent commitment and stronger leadership by the World Health Organization in protecting health in global policymaking fora in all sectors. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. Universal health coverage and the health Sustainable Development Goal: achievements and challenges for Sri Lanka.

    Science.gov (United States)

    de Silva, Amala; Ranasinghe, Thushara; Abeykoon, Palitha

    2016-09-01

    With state-funded health care that is free at the point of delivery, a sound primary health-care policy and widespread health-care services, Sri Lanka seems a good example of universal health coverage. Yet, health transition and disparities in provision and financing threaten this situation. Sri Lanka did well on the Millennium Development Goal health indicators, but the Sustainable Development Goal (SDG) for health has a wider purview, which is to "ensure healthy lives and promote well-being for all at all ages". The gender gap in life expectancy and the gap between life expectancy and healthy life expectancy make achievement of the health SDG more challenging. Although women and children do well overall, the comparative health disadvantage for men in Sri Lanka is a cause for concern. From a financing perspective, high out-of-pocket expenditure and high utilization of the private sector, even by those in the lowest income quintile, are concerns, as is the emerging "third tier", where some individuals accessing state health care that is free at the point of delivery actually bear some of the costs of drugs, investigations and surgery. This cost sharing is resulting in catastrophic health expenditure for individuals, and delays in and non-compliance with treatment. These concerns about provision and financing must be addressed, as health transition will intensify the morbidity burden and loss of well-being, and could derail plans to achieve the health SDG.

  18. Progress towards universal health coverage in BRICS: translating economic growth into better health.

    Science.gov (United States)

    Rao, Krishna D; Petrosyan, Varduhi; Araujo, Edson Correia; McIntyre, Diane

    2014-06-01

    Brazil, the Russian Federation, India, China and South Africa--the countries known as BRICS--represent some of the world's fastest growing large economies and nearly 40% of the world's population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation, poor coordination has led to the fragmented pooling and inefficient use of resources. In mixed health systems it is essential to harness both public and private sector resources.

  19. The importance of Leadership towards universal health coverage

    African Journals Online (AJOL)

    to travel over 10 km to reach the nearest public health centre and the distance .... that failure to implement the promise should breed pressure from parliaments, civil .... McCoy, D., H. Ashwood-Smith, E. Ratsma, and J. Kemp. Going from bad to ...

  20. Indonesia's road to universal health coverage: A political journey

    NARCIS (Netherlands)

    Pisani, E. (Elizabeth); Kok, M.O. (Maarten Olivier); Nugroho, K. (Kharisma)

    2017-01-01

    textabstractIn 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. This paper explores

  1. Telemedicine as a source of universal health coverage in pakistan

    International Nuclear Information System (INIS)

    Chowdhry, B.S.; Bhatti, M.I.; Baig, M.A.A.

    2013-01-01

    The combination of information and communication technologies (ICTs) for sustainable healthcare through telemedicine focuses on both changes in the access of healthcare information services as well as wider dissemination of healthcare related skills and professional expertise of medical community. Many developing countries are deficient in healthcare services and suffer from a shortage of doctors and other healthcare Professionals. In Pakistan, the inadequate allocation of doctors/specialists, infrastructures of telecommunications, roads and transport make it more difficult to provide in remote and rural areas. Where clinics and hospitals exist, they are often ill-equipped. The aim of this paper is to share knowledge about the use of telemedic solutions in the health sector in order to propose strategies and actions to formulate tactical recommendations for policy makers and advisors as well as researchers. The examples in this paper illustrate that telemedicine has clearly made an impact on healthcare. (author)

  2. Universal Health Coverage and the Right to Health: From Legal Principle to Post-2015 Indicators.

    Science.gov (United States)

    Sridhar, Devi; McKee, Martin; Ooms, Gorik; Beiersmann, Claudia; Friedman, Eric; Gouda, Hebe; Hill, Peter; Jahn, Albrecht

    2015-01-01

    Universal Health Coverage (UHC) is widely considered one of the key components for the post-2015 health goal. The idea of UHC is rooted in the right to health, set out in the International Covenant on Economic, Social, and Cultural Rights. Based on the Covenant and the General Comment of the Committee on Economic, Social, and Cultural Rights, which is responsible for interpreting and monitoring the Covenant, we identify 6 key legal principles that should underpin UHC based on the right to health: minimum core obligation, progressive realization, cost-effectiveness, shared responsibility, participatory decision making, and prioritizing vulnerable or marginalized groups. Yet, although these principles are widely accepted, they are criticized for not being specific enough to operationalize as post-2015 indicators for reaching the target of UHC. In this article, we propose measurable and achievable indicators for UHC based on the right to health that can be used to inform the ongoing negotiations on Sustainable Development Goals. However, we identify 3 major challenges that face any exercise in setting indicators post-2015: data availability as an essential criterion, the universality of targets, and the adaptation of global goals to local populations. © SAGE Publications 2015.

  3. Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals.

    Science.gov (United States)

    Tangcharoensathien, Viroj; Mills, Anne; Palu, Toomas

    2015-04-29

    The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.

  4. Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada

    OpenAIRE

    Soc?as, M. Eugenia; Shoveller, Jean; Bean, Chili; Nguyen, Paul; Montaner, Julio; Shannon, Kate

    2016-01-01

    Background Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC), sex workers? experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC. Methods Data was drawn from an ongoing community-based, prospective cohort of women sex worke...

  5. Strengthening Health Systems of Developing Countries: Inclusion of Surgery in Universal Health Coverage.

    Science.gov (United States)

    Okoroh, Juliet S; Chia, Victoria; Oliver, Emily A; Dharmawardene, Marisa; Riviello, Robert

    2015-08-01

    Universal health coverage (UHC) has its roots in the Universal Declaration of Human Rights and has recently gained momentum. Out-of-pocket payments (OPP) remain a significant barrier to care. There is an increasing global prevalence of non-communicable diseases, many of which are surgically treatable. We sought to provide a comparative analysis of the inclusion of surgical care in operating plans for UHC in low- and middle-income countries (LMIC). We systematically searched PubMed and Google Scholar using pre-defined criteria for articles published in English, Spanish, or French between January 1991 and November 2013. Keywords included "insurance," "OPP," "surgery," "trauma," "cancer," and "congenital anomalies." World Health Organization (WHO), World Bank, and Joint Learning Network for UHC websites were searched for supporting documents. Ministries of Health were contacted to provide further information on the inclusion of surgery. We found 696 articles and selected 265 for full-text review based on our criteria. Some countries enumerated surgical conditions in detail (India, 947 conditions). Other countries mentioned surgery broadly. Obstetric care was most commonly covered (19 countries). Solid organ transplantation was least covered. Cancer care was mentioned broadly, often without specifying the therapeutic modality. No countries were identified where hospitals are required to provide emergency care regardless of insurance coverage. OPP varied greatly between countries. Eighty percent of countries had OPP of 60% or more, making these services, even if partially covered, largely inaccessible. While OPP, delivery, and utilization continue to represent challenges to health care access in many LMICs, the inclusion of surgery in many UHC policies sets an important precedent in addressing a growing global prevalence of surgically treatable conditions. Barriers to access, including inequalities in financial protection in the form of high OPP, remain a fundamental

  6. The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand.

    Science.gov (United States)

    Ghislandi, Simone; Manachotphong, Wanwiphang; Perego, Viviana M E

    2015-07-01

    Thailand is among the first non-OECD countries to have introduced a form of Universal Health Coverage (UHC). This policy represents a natural experiment to evaluate the effects of public health insurance on health behaviours. In this paper, we examine the impact of Thailand's UHC programme on preventive activities, unhealthy or risky behaviours and health care consumption using data from the Thai Health and Welfare Survey. We use doubly robust estimators that combine propensity scores and linear regressions to estimate differences-in-differences (DD) and differences-in-DD models. Our results offer important insights. First, UHC increases individuals' likelihood of having an annual check-up, especially among women. Regarding health care consumption, we observe that UHC increases hospital admissions by over 2% and increases outpatient visits by 13%. However, there is no evidence that UHC leads to an increase in unhealthy behaviours or a reduction of preventive efforts. In other words, we find no evidence of ex ante moral hazard. Overall, these findings suggest positive health impacts among the Thai population covered by UHC.

  7. Achieving universal health coverage in small island states: could importing health services provide a solution?

    Science.gov (United States)

    Walls, Helen; Smith, Richard

    2018-01-01

    Background Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option. Methods Analysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu. Findings Medical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS. Interpretation Our findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control. PMID:29527349

  8. Public Health Insurance in Vietnam towards Universal Coverage: Identifying the challenges, issues, and problems in its design and organizational practices

    OpenAIRE

    Midori Matsushima; Hiroyuki Yamada

    2013-01-01

    Vietnam is attempting to achieve universal health insurance coverage by 2014. Despite great progress, the country faces some challenges, issues and problems. This paper reviewed official documents, existing reports, and related literature to address: (1) grand design for achieving universal health coverage, (2) current insurance coverage, (3) health insurance premium and subsidies by the government, (4) benefit package and payment rule, and (5) organizational practices. From the review, it be...

  9. Health-financing reforms in southeast Asia: challenges in achieving universal coverage.

    Science.gov (United States)

    Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Ir, Por; Aljunid, Syed Mohamed; Mukti, Ali Ghufron; Akkhavong, Kongsap; Banzon, Eduardo; Huong, Dang Boi; Thabrany, Hasbullah; Mills, Anne

    2011-03-05

    In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage.

    Science.gov (United States)

    Ooms, G; Marten, R; Waris, A; Hammonds, R; Mulumba, M; Friedman, E A

    2014-02-01

    Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,(1) why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  11. Performance of private sector health care: implications for universal health coverage.

    Science.gov (United States)

    Morgan, Rosemary; Ensor, Tim; Waters, Hugh

    2016-08-06

    Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision.

    Science.gov (United States)

    Fusheini, Adam; Eyles, John

    2016-10-07

    Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously

  13. Access to Medicines by Seguro Popular Beneficiaries: Pending Tasks towards Universal Health Coverage.

    Directory of Open Access Journals (Sweden)

    Edson Servan-Mori

    Full Text Available In the context of aiming to achieve universal health coverage in Mexico, this study compares access to prescribed medicines (ATPM between Seguro Popular (SP and non-SP affiliated outpatient health service users.ATPM by 6,123 users of outpatient services was analyzed using the National Health and Nutrition Survey 2012. Adjusted bi-probit models were performed incorporating instrumental variables.17.3% of SP and 10.1% of the non-SP population lacked ATPM. Two-thirds of all outpatient SP and 18.5% of all outpatient non-SP received health services at Ministry of Health facilities, among whom, 64.6 and 53.6% of the SP and non-SP population respectively reported ATPM at these facilities. Lack of medicines in health units, chronic health problems (compared to acute conditions and prescription ≥3 medicines were risk factors for non-ATPM. Adjusted models suggest that when using Ministry of Health services, the SP population has a higher probability of ATMP compared to the non-SP population.Given the aspirations of achieving universal health coverage in Mexico, it is important to increase ATPM in Ministry of Health facilities thereby ensuring basic rights to health care are met.

  14. Access to Medicines by Seguro Popular Beneficiaries: Pending Tasks towards Universal Health Coverage.

    Science.gov (United States)

    Servan-Mori, Edson; Heredia-Pi, Ileana; Montañez-Hernandez, Julio; Avila-Burgos, Leticia; Wirtz, Veronika J

    2015-01-01

    In the context of aiming to achieve universal health coverage in Mexico, this study compares access to prescribed medicines (ATPM) between Seguro Popular (SP) and non-SP affiliated outpatient health service users. ATPM by 6,123 users of outpatient services was analyzed using the National Health and Nutrition Survey 2012. Adjusted bi-probit models were performed incorporating instrumental variables. 17.3% of SP and 10.1% of the non-SP population lacked ATPM. Two-thirds of all outpatient SP and 18.5% of all outpatient non-SP received health services at Ministry of Health facilities, among whom, 64.6 and 53.6% of the SP and non-SP population respectively reported ATPM at these facilities. Lack of medicines in health units, chronic health problems (compared to acute conditions) and prescription ≥3 medicines were risk factors for non-ATPM. Adjusted models suggest that when using Ministry of Health services, the SP population has a higher probability of ATMP compared to the non-SP population. Given the aspirations of achieving universal health coverage in Mexico, it is important to increase ATPM in Ministry of Health facilities thereby ensuring basic rights to health care are met.

  15. Controlling cost escalation of healthcare: making universal health coverage sustainable in China

    Science.gov (United States)

    2012-01-01

    An increasingly number of low- and middle-income countries have developed and implemented a national policy towards universal coverage of healthcare for their citizens over the past decade. Among them is China which has expanded its population coverage by health insurance from around 29.7% in 2003 to over 90% at the end of 2010. While both central and local governments in China have significantly increased financial inputs into the two newly established health insurance schemes: new cooperative medical scheme (NCMS) for the rural population, and urban resident basic health insurance (URBMI), the cost of healthcare in China has also been rising rapidly at the annual rate of 17.0%% over the period of the past two decades years. The total health expenditure increased from 74.7 billion Chinese yuan in 1990 to 1998 billion Chinese yuan in 2010, while average health expenditure per capital reached the level of 1490.1 Chinese yuan per person in 2010, rising from 65.4 Chinese yuan per person in 1990. The repaid increased population coverage by government supported health insurance schemes has stimulated a rising use of healthcare, and thus given rise to more pressure on cost control in China. There are many effective measures of supply-side and demand-side cost control in healthcare available. Over the past three decades China had introduced many measures to control demand for health care, via a series of co-payment mechanisms. The paper introduces and discusses new initiatives and measures employed to control cost escalation of healthcare in China, including alternative provider payment methods, reforming drug procurement systems, and strengthening the application of standard clinical paths in treating patients at hospitals, and analyses the impacts of these initiatives and measures. The paper finally proposes ways forward to make universal health coverage in China more sustainable. PMID:22992484

  16. How changes to Irish healthcare financing are affecting universal health coverage.

    Science.gov (United States)

    Briggs, Adam D M

    2013-11-01

    In 2010, the World Health Organisation (WHO) published the World Health Report - Health systems financing: the path to universal coverage. The Director-General of the WHO, Dr Margaret Chan, commissioned the report "in response to a need, expressed by rich and poor countries alike, for practical guidance on ways to finance health care". Given the current context of global economic hardship and difficult budgetary decisions, the report offered timely recommendations for achieving universal health coverage (UHC). This article analyses the current methods of healthcare financing in Ireland and their implications for UHC. Three questions are asked of the Irish healthcare system: firstly, how is the health system financed; secondly, how can the health system protect people from the financial consequences of ill-health and paying for health services; and finally, how can the health system encourage the optimum use of available resources? By answering these three questions, this article argues that the Irish healthcare system is not achieving UHC, and that it is unclear whether recent changes to financing are moving Ireland closer or further away from the WHO's ambition for healthcare for all. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Population Consultation: A Powerful Means to Ensure that Health Strategies are Oriented Towards Universal Health Coverage.

    Science.gov (United States)

    Rohrer, Katja; Rajan, Dheepa; Schmets, Gerard

    2017-01-01

    We seek to highlight why population consultations need to be promoted more strongly as a powerful means to move health reforms towards Universal Health Coverage (UHC). However, despite this increasing recognition that the "population" is the key factor of successful health planning and high-quality service delivery, there has been very little systematic reflection and only limited (international) attention brought to the idea of specifically consulting the population to improve the quality and soundness of health policies and strategies and to strengthen the national health planning process and implementation. So far, research has done little to assess the significance of population consultations for the health sector and its importance for strategic planning and implementation processes; in addition, there has been insufficient evaluation of population consultations in the health sector or health-related areas. We drew on ongoing programmatic work of World Health Organization (WHO) offices worldwide, as most population consultations are not well-documented. In addition, we analyzed any existing documentation available on population consultations in health. We then elaborate on the potential benefits of bringing the population's voice into national health planning. We briefly mention the key methods used for population consultations, and we put forward recent country examples showing that population consultation is an effective way of assessing the population's needs and expectations, and should be more widely used in strategizing health. Giving the voice to the population is a means to strengthen accountability, to reinforce the commitment of policy makers, decision-makers and influencers (media, political parties, academics, etc.) to the health policy objectives of UHC, and, in the specific case of donor-dependent countries, to sensitize donors' engagement and alignment with national health strategies. The consequence of the current low international interest for

  18. The path towards universal health coverage in the Arab uprising countries Tunisia, Egypt, Libya, and Yemen.

    Science.gov (United States)

    Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M; Mataria, Awad; Sabri, Belgacem; Nasher, Jamal; Zeiton, Moez; Ahmad, Shaimaa; Siddiqi, Sameen

    2014-01-25

    The constitutions of many countries in the Arab world clearly highlight the role of governments in guaranteeing provision of health care as a right for all citizens. However, citizens still have inequitable health-care systems. One component of such inequity relates to restricted financial access to health-care services. The recent uprisings in the Arab world, commonly referred to as the Arab spring, created a sociopolitical momentum that should be used to achieve universal health coverage (UHC). At present, many countries of the Arab spring are considering health coverage as a priority in dialogues for new constitutions and national policy agendas. UHC is also the focus of advocacy campaigns of a number of non-governmental organisations and media outlets. As part of the health in the Arab world Series in The Lancet, this report has three overarching objectives. First, we present selected experiences of other countries that had similar social and political changes, and how these events affected their path towards UHC. Second, we present a brief overview of the development of health-care systems in the Arab world with regard to health-care coverage and financing, with a focus on Egypt, Libya, Tunisia, and Yemen. Third, we aim to integrate historical lessons with present contexts in a roadmap for action that addresses the challenges and opportunities for progression towards UHC. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Defining Pathways and Trade-offs Toward Universal Health Coverage Comment on “Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage”

    Directory of Open Access Journals (Sweden)

    Stéphane Verguet

    2016-07-01

    Full Text Available The World Health Organization’s (WHO’s World Health Report 2010, “Health systems financing, the path to universal coverage,” promoted universal health coverage (UHC as an aspirational objective for country health systems. Yet, in addition to the dimensions of services and coverage, distribution of coverage in the population, and financial risk protection highlighted by the report, the consideration of the budget constraint should be further strengthened in the ensuing debate on resource allocation toward UHC. Beyond the substantial financial constraints faced by low- and middle-income countries, additional considerations, such as the geographical context, the underlying country infrastructure, and the architecture of health systems, determine the feasibility, effectiveness, quality and cost of healthcare delivery. Therefore, increased production and use of local evidence tied to the criteria of health benefits, equity, financial risk protection, and costs accompanying health delivery are needed so that to highlight pathways and acceptable trade-offs toward UHC.

  20. Investing in Nurses is a Prerequisite for Ensuring Universal Health Coverage.

    Science.gov (United States)

    Kurth, Ann E; Jacob, Sheena; Squires, Allison P; Sliney, Anne; Davis, Sheila; Stalls, Suzanne; Portillo, Carmen J

    2016-01-01

    Nurses and midwives constitute the majority of the global health workforce and the largest health care expenditure. Efficient production, successful deployment, and ongoing retention based on carefully constructed policies regarding the career opportunities of nurses, midwives, and other providers in health care systems are key to ensuring universal health coverage. Yet nurses are constrained by practice regulations, workplaces, and career ladder barriers from contributing to primary health care delivery. Evidence shows that quality HIV care, comparable to that of physicians, is provided by trained nurses and associate clinicians, but many African countries' health systems remain dependent on limited numbers of physicians and fail to meet the demand for treatment. The World Health Organization endorses task sharing to ensure universal health coverage in HIV and maternal health, which requires an investment in nursing education, retention, and professional growth opportunities. Exemplars from Haiti, Rwanda, Republic of Georgia, and multi-country efforts are described. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  1. South Africa's universal health coverage reforms in the post-apartheid period.

    Science.gov (United States)

    van den Heever, Alexander Marius

    2016-12-01

    In 2011, the South African government published a Green Paper outlining proposals for a single-payer National Health Insurance arrangement as a means to achieve universal health coverage (UHC), followed by a White Paper in 2015. This follows over two decades of health reform proposals and reforms aimed at deepening UHC. The most recent reform departure aims to address pooling and purchasing weaknesses in the health system by internalising both functions within a single scheme. This contrasts with the post-apartheid period from 1994 to 2008 where pooling weaknesses were to be addressed using pooling schemes, in the form of government subsidies and risk-equalisation arrangements, external to the public and private purchasers. This article reviews both reform paths and attempts to reconcile what may appear to be very different approaches. The scale of the more recent set of proposals requires a very long reform path because in the mid-term (the next 25 years) no single scheme will be able to raise sufficient revenue to provide a universal package for the entire population. In the interim, reforms that maintain and improve existing forms of coverage are required. The earlier reform framework (1994-2008) largely addressed this concern while leaving open the final form of the system. Both reform approaches are therefore compatible: the earlier reforms addressed medium- to long-term coverage concerns, while the more recent define the long-term institutional goal. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Progress Toward Universal Health Coverage: A Comparative Analysis in 5 South Asian Countries.

    Science.gov (United States)

    Rahman, Md Mizanur; Karan, Anup; Rahman, Md Shafiur; Parsons, Alexander; Abe, Sarah Krull; Bilano, Ver; Awan, Rabia; Gilmour, Stuart; Shibuya, Kenji

    2017-09-01

    Achieving universal health coverage is one of the key targets in the newly adopted Sustainable Development Goals of the United Nations. To investigate progress toward universal health coverage in 5 South Asian countries and assess inequalities in health services and financial risk protection indicators. In a population-based study, nationally representative household (335 373 households) survey data from Afghanistan (2014 and 2015), Bangladesh (2010 and 2014), India (2012 and 2014), Nepal (2014 and 2015), and Pakistan (2014) were used to calculate relative indices of health coverage, financial risk protection, and inequality in coverage among wealth quintiles. The study was conducted from June 2012 to February 2016. Three dimensions of universal health coverage were assessed: access to basic services, financial risk protection, and equity. Composite and indicator-specific coverage rates, stratified by wealth quintiles, were then estimated. Slope and relative index of inequality were used to assess inequalities in service and financial indicators. Access to basic care varied substantially across all South Asian countries, with mean rates of overall prevention coverage and treatment coverage of 53.0% (95% CI, 42.2%-63.6%) and 51.2% (95% CI, 45.2%-57.1%) in Afghanistan, 76.5% (95% CI, 61.0%-89.0%) and 44.8% (95% CI, 37.1%-52.5%) in Bangladesh, 74.2% (95% CI, 57.0%-88.1%) and 83.5% (95% CI, 54.4%-99.1%) in India, 76.8% (95% CI, 66.5%-85.7%) and 57.8% (95% CI, 50.1%-65.4%) in Nepal, and 69.8% (95% CI, 58.3%-80.2%) and 50.4% (95% CI, 37.1%-63.6%) in Pakistan. Financial risk protection was generally low, with 15.3% (95% CI, 14.7%-16.0%) of respondents in Afghanistan, 15.8% (95% CI, 14.9%-16.8%) in Bangladesh, 17.9% (95% CI, 17.7%-18.2%) in India, 11.8% (95% CI, 11.8%-11.9%) in Nepal, and 4.4% (95% CI, 4.0%-4.9%) in Pakistan reporting incurred catastrophic payments due to health care costs. Access to at least 4 antenatal care visits, institutional delivery, and presence

  3. Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector

    Directory of Open Access Journals (Sweden)

    Abiiro Gilbert

    2012-10-01

    Full Text Available Abstract Background Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP policy in Ghana. Discussion Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing, as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems. Summary The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It

  4. Confronting the fear factor: the coverage/access disparity in universal health care.

    Science.gov (United States)

    Litow, Mark E

    2007-01-01

    Since their introduction following World War II, single-payer health care systems and universally mandated health care systems have stumbled, but in their pratfalls are many lessons that apply to the universal health care proposals currently on the table in the United States. The critical and often-over-looked point is that universal coverage does not guarantee that individuals will receive needed care--In many cases guaranteed access to care is a false promise or available only on a delayed timetable. A more feasible alternative lies in providing a safety net for citizens who truly need care and financial support with an appropriate system of checks and balances--without disrupting the economic and actuarial fundamental principles of supply and demand and risk classification.

  5. Is universal coverage via social health insurance financially feasible in Swaziland?

    Science.gov (United States)

    Mathauer, Inke; Musango, Laurent; Sibandze, Sibusiso; Mthethwa, Khosi; Carrin, Guy

    2011-03-01

    The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population. The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team. SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018.

  6. Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health

    Science.gov (United States)

    2016-01-01

    Abstract The goal of universal health coverage is to “ensure that all people obtain the health services they need without suffering financial hardship when paying for them.” There are many connections between this goal and the state’s legal obligation to realize the human right to health. In the context of this goal, it is important to assess private actors’ involvement in the health sector. For example, private actors may not always have the incentives to deal with externalities that affect the availability, accessibility, acceptability, and quality of health care services; they may not be in a position to provide “public goods”; or they may operate under imperfect information. This paper sets out to answer the question, what legal human rights obligations do states have in terms of regulating private sector involvement in health care? PMID:28559678

  7. Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health.

    Science.gov (United States)

    Hallo De Wolf, Antenor; Toebes, Brigit

    2016-12-01

    The goal of universal health coverage is to "ensure that all people obtain the health services they need without suffering financial hardship when paying for them." There are many connections between this goal and the state's legal obligation to realize the human right to health. In the context of this goal, it is important to assess private actors' involvement in the health sector. For example, private actors may not always have the incentives to deal with externalities that affect the availability, accessibility, acceptability, and quality of health care services; they may not be in a position to provide "public goods"; or they may operate under imperfect information. This paper sets out to answer the question, what legal human rights obligations do states have in terms of regulating private sector involvement in health care?

  8. The Politics of Universal Health Coverage in Low- and Middle-Income Countries: A Framework for Evaluation and Action.

    Science.gov (United States)

    Fox, Ashley M; Reich, Michael R

    2015-10-01

    Universal health coverage has recently become a top item on the global health agenda pressed by multilateral and donor organizations, as disenchantment grows with vertical, disease-specific health programs. This increasing focus on universal health coverage has brought renewed attention to the role of domestic politics and the interaction between domestic and international relations in the health reform process. This article proposes a theory-based framework for analyzing the politics of health reform for universal health coverage, according to four stages in the policy cycle (agenda setting, design, adoption, and implementation) and four variables that affect reform (interests, institutions, ideas, and ideology). This framework can assist global health policy researchers, multilateral organization officials, and national policy makers in navigating the complex political waters of health reforms aimed at achieving universal health coverage. To derive the framework, we critically review the theoretical and applied literature on health policy reform in developing countries and illustrate the framework with examples of health reforms moving toward universal coverage in low- and middle-income countries. We offer a series of lessons stemming from these experiences to date. Copyright © 2015 by Duke University Press.

  9. Assessing government’s fiscal space for moving towards universal health coverage in Cambodia

    Directory of Open Access Journals (Sweden)

    Kouland Thin

    2017-01-01

    Full Text Available Background In line with the global trend, it becomes clear that the Cambodian government’s policy direction is leaning toward universal health coverage, the agreed target within the newly ratified Sustainable Development Goals. Thus, the health system will need to be further reformed to achieve this target by 2030. To assess if the Cambodian government is able to increase the proportion of health budget out of the total government expenditure, this study will evaluate the government’s fiscal space and propose feasible options where and to what extent new resources can be generated for improving the health system. Design The data used for this analysis were obtained from World Bank online database and a series of Cambodia’s economic updates produced by the World Bank office in Cambodia. We observed the trends over time from 2011 to 2018 to provide insights into the extent to which fiscal space for health can be expanded. Findings By assessing the key fiscal indicators, it is unlikely that the Cambodian government is able to increase the proportion of health budget out of its total budget in the short run. Health budget is increased in absolute terms but not in real terms, which is linked tightly to the predicted 7% economic growth per annum. Conclusion The proportion of health budget from now until 2018 is expected to remain the same, and the revenues raised through pre‐payment mechanisms are still too small to address the pressing issues in the current health system. The Ministry of Health could benefit from putting a much stronger effort on improving efficiency and equity in the distribution of resources, as well as transparency and accountability, to achieve the immediate objectives for universal health coverage.

  10. Health in Southeast Asia 6 Health-financing reforms in southeast Asia: challenges in achieving universal coverage

    OpenAIRE

    Tangcharoensathien, V; Patcharanarumol, W; Ir, P; Aljunid, SM; Mukti, AG; Akkhavong, K; Banzon, E; Huong, DB; Thabrany, H; Mills, A

    2011-01-01

    In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for natio...

  11. India's Proposed Universal Health Coverage Policy: Evidence for Age Structure Transition Effect and Fiscal Sustainability.

    Science.gov (United States)

    Narayana, Muttur Ranganathan

    2016-12-01

    India's High Level Expert Group on Universal Health Coverage in 2011 recommended a universal, public-funded and national health coverage policy. As a plausible forward-looking macroeconomic reform in the health sector, this policy proposal on universal health coverage (UHC) needs to be evaluated for age structure transition effect and fiscal sustainability to strengthen its current design and future implementation. Macroeconomic analyses of the long-term implications of age structure transition and fiscal sustainability on India's proposed UHC policy. A new measure of age-specific UHC is developed by combining the age profile of public and private health consumption expenditure by using the National Transfer Accounts methodology. Different projections of age-specific public health expenditure are calculated over the period 2005-2100 to account for the age structure transition effect. The projections include changes in: (1) levels of the expenditure as gross domestic product grows, (2) levels and shape of the expenditure as gross domestic product grows and expenditure converges to that of developed countries (or convergence scenario) based on the Lee-Carter model of forecasting mortality rates, and (3) levels of the expenditure as India moves toward a UHC policy. Fiscal sustainability under each health expenditure projection is determined by using the measures of generational imbalance and sustainability gap in the Generational Accounting methodology. Public health expenditure is marked by age specificities and the elderly population is costlier to support for their healthcare needs in the future. Given the discount and productivity growth rates, the proposed UHC is not fiscally sustainable under India's current fiscal policies except for the convergence scenario. However, if the income elasticity of public expenditure on social welfare and health expenditure is less than one, fiscal sustainability of the UHC policy is attainable in all scenarios of projected public

  12. The implication of the shortage of health workforce specialist on universal health coverage in Kenya.

    Science.gov (United States)

    Miseda, Mumbo Hazel; Were, Samuel Odhiambo; Murianki, Cirindi Anne; Mutuku, Milo Peter; Mutwiwa, Stephen N

    2017-12-01

    Globally, there is an acute shortage of human resources for health (HRH), and the greatest burden is borne by low-income countries especially in sub-Saharan Africa and some parts of Asia. This shortage has not only considerably constrained the achievement of health-related development goals but also impeded accelerated progress towards universal health coverage (UHC). Like any other low-income country, Kenya is experiencing health workforce shortage particularly in specialized healthcare workers to cater for the rapidly growing need for specialized health care (MOH Training Needs Assessment report (2015)). Efficient use of the existing health workforce including task shifting is under consideration as a short-term stop gap measure while deliberate efforts are being put on retention policies and increased production of HRH. The Ministry of Health (MOH) with support from the United States Agency for International Development-funded FUNZOKenya project and MOH/Japan International Cooperation Agency (JICA) project conducted a country-wide training needs assessment (TNA) to identify skill gaps in the provision of specialized health care in private and public hospitals in 46 out of Kenya's 47 counties between April and June 2015. A total of 99 respondents participated in the TNA. Structured questionnaires were used to undertake this assessment. The assessment sought to determine the extent of skill gaps on the basis of the national guidelines and as perceived by the County Directors of Health (CDH). The questionnaires were posted to and received by all the respondents a week prior to a face-to-face interview with the respondents for familiarization. Data analysis was done using SPSS statistical package. Overall, the findings revealed average skill gaps on selected specialists (healthcare professional whose practice is limited to a particular area, such as a branch of medicine, surgery, or nursing, especially, one who by virtue of advanced training is certified by a

  13. Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing.

    Science.gov (United States)

    Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

    2015-11-01

    Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite

  14. Rotavirus vaccines contribute towards universal health coverage in a mixed public-private healthcare system.

    Science.gov (United States)

    Loganathan, Tharani; Jit, Mark; Hutubessy, Raymond; Ng, Chiu-Wan; Lee, Way-Seah; Verguet, Stéphane

    2016-11-01

    To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes. The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model. We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles. We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency. © 2016 John Wiley & Sons Ltd.

  15. Assessing the universal health coverage target in the Sustainable Development Goals from a human rights perspective.

    Science.gov (United States)

    Chapman, Audrey R

    2016-12-15

    The UN's Sustainable Development Goals (SDGs), adopted in September 2015, include a comprehensive health goal, "to ensure healthy lives and promote well-being at all ages." The health goal (SDG 3) has nine substantive targets and four additional targets which are identified as a means of implementation. One of these commitments, to achieve universal health coverage (UHC), has been acknowledged as central to the achievement of all of the other health targets. As defined in the SDGs, UHC includes financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all. This article evaluates the extent to which the UHC target in the SDGs conforms with the requirements of the right to health enumerated in the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of the Child, and other international human rights instruments and interpreted by international human rights bodies. It does so as a means to identify strengths and weaknesses in the framing of the UHC target that are likely to affect its implementation. While UHC as defined in the SDGs overlaps with human rights standards, there are important human rights omissions that will likely weaken the implementation and reduce the potential benefits of the UHC target. The most important of these is the failure to confer priority to providing access to health services to poor and disadvantaged communities in the process of expanding health coverage and in determining which health services to provide. Unless the furthest behind are given priority and strategies adopted to secure their participation in the development of national health plans, the SDGs, like the MDGs, are likely to leave the most disadvantaged and vulnerable communities behind.

  16. Family Planning in the Context of Latin America's Universal Health Coverage Agenda.

    Science.gov (United States)

    Fagan, Thomas; Dutta, Arin; Rosen, James; Olivetti, Agathe; Klein, Kate

    2017-09-27

    Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts. Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method

  17. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success.

    Science.gov (United States)

    Rodney, Anna M; Hill, Peter S

    2014-10-10

    Equity should be implicit within universal health coverage (UHC) however, emerging evidence is showing that without adequate focus on measurement of equity, vulnerable populations may continue to receive inadequate or inferior health care. This study undertakes a narrative review which aims to: (i) elucidate how equity is contextualised and measured within UHC, and (ii) describe tools, resources and lessons which will assist decision makers to plan and implement UHC programmes which ensure equity for all. A narrative review of peer-reviewed literature published in English between 2005 and 2013, retrieved from PubMed via the search words, 'universal health coverage/care' and 'equity/inequity' was performed. Websites of key global health organizations were also searched for relevant grey literature. Papers were excluded if they failed to focus on equity (of access, financial risk protection or health outcomes) as well as focusing on one of the following: (i) the impact of UHC programmes, policies or interventions on equity (ii) indicators, measurement, monitoring and/or evaluation of equity within UHC, or (iii) tools or resources to assist with measurement. Eighteen journal articles consisting mostly of secondary analysis of country data and qualitative case studies in the form of commentaries/reviews, and 13 items of grey literature, consisting largely of reports from working groups and expert meetings focusing on defining, understanding and measuring inequity in UHC (including recent drafts of global/country monitoring frameworks) were included. The literature advocates for progressive universalism addressing monetary and non-monetary barriers to access and strengthening existing health systems. This however relies on countries being effectively able to identify and reach disadvantaged populations and estimate unmet need. Countries should assess the new WHO/WB-proposed framework for its ability to adequately track the progress of disadvantaged populations in terms

  18. Universal health coverage at the macro level: Synthetic control evidence from Thailand.

    Science.gov (United States)

    Rieger, Matthias; Wagner, Natascha; Bedi, Arjun S

    2017-01-01

    As more and more countries are moving towards Universal Health Coverage (UHC), it is important to understand the macro level or aggregate impacts of such a policy. We use synthetic control methods to study the impact of UHC, introduced in Thailand in 2001, on various macroeconomic and health outcomes. Thailand is compared to a weighted average of control countries in terms of aggregate health financing indicators, aggregate health outcomes and economic performance, over the period 1995 to 2012. Our results suggest that UHC helps alleviate the financial consequences of illnesses. The estimated treatment effect of UHC on out-of-pocket payments as a percentage of overall health expenditures is negative 13 percentage points and its effect on annual government per capita health spending is US$ 79. We detect a smaller effect of US$ 60.8 on total health spending per capita which appears with a lag. We document positive health effects as captured by reductions in infant and child mortality. We do not find any effect on GDP and the share of the government budget devoted to health. Overall, our results complement micro evidence based on within country variation. The counterfactual design implemented here may be used to inform other countries on the macro level repercussions of UHC. Copyright © 2016. Published by Elsevier Ltd.

  19. Universal health insurance coverage for 1.3 billion people: What accounts for China's success?

    Science.gov (United States)

    Yu, Hao

    2015-09-01

    China successfully achieved universal health insurance coverage in 2011, representing the largest expansion of insurance coverage in human history. While the achievement is widely recognized, it is still largely unexplored why China was able to attain it within a short period. This study aims to fill the gap. Through a systematic political and socio-economic analysis, it identifies seven major drivers for China's success, including (1) the SARS outbreak as a wake-up call, (2) strong public support for government intervention in health care, (3) renewed political commitment from top leaders, (4) heavy government subsidies, (5) fiscal capacity backed by China's economic power, (6) financial and political responsibilities delegated to local governments and (7) programmatic implementation strategy. Three of the factors seem to be unique to China (i.e., the SARS outbreak, the delegation, and the programmatic strategy.) while the other factors are commonly found in other countries' insurance expansion experiences. This study also discusses challenges and recommendations for China's health financing, such as reducing financial risk as an immediate task, equalizing benefit across insurance programs as a long-term goal, improving quality by tying provider payment to performance, and controlling costs through coordinated reform initiatives. Finally, it draws lessons for other developing countries. Copyright © 2015 The Author. Published by Elsevier Ireland Ltd.. All rights reserved.

  20. A difficult balancing act: policy actors' perspectives on using economic evaluation to inform health-care coverage decisions under the Universal Health Insurance Coverage scheme in Thailand.

    Science.gov (United States)

    Teerawattananon, Yot; Russell, Steve

    2008-03-01

    In Thailand, policymakers have come under increasing pressure to use economic evaluation to inform health-care resource allocation decisions, especially after the introduction of the Universal Health Insurance Coverage (UC) scheme. This article presents qualitative findings from research that assessed a range of policymakers' perspectives on the acceptability of using economic evaluation for the development of health-care benefit packages in Thailand. The policy analysis examined their opinions about existing decision-making processes for including health interventions in the UC benefit package, their understanding of health economic evaluation, and their attitudes, acceptance, and values relating to the use of the method. Semistructured interviews were conducted with 36 policy actors who play a major role or have some input into health resource allocation decisions within the Thai health-care system. These included 14 senior policymakers at the national level, 5 hospital directors, 10 health professionals, and 7 academics. Policy actors thought that economic evaluation information was relevant for decision-making because of the increasing need for rationing and more transparent criteria for making UC coverage decisions. Nevertheless, they raised several difficulties with using economic evaluation that would pose barriers to its introduction, including distrust in the method, conflicting philosophical positions and priorities compared to that of "health maximization," organizational allegiances, existing decision-making procedures that would be hard to change, and concerns about political pressure and acceptability.

  1. Analysis of selected policies towards universal health coverage in Uganda: the policy implementation barometer protocol.

    Science.gov (United States)

    Hongoro, Charles; Rutebemberwa, Elizeus; Twalo, Thembinkosi; Mwendera, Chikondi; Douglas, Mbuyiselo; Mukuru, Moses; Kasasa, Simon; Ssengooba, Freddie

    2018-01-01

    Policy implementation remains an under researched area in most low and middle income countries and it is not surprising that several policies are implemented without a systematic follow up of why and how they are working or failing. This study is part of a larger project called Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda. It seeks to support policymakers monitor the implementation of vital programmes for the realisation of policy goals for Universal Health Coverage. A Policy Implementation Barometer (PIB) is proposed as a mechanism to provide feedback to the decision makers about the implementation of a selected set of policy programmes at various implementation levels (macro, meso and micro level). The main objective is to establish the extent of implementation of malaria, family planning and emergency obstetric care policies in Uganda and use these results to support stakeholder engagements for corrective action. This is the first PIB survey of the three planned surveys and its specific objectives include: assessment of the perceived appropriateness of implementation programmes to the identified policy problems; determination of enablers and constraints to implementation of the policies; comparison of on-line and face-to-face administration of the PIB questionnaire among target respondents; and documentation of stakeholder responses to PIB findings with regard to corrective actions for implementation. The PIB will be a descriptive and analytical study employing mixed methods in which both quantitative and qualitative data will be systematically collected and analysed. The first wave will focus on 10 districts and primary data will be collected through interviews. The study seeks to interview 570 respondents of which 120 will be selected at national level with 40 based on each of the three policy domains, 200 from 10 randomly selected districts, and 250 from 50 facilities. Half of the respondents at

  2. Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand

    NARCIS (Netherlands)

    S. Limwattananon (Supon); S. Neelsen (Sven); O.A. O'Donnell (Owen); P. Prakongsai (Phusit); V. Tangcharoensathien (Viroj); E.K.A. van Doorslaer (Eddy)

    2013-01-01

    textabstractWe estimate the impact on health care utilization and out-of-pocket (OOP) expenditures of a major reform in Thailand that extended health insurance to one-quarter of the population to achieve universal coverage while keeping health spending below 4% of GDP. Identification is through

  3. Coverage, universal access and equity in health: a characterization of scientific production in nursing.

    Science.gov (United States)

    Mendoza-Parra, Sara

    2016-01-01

    to characterize the scientific contribution nursing has made regarding coverage, universal access and equity in health, and to understand this production in terms of subjects and objects of study. this was cross-sectional, documentary research; the units of analysis were 97 journals and 410 documents, retrieved from the Web of Science in the category, "nursing". Descriptors associated to coverage, access and equity in health, and the Mesh thesaurus, were applied. We used bibliometric laws and indicators, and analyzed the most important articles according to amount of citations and collaboration. the document retrieval allowed for 25 years of observation of production, an institutional and an international collaboration of 31% and 7%, respectively. The mean number of coauthors per article was 3.5, with a transience rate of 93%. The visibility index was 67.7%, and 24.6% of production was concentrated in four core journals. A review from the nursing category with 286 citations, and a Brazilian author who was the most productive, are issues worth highlighting. the nursing collective should strengthen future research on the subject, defining lines and sub-lines of research, increasing internationalization and building it with the joint participation of the academy and nursing community.

  4. Universal health coverage for India by 2022: a utopia or reality?

    Science.gov (United States)

    Singh, Zile

    2013-04-01

    It is the obligation of the state to provide free and universal access to quality health-care services to its citizens. India continues to be among the countries of the world that have a high burden of diseases. The various health program and policies in the past have not been able to achieve the desired goals and objectives. 65(th) World Health Assembly in Geneva identified universal health coverage (UHC) as the key imperative for all countries to consolidate the public health advances. Accordingly, Planning Commission of India constituted a high level expert group (HLEG) on UHC in October 2010. HLEG submitted its report in Nov 2011 to Planning Commission on UHC for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. India faces enormous challenges to achieve UHC by 2022 such as high disease prevalence, issues of gender equality, unregulated and fragmented health-care delivery system, non-availability of adequate skilled human resource, vast social determinants of health, inadequate finances, lack of inter-sectoral co-ordination and various political pull and push of different forces, and interests. These challenges can be met by a paradigm shift in health policies and programs in favor of vulnerable population groups, restructuring of public health cadres, reorientation of undergraduate medical education, more emphasis on public health research, and extensive education campaigns. There are still areas of concern in fulfilling the objectives of achieving UHC by 2022 regarding financing model for health-care delivery, entitlement package, cost of health-care interventions and declining state budgets. However, the Government's commitment to provide adequate finances, recent bold social policy initiatives and enactments such as food

  5. Universal Health Insurance Coverage in Vietnam: A Stakeholder Analysis From Policy Proposal (1989) to Implementation (2014).

    Science.gov (United States)

    Hoang, Chi K; Hill, Peter; Nguyen, Huong T

    In 1989, health insurance (HI) was introduced in Vietnam and began to be implemented in 1992. There was limited progress until the 2014 Law on HI that was revised with the aim of universal health insurance coverage (UHIC) by 2020. This article explores stakeholder roles and positions from the initial introduction of HI to the implementation of the Master Plan accelerating UHIC. To better understand the influence of stakeholders in accelerating UHIC to achieve equity in health care. Using a qualitative study design, we conducted content analysis of HI-related documents and interviewed social security and health system key informants, government representatives, and community stakeholders to determine their positions and influence on UHIC. Our findings demonstrate different levels of support of stakeholders that influence in the HI formulation and implementation, from opposition when HI was first introduced in 1989 to collaboration of stakeholders from 2013 when the Master Plan for UHIC was implemented. Despite an initial failure to secure the support of the Parliament for a Law on HI, a subsequent series of alternative legislative strategies brought limited increases in HI coverage. With government financial subsidization, the involvement of multiple stakeholders, political commitment, and flexible working mechanisms among stakeholders have remained important, with an increasing recognition that HI is not only a technical aspect of the health system but also a broader socioeconomic and governance issue. The different levels of power and influence among stakeholders, together with their commercial and political interests and their different perceptions of HI, have influenced stakeholders' support or opposition to HI policies. Despite high-level policy support, stakeholders' positions may vary, depending on their perceptions of the policy implications. A shift in government stakeholder positions, especially at the provincial level, has been necessary to accelerate

  6. Women's Health Insurance Coverage

    Science.gov (United States)

    ... Women's Health Policy Women’s Health Insurance Coverage Women’s Health Insurance Coverage Published: Oct 31, 2017 Facebook Twitter LinkedIn ... that many women continue to face. Sources of Health Insurance Coverage Employer-Sponsored Insurance: Approximately 57.9 million ...

  7. Universal Health Insurance and the Reasons of not Coverage in Iran: Secondary Analysis of a National Household Survey

    Directory of Open Access Journals (Sweden)

    Shirin Nosratnejad

    2015-08-01

    Full Text Available Background and objectives : Universal insurance coverage is considered as one of the main goals of health systems around the world. Although Universal Health Insurance Law was legislated with the objective of covering all Iranian population under health insurance coverage in 1994, but imperfect insurance coverage has remained as a threatening dilemma. Heterogeneous statistics reported by insurer in Iran and the lack of appropriate, comprehensive databases have failed any judgments about the number of uninsured people and the reasons for it. Present study aimed to give better insight on insurance coverage among Iranian people and examine key reasons of imperfect coverage through a deep analysis of a national household survey. Material and Methods : Data which were collected from a national survey of health care utilization in Iran that covered over 102000 people of Iranians were analyzed. The survey had been implemented in 2007 by Iran's Ministry of Health. In order to identify possible reasons for imperfect coverage, national and international databases like SID, Iranmedex, ISC, Pubmed, Scopus, official statistics of Statistical Center of Iran (SCI, Iranian Social Security Organization (ISSO and Central Insurance of IRIRAN (CII were searched. Data management was accomplished in Microsoft Excel software.  Results : Study results showed that 85% of Iranian households had health insurance coverage, compared to 15% without any coverage. Medical services insurance fund had the greater proportion of coverage (59.27% and basic private insurance coverage was accountable for the least coverage (0.2%. More than half of households (51% stated financial inability to pay as the main reason for not getting coverage, followed by the lack of knowledge about insurance (12%, unemployment (12% and bypass by employers (10%. A worthwhile finding was that, 13% of households implied they felt no need to health insurance and 2% found it useless. Conclusion : Despite

  8. Realizing universal health coverage for maternal health services in the Republic of Guinea : the use of workforce projections to design health labor market interventions

    NARCIS (Netherlands)

    Jansen, Christel; Codjia, Laurence; Cometto, Giorgio; Yansané, Mohamed Lamine; Dieleman, Marjolein

    2014-01-01

    BACKGROUND: Universal health coverage requires a health workforce that is available, accessible, and well-performing. This article presents a critical analysis of the health workforce needs for the delivery of maternal and neonatal health services in Guinea, and of feasible and relevant

  9. Realizing Universal Health Coverage in East Africa: the relevance of human rights.

    Science.gov (United States)

    Yamin, Alicia Ely; Maleche, Allan

    2017-08-03

    Applying a robust human rights framework would change thinking and decision-making in efforts to achieve Universal Health Coverage (UHC), and advance efforts to promote women's, children's, and adolescents' health in East Africa, which is a priority under the Sustainable Development Agenda. Nevertheless, there is a gap between global rhetoric of human rights and ongoing health reform efforts. This debate article seeks to fill part of that gap by setting out principles of human rights-based approaches (HRBAs), and then applying those principles to questions that countries undertaking efforts toward UHC and promoting women's, children's and adolescents' health, will need to face, focusing in particular on ensuring enabling legal and policy frameworks, establishing fair financing; priority-setting processes, and meaningful oversight and accountability mechanisms. In a region where democratic institutions are notoriously weak, we argue that the explicit application of a meaningful human rights framework could enhance equity, participation and accountability, and in turn the democratic legitimacy of health reform initiatives being undertaken in the region.

  10. Equity in health personnel financing after Universal Coverage: evidence from Thai Ministry of Public Health's hospitals from 2008-2012.

    Science.gov (United States)

    Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya

    2015-07-18

    Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from health insurance. This allowed public hospitals more flexibility in hiring additional staff. Financial measures and incentives such as special allowances for non-private practice and additional payments for remote staff have been implemented to attract and retain them. To understand the distributional effect of such change in health workforce financing, this study evaluates the equity in health workforce financing for 838 hospitals under the Ministry of Public Health across all 75 provinces from 2008-2012. Data were collected from routine reports of public hospital financing from the Ministry of Public Health with specific identification on health workforce spending. The components and sources of health workforce financing were descriptively analysed based on the geographic location of the hospitals, their size and the core hospital functions. Inequalities in health workforce financing across provinces were assessed. We calculated the Gini coefficient and concentration index to explore horizontal and vertical inequity in the public sector health workforce financing in Thailand. Separate analyses were carried out for funding from government budget and funding from hospital revenue to understand the difference between the two financial sources. Health workforce financing accounted for about half of all hospital non-capital expenses in 2012, about a 30 % increase from the level of spending in 2008. Almost one third of the workforce financing came from hospital revenue, an increase from only one

  11. Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru.

    Science.gov (United States)

    Neelsen, Sven; O'Donnell, Owen

    2017-12-01

    Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to health care by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population's change in health care utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal health care when sick is increased by almost two fifths, but the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow coverage offered, there is no impact on use of inpatient care. Neither is there any effect on average out-of-pocket health care expenditure, but medical spending is reduced by up to 25% in the top quarter of the distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Availability, use, and affordability of medicines in urban China under universal health coverage : an empirical study in Hangzhou and Baoji

    NARCIS (Netherlands)

    Huang, Yunyu; Jiang, Youfen; Zhang, Luying; Mao, Wenhui; van Boven, Job F M; Postma, Maarten J; Chen, Wen

    2018-01-01

    BACKGROUND: This study aimed to examine the availability, use, and affordability of medicines in urban China following the 2009 Health Care System Reform that included implementation of universal health coverage (UHC). METHODS: This longitudinal study was performed in Hangzhou (high income, eastern

  13. Availability, use, and affordability of medicines in urban China under universal health coverage : an empirical study in Hangzhou and Baoji

    NARCIS (Netherlands)

    Huang, Yunyu; Jiang, Youfen; Zhang, Luying; Mao, Wenhui; van Boven, Job F. M.; Postma, Maarten J.; Chen, Wen

    2018-01-01

    Background: This study aimed to examine the availability, use, and affordability of medicines in urban China following the 2009 Health Care System Reform that included implementation of universal health coverage (UHC). Methods: This longitudinal study was performed in Hangzhou (high income, eastern

  14. Thailand's universal coverage scheme and its impact on health-seeking behavior.

    Science.gov (United States)

    Paek, Seung Chun; Meemon, Natthani; Wan, Thomas T H

    2016-01-01

    Thailand's Universal Coverage Scheme (UCS) has improved healthcare access and utilization since its initial introduction in 2002. However, a substantial proportion of beneficiaries has utilized care outside the UCS boundaries. Because low utilization may be an indication of a policy gap between people's health needs and the services available to them, we investigated the patterns of health-seeking behavior and their social/contextual determinants among UCS beneficiaries in the year 2013. The study findings from the outpatient analysis showed that the use of designated facilities for care was significantly higher in low-income, unemployed, and chronic status groups. The findings from the inpatient analysis showed that the use of designated facilities for care was significantly higher in the low-income, older, and female groups. Particularly, for the low-income group, we found that they (1) had greater health care needs, (2) received a larger number of services from designated facilities, and (3) paid the least for both inpatient and outpatient services. This pro-poor impact indicated that the UCS could adequately respond to beneficiaries' needs in terms of vertical equity. However, we also found that a considerable proportion of beneficiaries utilized out-of-network services, which implied a lack of universal access to policy services from a horizontal equity point of view. Thus, the policy should continue expanding and diversifying its service benefits to strengthen horizontal equity. Particularly, private sector involvement for those who are employed as well as the increased unmet health needs of those in rural areas may be important policy priorities for that. Lastly, methodological issues such as severity adjustment and a detailed categorization of health-seeking behaviors need to be further considered for a better understanding of the policy impact.

  15. Universal coverage challenges require health system approaches; the case of India.

    Science.gov (United States)

    Duran, Antonio; Kutzin, Joseph; Menabde, Nata

    2014-02-01

    This paper uses the case of India to demonstrate that Universal Health Coverage (UHC) is about not only health financing; personal and population services production issues, stewardship of the health system and generation of the necessary resources and inputs need to accompany the health financing proposals. In order to help policy makers address UHC in India and sort out implementation issues, the framework developed by the World Health Organization (WHO) in the World Health Report 2000 and its subsequent extensions are advocated. The framework includes final goals, generic intermediate objectives and four inter-dependent functions which interact as a system; it can be useful by diagnosing current shortcomings and facilitating the filling up of gaps between functions and goals. Different positions are being defended in India re the preconditions for UHC to succeed. This paper argues that more (public) money will be important, but not enough; it needs to be supplemented with broad interventions at various health system levels. The paper analyzes some of the most important issues in relation to the functions of service production, generation of inputs and the necessary stewardship. It also pays attention to reform implementation, as different from its design, and suggests critical aspects emanating from a review of recent health system reforms. Precisely because of the lack of comparative reference for India, emphasis is made on the need to accompany implementation with analysis, so that the "solutions" ("what to do?", "how to do it?") are found through policy analysis and research embedded into flexible implementation. Strengthening "evidence-to-policy" links and the intelligence dimension of stewardship/leadership as well as accountability during implementation are considered paramount. Countries facing similar challenges to those faced by India can also benefit from the above approaches. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes.

    Science.gov (United States)

    Valentine, Nicole Britt; Bonsel, Gouke J

    2016-01-01

    Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child

  17. Universal health coverage in ‘One ASEAN’: are migrants included?

    Science.gov (United States)

    Guinto, Ramon Lorenzo Luis R.; Curran, Ufara Zuwasti; Suphanchaimat, Rapeepong; Pocock, Nicola S.

    2015-01-01

    Background As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC

  18. Universal health coverage in ‘One ASEAN’: are migrants included?

    Directory of Open Access Journals (Sweden)

    Ramon Lorenzo Luis R. Guinto

    2015-01-01

    Full Text Available Background: As the Association of South East Asian Nations (ASEAN gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design: A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results: In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as

  19. Moving from ideas to action - developing health financing systems towards universal coverage in Africa

    Directory of Open Access Journals (Sweden)

    Musango Laurent

    2012-11-01

    Full Text Available Abstract Background Accelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used. Summary The discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies. Discussion Based on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget

  20. Moving from ideas to action - developing health financing systems towards universal coverage in Africa.

    Science.gov (United States)

    Musango, Laurent; Orem, Juliet Nabyonga; Elovainio, Riku; Kirigia, Joses

    2012-11-08

    Accelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used. The discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies. Based on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget allocations for health can be solved with a more evidence based

  1. Promoting universal financial protection: a policy analysis of universal health coverage in Costa Rica (1940-2000).

    Science.gov (United States)

    Vargas, Juan Rafael; Muiser, Jorine

    2013-08-21

    This paper explores the implementation and sustenance of universal health coverage (UHC) in Costa Rica, discussing the development of a social security scheme that covered 5% of the population in 1940, to one that finances and provides comprehensive healthcare to the whole population today. The scheme is financed by mandatory, tri-partite social insurance contributions complemented by tax funding to cover the poor. The analysis takes a historical perspective and explores the policy process including the key actors and their relative influence in decision-making. Data were collected using qualitative research instruments, including a review of literature, institutional and other documents, and in-depth interviews with key informants. Key lessons to be learned are: i) population health was high on the political agenda in Costa Rica, in particular before the 1980s when UHC was enacted and the transfer of hospitals to the social security institution took place. Opposition to UHC could therefore be contained through negotiation and implemented incrementally despite the absence of real consensus among the policy elite; ii) since the 1960s, the social security institution has been responsible for UHC in Costa Rica. This institution enjoys financial and managerial autonomy relative to the general government, which has also facilitated the UHC policy implementation process; iii) UHC was simultaneously constructed on three pillars that reciprocally strengthened each other: increasing population coverage, increasing availability of financial resources based on solidarity financing mechanisms, and increasing service coverage, ultimately offering comprehensive health services and the same benefits to every resident in the country; iv) particularly before the 1980s, the fruits of economic growth were structurally invested in health and other universal social policies, in particular education and sanitation. The social security institution became a flagship of Costa Rica

  2. Equity-Oriented Monitoring in the Context of Universal Health Coverage

    Science.gov (United States)

    Hosseinpoor, Ahmad Reza; Bergen, Nicole; Koller, Theadora; Prasad, Amit; Schlotheuber, Anne; Valentine, Nicole; Lynch, John; Vega, Jeanette

    2014-01-01

    Monitoring inequalities in health is fundamental to the equitable and progressive realization of universal health coverage (UHC). A successful approach to global inequality monitoring must be intuitive enough for widespread adoption, yet maintain technical credibility. This article discusses methodological considerations for equity-oriented monitoring of UHC, and proposes recommendations for monitoring and target setting. Inequality is multidimensional, such that the extent of inequality may vary considerably across different dimensions such as economic status, education, sex, and urban/rural residence. Hence, global monitoring should include complementary dimensions of inequality (such as economic status and urban/rural residence) as well as sex. For a given dimension of inequality, subgroups for monitoring must be formulated taking into consideration applicability of the criteria across countries and subgroup heterogeneity. For economic-related inequality, we recommend forming subgroups as quintiles, and for urban/rural inequality we recommend a binary categorization. Inequality spans populations, thus appropriate approaches to monitoring should be based on comparisons between two subgroups (gap approach) or across multiple subgroups (whole spectrum approach). When measuring inequality absolute and relative measures should be reported together, along with disaggregated data; inequality should be reported alongside the national average. We recommend targets based on proportional reductions in absolute inequality across populations. Building capacity for health inequality monitoring is timely, relevant, and important. The development of high-quality health information systems, including data collection, analysis, interpretation, and reporting practices that are linked to review and evaluation cycles across health systems, will enable effective global and national health inequality monitoring. These actions will support equity-oriented progressive realization of UHC

  3. Universal Health Coverage through Community Nursing Services: China vs. Hong Kong.

    Science.gov (United States)

    Chan, Wai Yee; Fung, Ita M; Chan, Eric

    2017-01-30

    this article looks at how the development of community nursing services in China and Hong Kong can enhance universal health coverage. literature and data review have been utilized in this study. nursing services have evolved much since the beginning of the nursing profession. The development of community nursing services has expanded the scope of nursing services to those in need of, not just hospital-level nursing care, but more holistic care to improve health and quality of life. despite the one-country-two-systems governance and the difference in population and geography, Hong Kong and China both face the aging population and its complications. Community nursing services help to pave the road to Universal Health Coverage. este artigo analisa a forma como o desenvolvimento de serviços de enfermagem comunitários na China e Hong Kong pode melhorar a cobertura universal de saúde. literatura e revisão de dados foram utilizados neste estudo. serviços de enfermagem têm evoluído muito desde o início da profissão de enfermagem. O desenvolvimento dos serviços de enfermagem da comunidade ampliou o escopo dos serviços de enfermagem, para aqueles que precisam não apenas de cuidados de enfermagem de nível de hospital, mas cuidados mais holísticos para melhorar a saúde e qualidade de vida. apesar de ser "um-país-dois-sistemas" de governo, e as diferenças de população e geografia, Hong Kong e China enfrentam o envelhecimento da população e suas complicações. Os serviços de enfermagem da comunidade ajudam a pavimentar o caminho para a cobertura de saúde universal. este artículo analiza cómo el desarrollo de los servicios de enfermería comunitaria en China y Hong Kong pueden expandir la cobertura universal de salud. revisión de datos y literatura han sido utilizados en este estudio. los servicios de enfermería han evolucionado mucho desde el comienzo de la profesión. El desarrollo de los servicios de enfermería comunitaria han ampliado el alcance

  4. Equity in health personnel financing after Universal Coverage: evidence from Thai Ministry of Public Health?s hospitals from 2008?2012

    OpenAIRE

    Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya

    2015-01-01

    Background Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from hea...

  5. Incoherent policies on universal coverage of health insurance and promotion of international trade in health services in Thailand.

    Science.gov (United States)

    Pachanee, Cha-aim; Wibulpolprasert, Suwit

    2006-07-01

    The Thai government has implemented universal coverage of health insurance since October 2001. Universal access to antiretroviral (ARV) drugs has also been included since October 2003. These two policies have greatly increased the demand for health services and human resources for health, particularly among public health care providers. After the 1997 economic crisis, private health care providers, with the support of the government, embarked on new marketing strategies targeted at attracting foreign patients. Consequently, increasing numbers of foreign patients are visiting Thailand to seek medical care. In addition, the economic recovery since 2001 has greatly increased the demand for private health services among the Thai population. The increasing demand and much higher financial incentives from urban private providers have attracted health personnel, particularly medical doctors, from rural public health care facilities. Responding to this increasing demand and internal brain drain, in mid-2004 the Thai government approved the increased production of medical doctors by 10,678 in the following 15 years. Many additional financial incentives have also been applied. However, the immediate shortage of human resources needs to be addressed competently and urgently. Equity in health care access under this situation of competing demands from dual track policies is a challenge to policy makers and analysts. This paper summarizes the situation and trends as well as the responses by the Thai government. Both supply and demand side responses are described, and some solutions to restore equity in health care access are proposed.

  6. Decision Making and Priority Setting: The Evolving Path Towards Universal Health Coverage.

    Science.gov (United States)

    Paolucci, Francesco; Redekop, Ken; Fouda, Ayman; Fiorentini, Gianluca

    2017-12-01

    Health technology assessment (HTA) is widely viewed as an essential component in good universal health coverage (UHC) decision-making in any country. Various HTA tools and metrics have been developed and refined over the years, including systematic literature reviews (Cochrane), economic modelling, and cost-effectiveness ratios and acceptability curves. However, while the cost-effectiveness ratio is faithfully reported in most full economic evaluations, it is viewed by many as an insufficient basis for reimbursement decisions. Emotional debates about the reimbursement of cancer drugs, orphan drugs, and end-of-life treatments have revealed fundamental disagreements about what should and should not be considered in reimbursement decisions. Part of this disagreement seems related to the equity-efficiency tradeoff, which reflects fundamental differences in priorities. All in all, it is clear that countries aiming to improve UHC policies will have to go beyond the capacity building needed to utilize the available HTA toolbox. Multi-criteria decision analysis (MCDA) offers a more comprehensive tool for reimbursement decisions where different weights of different factors/attributes can give policymakers important insights to consider. Sooner or later, every country will have to develop their own way to carefully combine the results of those tools with their own priorities. In the end, all policymaking is based on a mix of facts and values.

  7. Indicators for Universal Health Coverage: can Kenya comply with the proposed post-2015 monitoring recommendations?

    Science.gov (United States)

    Obare, Valerie; Brolan, Claire E; Hill, Peter S

    2014-12-20

    Universal Health Coverage (UHC), referring to access to healthcare without financial burden, has received renewed attention in global health spheres. UHC is a potential goal in the post-2015 development agenda. Monitoring of progress towards achieving UHC is thus critical at both country and global level, and a monitoring framework for UHC was proposed by a joint WHO/World Bank discussion paper in December 2013. The aim of this study was to determine the feasibility of the framework proposed by WHO/World Bank for global UHC monitoring framework in Kenya. The study utilised three documents--the joint WHO/World Bank UHC monitoring framework and its update, and the Bellagio meeting report sponsored by WHO and the Rockefeller Foundation--to conduct the research. These documents informed the list of potential indicators that were used to determine the feasibility of the framework. A purposive literature search was undertaken to identify key government policy documents and relevant scholarly articles. A desk review of the literature was undertaken to answer the research objectives of this study. Kenya has yet to establish an official policy on UHC that provides a clear mandate on the goals, targets and monitoring and evaluation of performance. However, a significant majority of Kenyans continue to have limited access to health services as well as limited financial risk protection. The country has the capacity to reasonably report on five out of the seven proposed UHC indicators. However, there was very limited capacity to report on the two service coverage indicators for the chronic condition and injuries (CCIs) interventions. Out of the potential tracer indicators (n = 27) for aggregate CCI-related measures, four tracer indicators were available. Moreover the country experiences some wider challenges that may impact on the implementation and feasibility of the WHO/World Bank framework. The proposed global framework for monitoring UHC will only be feasible in Kenya if

  8. Nurses' knowledge of universal health coverage for inclusive and sustainable elderly care services

    Directory of Open Access Journals (Sweden)

    Fabian Ling Ngai Tung

    2016-01-01

    Full Text Available Objectives: to explore nurses' knowledge of universal health coverage (UHC for inclusive and sustainable development of elderly care services. Method: this was a cross-sectional survey. A convenience sample of 326 currently practicing enrolled nurses (EN or registered nurses (RN was recruited. Respondents completed a questionnaire which was based on the implementation strategies advocated by the WHO Global Forum for Governmental Chief Nursing Officers and Midwives (GCNOMs. Questions covered the government initiative, healthcare financing policy, human resources policy, and the respondents' perception of importance and contribution of nurses in achieving UHC in elderly care services. Results: the knowledge of nurses about UHC in elderly care services was fairly satisfactory. Nurses in both clinical practice and management perceived themselves as having more contribution and importance than those in education. They were relatively indifferent to healthcare policy and politics. Conclusion: the survey uncovered a considerable knowledge gap in nurses' knowledge of UHC in elderly care services, and shed light on the need for nurses to be more attuned to healthcare policy. The educational curriculum for nurses should be strengthened to include studies in public policy and advocacy. Nurses can make a difference through their participation in the development and implementation of UHC in healthcare services.

  9. The development of universal health insurance coverage in Thailand: Challenges of population aging and informal economy.

    Science.gov (United States)

    Hsu, Minchung; Huang, Xianguo; Yupho, Somrasri

    2015-11-01

    This paper quantitatively investigates the sustainability of the universal health insurance coverage (UHI) system in Thailand while taking into account the country's rapidly aging population and large informal labor sector. We examine the effects of population aging and informal employment across three tax options for financing the UHI. A modern dynamic general equilibrium framework is utilized to conduct policy experiments and welfare analysis. In the case of labor income tax being used to finance the cost of UHI, an additional 11-15% of labor tax will be required with the 2050 population age structure, compared with the 2005 benchmark economy. We also find that an expansion of income tax base to the informal sector can substantially alleviate the tax burden. Based on welfare comparisons across the alternative tax options, the labor income tax is the most preferred because the inequality between formal/informal sectors is large. If the informal sector cannot avoid labor income tax, capital tax will be preferred over labor and consumption taxes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Exploring models for the roles of health systems’ responsiveness and social determinants in explaining universal health coverage and health outcomes

    Directory of Open Access Journals (Sweden)

    Nicole Britt Valentine

    2016-03-01

    Full Text Available Background: Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. Objective: To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. Design: The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002–2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems’ responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Results: Health determinants’ indicators – access to improved drinking sources, accountability, and average years of schooling – were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the

  11. Policy Choices for Progressive Realization of Universal Health Coverage; Comment on “Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage”

    Directory of Open Access Journals (Sweden)

    Viroj Tangcharoensathien

    2017-03-01

    Full Text Available In responses to Norheim’s editorial, this commentary offers reflections from Thailand, how the five unacceptable trade-offs were applied to the universal health coverage (UHC reforms between 1975 and 2002 when the whole 64 million people were covered by one of the three public health insurance systems. This commentary aims to generate global discussions on how best UHC can be gradually achieved. Not only the proposed five discrete tradeoffs within each dimension, there are also trade-offs between the three dimensions of UHC such as population coverage, service coverage and cost coverage. Findings from Thai UHC show that equity is applied for the population coverage extension, when the low income households and the informal sector were the priority population groups for coverage extension by different prepayment schemes in 1975 and 1984, respectively. With an exception of public sector employees who were historically covered as part of fringe benefits were covered well before the poor. The private sector employees were covered last in 1990. Historically, Thailand applied a comprehensive benefit package where a few items are excluded using the negative list; until there was improved capacities on technology assessment that cost-effectiveness are used for the inclusion of new interventions into the benefit package. Not only costeffectiveness, but long term budget impact, equity and ethical considerations are taken into account. Cost coverage is mostly determined by the fiscal capacities. Close ended budget with mix of provider payment methods are used as a tool for trade-off service coverage and financial risk protection. Introducing copayment in the context of feefor-service can be harmful to beneficiaries due to supplier induced demands, inefficiency and unpredictable out of pocket payment by households. UHC achieves favorable outcomes as it was implemented when there was a full geographical coverage of primary healthcare coverage in all

  12. In Madagascar, Use Of Health Care Services Increased When Fees Were Removed: Lessons For Universal Health Coverage.

    Science.gov (United States)

    Garchitorena, Andres; Miller, Ann C; Cordier, Laura F; Ramananjato, Ranto; Rabeza, Victor R; Murray, Megan; Cripps, Amber; Hall, Laura; Farmer, Paul; Rich, Michael; Orlan, Arthur Velo; Rabemampionona, Alexandre; Rakotozafy, Germain; Randriantsimaniry, Damoela; Gikic, Djordje; Bonds, Matthew H

    2017-08-01

    Despite overwhelming burdens of disease, health care access in most developing countries is extremely low. As governments work toward achieving universal health coverage, evidence on appropriate interventions to expand access in rural populations is critical for informing policies. Using a combination of population and health system data, we evaluated the impact of two pilot fee exemption interventions in a rural area of Madagascar. We found that fewer than one-third of people in need of health care accessed treatment when point-of-service fees were in place. However, when fee exemptions were introduced for targeted medicines and services, the use of health care increased by 65 percent for all patients, 52 percent for children under age five, and over 25 percent for maternity consultations. These effects were sustained at an average direct cost of US$0.60 per patient. The pilot interventions can become a key element of universal health care in Madagascar with the support of external donors. Project HOPE—The People-to-People Health Foundation, Inc.

  13. [Leadership and vision in the improvement of universal health care coverage in low-income countries].

    Science.gov (United States)

    Meda, Ziemlé Clément; Konate, Lassina; Ouedraogo, Hyacinthe; Sanou, Moussa; Hercot, David; Sombie, Issiaka

    2011-01-01

    implementing a decentralized approach to tuberculosis detection, succeeded in improving access to care and enabled us to quantify the rate of tuberculosis-HIV co-infection in the HD. The fourth intervention improved financial access to emergency obstetric care by providing essential drugs and consumables for emergency obstetric surgery free of charge. The fifth intervention boosted the motivation of health workers by an annual 'competition of excellence', organised for workers and teams in the HD. Finally, our sixth intervention was the introduction of a "culture" of evaluation and transparency, by means of a local health journal, used to interact with stakeholders both at the local level and in the health sector more broadly. We also present our experiences regularly during national health science symposia. Although the DT operates with limited resources, it has over time managed to improve care and services in the HD, through its dynamic management and strategic planning. It has reduced inpatient mortality and improved access to care, particularly for vulnerable groups, in line with the Primary Health Care and Bamako Initiative principles. This case study would have benefited from a stronger methodology. However, it shows that in a context of limited resources it is still possible to strengthen the local health system by improving management practices. To progress towards universal health coverage, all core functions of a DT are worth implementing, including leadership and vision. National and international health strategies should thus include a plan to provide for and train local health system managers who can provide both leadership and strategic vision.

  14. Equity of the premium of the Ghanaian National Health Insurance Scheme and the implications for achieving universal coverage.

    Science.gov (United States)

    Amporfu, Eugenia

    2013-01-07

    The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

  15. Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

    Directory of Open Access Journals (Sweden)

    Amporfu Eugenia

    2013-01-01

    Full Text Available Abstract The Ghanaian National Health Insurance Scheme (NHIS was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

  16. Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives.

    Science.gov (United States)

    He, Alex Jingwei; Wu, Shaolong

    2017-12-01

    China's remarkable progress in building a comprehensive social health insurance (SHI) system was swift and impressive. Yet the country's decentralized and incremental approach towards universal coverage has created a fragmented SHI system under which a series of structural deficiencies have emerged with negative impacts. First, contingent on local conditions and financing capacity, benefit packages vary considerably across schemes, leading to systematic inequity. Second, the existence of multiple schemes, complicated by massive migration, has resulted in weak portability of SHI, creating further barriers to access. Third, many individuals are enrolled on multiple schemes, which causes inefficient use of government subsidies. Moral hazard and adverse selection are not effectively managed. The Chinese government announced its blueprint for integrating the urban and rural resident schemes in early 2016, paving the way for the ultimate consolidation of all SHI schemes and equal benefits for all. This article proposes three policy alternatives to inform the consolidation: (1) a single-pool system at the prefectural level with significant government subsidies, (2) a dual-pool system at the prefectural level with risk-equalization mechanisms, and (3) a household approach without merging existing pools. Vertical integration to the provincial level is unlikely to happen in the near future. Two caveats are raised to inform this transition towards universal health coverage.

  17. Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Gupta, Rakesh; Sharma, Atul; Rana, Saroj Kumar; Kumar, Rajesh

    2015-01-01

    India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery), population coverage (coverage among different districts and wealth quintiles of the population) and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery). We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery--proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state. The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2) and INR 12,479 (USD 229), respectively, which were catastrophic for 1.6% and 22% of households, respectively. Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across districts and among different socio

  18. Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada.

    Directory of Open Access Journals (Sweden)

    M Eugenia Socías

    Full Text Available Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC, sex workers' experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC.Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers' Health Access. Multivariable logistic regression analyses, using generalized estimating equations (GEE, were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013.In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4% women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%, limited hours of operation (36.5%, and perceived disrespect by health care providers (26.1%. In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10-1.94, workplace- (AOR = 1.31, 95% CI 1.05-1.63, and community-level violence (AOR = 1.41, 95% CI 1.04-1.92, as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03-1.69, a mental illness diagnosis (AOR = 1.66, 95% CI 1.34-2.06, and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59-7.57 emerged as independent correlates of institutional barriers to health services.Despite Canada's UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex

  19. Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada.

    Science.gov (United States)

    Socías, M Eugenia; Shoveller, Jean; Bean, Chili; Nguyen, Paul; Montaner, Julio; Shannon, Kate

    2016-01-01

    Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC), sex workers' experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC. Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers' Health Access). Multivariable logistic regression analyses, using generalized estimating equations (GEE), were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013). In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4%) women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%), limited hours of operation (36.5%), and perceived disrespect by health care providers (26.1%). In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10-1.94), workplace- (AOR = 1.31, 95% CI 1.05-1.63), and community-level violence (AOR = 1.41, 95% CI 1.04-1.92), as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03-1.69), a mental illness diagnosis (AOR = 1.66, 95% CI 1.34-2.06), and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59-7.57) emerged as independent correlates of institutional barriers to health services. Despite Canada's UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex workers

  20. Public views of health insurance in Japan during the era of attaining universal health coverage: a secondary analysis of an opinion poll on health insurance in 1967

    Directory of Open Access Journals (Sweden)

    Ikuma Nozaki

    2017-07-01

    Full Text Available While Japan’s success in achieving universal health insurance over a short period with controlled healthcare costs has been studied from various perspectives, that of beneficiaries have been overlooked. We conducted a secondary analysis of an opinion poll on health insurance in 1967, immediately after reaching universal coverage. We found that people continued to face a slight barrier to healthcare access (26.8% felt medical expenses were a heavy burden and had high expectations for health insurance (60.5% were satisfied with insured medical services and 82.4% were willing to pay a premium. In our study, younger age, having children before school age, lower living standards, and the health insurance scheme were factors that were associated with a willingness to pay premiums. Involving high-income groups in public insurance is considered to be the key to ensuring universal coverage of social insurance.

  1. Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage.

    Directory of Open Access Journals (Sweden)

    Jacqueline Ramke

    Full Text Available To define and demonstrate effective cataract surgical coverage (eCSC, a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC with quality (post-operative visual outcome.All Rapid Assessment of Avoidable Blindness (RAAB surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60, CSC (operated cataract as a proportion of operable plus operated cataract and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated.Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries. Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%, CSOGood was 58.9% (IQR 53.7-67.6% and CSOPoor was 17.7% (IQR 11.3-21.1%. Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%, approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1% than for CSC (median 2.3% IQR -1.5-11.6%.eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

  2. Socioeconomic inequality in self-reported oral health status: the experience of Thailand after implementation of the universal coverage policy.

    Science.gov (United States)

    Somkotra, Tewarit

    2011-06-01

    This study aimed to quantify the extent to which socioeconomic-related inequality in self-reported oral health status among Thais is present after the country implemented the Universal Coverage policy and to decompose the determinants and their associations with inequality in self-reported oral health status in particular with the worse condition. The study employed a concentration index to measure socioeconomic-related inequality in self-reported oral health status, and the decomposition method to identify the determinants and their associations with inequality in oral health-related measures. Data from 32,748 Thai adults aged 15-75 years from the nationally representative Health &Welfare Survey and Socio-Economic Survey 2006 were used in analyses. Reports of worse oral health status of the lower socioeconomic-status group were more common than their higher socioeconomic-status counterparts. The concentration index (equaling -0.208) corroborates the finding of pro-poor inequality in self-reported worse oral health. Decomposition analysis demonstrated certain demographic-, socioeconomic-, and geographic characteristics are particularly associated with poor-rich differences in self-reported oral health status among Thai adults. This study demonstrated socioeconomic-related inequality in oral health is discernable along the entire spectrum of socioeconomic status. Inequality in perceived oral health status among Thais is present even while the country has virtually achieved universality of health coverage. The study also indicates population subgroups, particularly the poor, should receive consideration for improving oral health status as revealed by underlying determinants.

  3. Health sector employment: a tracer indicator for universal health coverage in national Social Protection Floors.

    Science.gov (United States)

    Scheil-Adlung, Xenia; Behrendt, Thorsten; Wong, Lorraine

    2015-08-31

    Health sector employment is a prerequisite for availability, accessibility, acceptability and quality (AAAQ) of health services. Thus, in this article health worker shortages are used as a tracer indicator estimating the proportion of the population lacking access to such services: The SAD (ILO Staff Access Deficit Indicator) estimates gaps towards UHC in the context of Social Protection Floors (SPFs). Further, it highlights the impact of investments in health sector employment equity and sustainable development. The SAD is used to estimate the share of the population lacking access to health services due to gaps in the number of skilled health workers. It is based on the difference of the density of the skilled health workforce per population in a given country and a threshold indicating UHC staffing requirements. It identifies deficits, differences and developments in access at global, regional and national levels and between rural and urban areas. In 2014, the global UHC deficit in numbers of health workers is estimated at 10.3 million, with most important gaps in Asia (7.1 million) and Africa (2.8 million). Globally, 97 countries are understaffed with significantly higher gaps in rural than in urban areas. Most affected are low-income countries, where 84 per cent of the population remains excluded from access due to the lack of skilled health workers. A positive correlation of health worker employment and population health outcomes could be identified. Legislation is found to be a prerequisite for closing access as gaps. Health worker shortages hamper the achievement of UHC and aggravate weaknesses of health systems. They have major impacts on socio-economic development, particularly in the world's poorest countries where they act as drivers of health inequities. Closing the gaps by establishing inclusive multi-sectoral policy approaches based on the right to health would significantly increase equity, reduce poverty due to ill health and ultimately contribute

  4. The Role of Hospital Information Systems in Universal Health Coverage Monitoring in Rwanda.

    Science.gov (United States)

    Karara, Gustave; Verbeke, Frank; Nyssen, Marc

    2015-01-01

    In this retrospective study, the authors monitored the patient health coverage in 6 Rwandan hospitals in the period between 2011 and 2014. Among the 6 hospitals, 2 are third level hospitals, 2 district hospitals and 2 private hospitals. Patient insurance and financial data were extracted and analyzed from OpenClinic GA, an open source hospital information system (HIS) used in those 6 hospitals. The percentage of patients who had no health insurer globally decreased from 35% in 2011 to 15% in 2014. The rate of health insurance coverage in hospitals varied between 75% in private hospitals and 84% in public hospitals. The amounts paid by the patients for health services decreased in private hospitals to 25% of the total costs in 2014 (-7.4%) and vary between 14% and 19% in public hospitals. Although the number of insured patients has increased and the patient share decreased over the four years of study, the patients' out-of-pocket payments increased especially for in-patients. This study emphasizes the value of integrated hospital information systems for this kind of health economics research in developing countries.

  5. How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis.

    Science.gov (United States)

    Cucunubá, Zulma M; Manne-Goehler, Jennifer M; Díaz, Diana; Nouvellet, Pierre; Bernal, Oscar; Marchiol, Andrea; Basáñez, María-Gloria; Conteh, Lesong

    2017-02-01

    Limited access to Chagas disease diagnosis and treatment is a major obstacle to reaching the 2020 World Health Organization milestones of delivering care to all infected and ill patients. Colombia has been identified as a health system in transition, reporting one of the highest levels of health insurance coverage in Latin America. We explore if and how this high level of coverage extends to those with Chagas disease, a traditionally marginalised population. Using a mixed methods approach, we calculate coverage for screening, diagnosis and treatment of Chagas. We then identify supply-side constraints both quantitatively and qualitatively. A review of official registries of tests and treatments for Chagas disease delivered between 2008 and 2014 is compared to estimates of infected people. Using the Flagship Framework, we explore barriers limiting access to care. Screening coverage is estimated at 1.2% of the population at risk. Aetiological treatment with either benznidazol or nifurtimox covered 0.3-0.4% of the infected population. Barriers to accessing screening, diagnosis and treatment are identified for each of the Flagship Framework's five dimensions of interest: financing, payment, regulation, organization and persuasion. The main challenges identified were: a lack of clarity in terms of financial responsibilities in a segmented health system, claims of limited resources for undertaking activities particularly in primary care, non-inclusion of confirmatory test(s) in the basic package of diagnosis and care, poor logistics in the distribution and supply chain of medicines, and lack of awareness of medical personnel. Very low screening coverage emerges as a key obstacle hindering access to care for Chagas disease. Findings suggest serious shortcomings in this health system for Chagas disease, despite the success of universal health insurance scale-up in Colombia. Whether these shortcomings exist in relation to other neglected tropical diseases needs investigating

  6. Universal health coverage in the context of population ageing: What determines health insurance enrolment in rural Ghana?

    Science.gov (United States)

    Van der Wielen, Nele; Channon, Andrew Amos; Falkingham, Jane

    2018-05-24

    Population ageing presents considerable challenges for the attainment of universal health coverage (UHC), especially in countries where such coverage is still in its infancy. Ghana presents an important case study on the effectiveness of policies aimed at achieving UHC in the context of population ageing in low and middle-income countries. It has witnessed a profound recent demographic transition, including a large increase in the number of older adults, which coincided with the development and implementation of a National Health Insurance Scheme (NHIS), designed to help achieve UHC. The objective of this paper is to examine the community, household and individual level determinants of NHIS enrolment among older adults aged 50-69 and 70 plus. The latter are exempt from NHIS premium payments. Using the Ghanaian Living Standards Survey from 2012 to 2013, determinants of NHIS enrolment for individuals aged 50-69 and 70 plus living in rural Ghana are examined through the application of multilevel regression analysis. Previous studies have mainly focused on the enrolment of young and middle aged adults and considered mainly demographic and socio-economic factors. The novel inclusion of spatial barriers within this analysis demonstrates that levels of NHIS enrolment are determined in part by the community provision of healthcare facilities. In addition, the findings imply that insurance enrolment increases with household expenditure even for those aged 70 plus who are exempt from the NHIS premium payment. Adequate and appropriate infrastructure as well as health insurance is vital to ensure movement to UHC in low and middle income countries. Overall, the results confirm that there remain significant inequalities in enrolment by expenditure quintile that future policy reform will need to address.

  7. Who benefits from public health financing in Zimbabwe? Towards universal health coverage.

    Science.gov (United States)

    Shamu, Shepherd; January, James; Rusakaniko, Simbarashe

    2017-09-01

    Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of -0.13 [CI:-0.2 to -0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1-0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2-0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.

  8. Helicopter dropping of 50 free allopathic medicines; prescribed by homoeopathic doctors at ground: Sorry this is not universal health coverage

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2014-01-01

    Full Text Available The provision of Universal Health Coverage (UHC is being discussed in India. Crippled by the charges of corruption and unethical practice by media and public at large, medical professionals are largely unaware, disinterested, isolated and edged out from this debate. The traditional general practitioner is a dying breed and deficiency of doctors willing to work in community settings is rampant. Is UHC model proposed in present form good for an ordinary Indian citizen? This editorial looks into the underlying politics of health care in India in the past and how this ongoing debate could impact the future of primary care and health care of people in India.

  9. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage.

    Science.gov (United States)

    Mills, Anne; Ataguba, John E; Akazili, James; Borghi, Jo; Garshong, Bertha; Makawia, Suzan; Mtei, Gemini; Harris, Bronwyn; Macha, Jane; Meheus, Filip; McIntyre, Di

    2012-07-14

    Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis--integrating both public and private sectors--of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation. Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality. European Union and International Development Research Centre. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. A composite indicator to measure universal health care coverage in India: way forward for post-2015 health system performance monitoring framework.

    Science.gov (United States)

    Prinja, Shankar; Gupta, Rakesh; Bahuguna, Pankaj; Sharma, Atul; Kumar Aggarwal, Arun; Phogat, Amit; Kumar, Rajesh

    2017-02-01

    There is limited work done on developing methods for measurement of universal health coverage. We undertook a study to develop a methodology and demonstrate the practical application of empirically measuring the extent of universal health coverage at district level. Additionally, we also develop a composite indicator to measure UHC. A cross-sectional survey was undertaken among 51 656 households across 21 districts of Haryana state in India. Using the WHO framework for UHC, we identified indicators of service coverage, financial risk protection, equity and quality based on the Government of India and the Haryana Government's proposed UHC benefit package. Geometric mean approach was used to compute a composite UHC index (CUHCI). Various statistical approaches to aggregate input indicators with or without weighting, along with various incremental combinations of input indicators were tested in a comprehensive sensitivity analysis. The population coverage for preventive and curative services is presented. Adjusting for inequality, the coverage for all the indicators were less than the unadjusted coverage by 0.1-6.7% in absolute term and 0.1-27% in relative term. There was low unmet need for curative care. However, about 11% outpatient consultations were from unqualified providers. About 30% households incurred catastrophic health expenditures, which rose to 38% among the poorest 20% population. Summary index (CUHCI) for UHC varied from 12% in Mewat district to 71% in Kurukshetra district. The inequality unadjusted coverage for UHC correlates highly with adjusted coverage. Our paper is an attempt to develop a methodology to measure UHC. However, careful inclusion of others indicators of service coverage is recommended for a comprehensive measurement which captures the spirit of universality. Further, more work needs to be done to incorporate quality in the measurement framework. © The Author 2016. Published by Oxford University Press in association with The London

  11. A Fair Path Toward Universal Coverage: National Case Study for ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    A Fair Path Toward Universal Coverage: National Case Study for Ethiopia, Uganda, and Zambia. As national health systems in developing countries make progress toward achieving universal health service coverage, many face ethical challenges. In its 2010 World Health Report, the World Health Assembly called on the ...

  12. Identifying the poor for premium exemption: a critical step towards universal health coverage in Sub-Saharan Africa.

    Science.gov (United States)

    Umeh, Chukwuemeka A

    2017-01-01

    Premium exemption for the poor is a critical step towards achieving universal health coverage in sub-Saharan Africa due to the large proportion of the population living in extreme poverty who cannot pay premium. However, identifying the poor for premium exemption has been a big challenge for SSA countries. This paper is a succinct review of four methods available for identifying the poor, outlining the ideal conditions under which each of the methods should be used and the drawbacks associated with using each of the methods.

  13. Universal Health Coverage in Francophone Sub-Saharan Africa: Assessment of Global Health Experts' Confidence in Policy Options.

    Science.gov (United States)

    Paul, Elisabeth; Fecher, Fabienne; Meloni, Remo; van Lerberghe, Wim

    2018-05-29

    Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years' experience in the broad region, participated in the 2 rounds of the study. The results provide an initial "mapping" of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to

  14. Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage.

    Science.gov (United States)

    Nandi, Sulakshana; Schneider, Helen; Dixit, Priyanka

    2017-01-01

    Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India's National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure). The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to

  15. Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage.

    Directory of Open Access Journals (Sweden)

    Sulakshana Nandi

    Full Text Available Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India's National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private and out of pocket (OOP expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members of the 2014 National Sample Survey (71st Round on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure. The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests

  16. Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities.

    Science.gov (United States)

    Ramirez, Michelle; Chang, David C; Rogers, Selwyn O; Yu, Peter T; Easterlin, Molly; Coimbra, Raul; Kobayashi, Leslie

    2013-06-15

    Health outcome disparities in racial minorities are well documented. However, it is unknown whether such disparities exist among elderly injured patients. We hypothesized that such disparities might be reduced in the elderly owing to insurance coverage under Medicare. We investigated this issue by comparing the trauma outcomes in young and elderly patients in California. A retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database was performed for all publicly available years from 1995 to 2008. Trauma admissions were identified by International Classification of Disease, Ninth Revision, primary diagnosis codes from 800 to 959, with certain exclusions. Multivariate analysis examined the adjusted risk of in-hospital mortality in young (<65 y) and elderly (≥65 y) patients, controlling for age, gender, injury severity as measured by the survival risk ratio, Charlson comorbidity index, insurance status, calendar year, and teaching hospital status. A total of 1,577,323 trauma patients were identified. Among the young patients, the adjusted odds ratio of death relative to non-Hispanic whites for blacks, Hispanics, Asians, and Native Americans/others was 1.2, 1.2, 0.90, and 0.78, respectively. The corresponding adjusted odds ratios of death for elderly patients were 0.78, 0.87, 0.92, and 0.61. Young black and Hispanic trauma patients had greater mortality risks relative to non-Hispanic white patients. Interestingly, elderly black and Hispanic patients had lower mortality risks compared with non-Hispanic whites. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Geographic variations in avoidable hospitalizations in the elderly, in a health system with universal coverage

    Directory of Open Access Journals (Sweden)

    Alberquilla Angel

    2008-02-01

    Full Text Available Abstract Background The study of Hospitalizations for ambulatory care sensitive conditions (ACSH has been proposed as an indirect measure of access to and receipt of care by older persons at the entryway to the Spanish public health system. The aim of this work is to identify the rates of ACSH in persons 65 years or older living in different small-areas of the Community of Madrid (CM and to detect possible differences in ACSH. Methods Cross-sectional, ecologic study, which covered all 34 health districts of the CM. The study population consisted of all individuals aged 65 years or older residing in the CM between 2001 and 2003, inclusive. Using hospital discharge data, avoidable ACSH were selected from the list of conditions validated for Spain. Age- and sex-adjusted ACSH rates were calculated for the population of each health district and the statistics describing the data variability. Point graphs and maps were designed to represent the ACSH rates in the different health districts. Results Of all the hospitalizations, 16.5% (64,409 were ACSH. Globally, the rate was higher among men: 33.15 per 1,000 populations vs. 22.10 in women and these differences were statistically significant (p Conclusion A significant variation is demonstrated in "preventable" hospitalizations between the different districts. In all the districts the men present rates significantly higher than women. Important variations in the access are observed the Primary Attention in spite of existing a universal sanitary cover.

  18. Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage

    Directory of Open Access Journals (Sweden)

    Rowaida Al Maaitah

    Full Text Available ABSTRACT Objective: to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs towards the achievement of Universal Health Converge (UHC as perceived by health key informants in Jordan. Methods: an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. Results: the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. Conclusion: study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation.

  19. Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage.

    Science.gov (United States)

    Maaitah, Rowaida Al; AbuAlRub, Raeda Fawzi

    2017-01-30

    to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs) towards the achievement of Universal Health Converge (UHC) as perceived by health key informants in Jordan. an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation. analisar as ações prioritárias para o fortalecimento do papel da enfermeira em prática avançada na Cobertura Universal de Saúde , segundo a percepção dos informantes-chave na Jordânia. foi utilizado desenho qualitativo exploratório, com um questionário semiestruturado. A amostra intencional de dezessete informantes-chave de vários setores de enfermagem e de saúde foi recrutado para o propósito do estudo. A análise de conteúdo utilizando a abordagem do quadro de cinco estágios foi utilizada para a análise de dados. os resultados revelaram que as políticas e regulações, educação em enfermagem, pesquisa e força de trabalho foram identificados como os principais elementos que influenciam o papel da enfermeira em prática avançada em contribuir para a realização da

  20. Selling my sheep to pay for medicines - household priorities and coping strategies in a setting without universal health coverage.

    Science.gov (United States)

    Husøy, Onarheim Kristine; Molla, Sisay Mitike; Muluken, Gizaw; Marie, Moland Karen; Frithof, Norheim Ole; Ingrid, Miljeteig

    2018-03-02

    The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families' opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities. A qualitative study was conducted in 2015 in Butajira, Ethiopia, comprising observation, semi-structured interviews, and focus group discussions with household members, health workers, and community members. Household members with hospitalized newborns or who had experienced neonatal death were primary informants. In this predominantly rural and poor district, households struggled to pay out-of-pocket for services such as admission, diagnostics, drugs, and transportation. When newborns fell ill, families made hard choices balancing concerns for newborn health and other household needs. The ability to seek care, obtain services, and follow medical advice depended on the social and economic assets of the household. It was common to borrow money from friends and family, or even to sell a sheep or the harvest, if necessary. In managing household priorities and high costs, families waited before seeking health care, or used cheaper traditional medicines. For poor families with no money or opportunity to borrow, it became impossible to follow medical advice or even seek care in the first place. This had fatal health consequences for the sick newborns. While improving neonatal health is prioritized at policy level in Ethiopia, poor households with sick neonates may prioritize differently. With limited money at hand and high direct health care costs, families balanced conflicting

  1. Realizing universal health coverage for maternal health services in the Republic of Guinea: the use of workforce projections to design health labor market interventions

    Directory of Open Access Journals (Sweden)

    Jansen C

    2014-11-01

    Full Text Available Christel Jansen,1 Laurence Codjia,2 Giorgio Cometto,3 Mohamed Lamine Yansané,4 Marjolein Dieleman1 1Health Unit, Royal Tropical Institute, Amsterdam, the Netherlands; 2Health Workforce, World Health Organization, Geneva, Switzerland; 3Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland; 4Health Focus GmbH, Conakry, Guinea Background: Universal health coverage requires a health workforce that is available, accessible, and well-performing. This article presents a critical analysis of the health workforce needs for the delivery of maternal and neonatal health services in Guinea, and of feasible and relevant interventions to improve the availability, accessibility, and performance of the health workforce in the country. Methods: A needs-based approach was used to project human resources for health (HRH requirements. This was combined with modeling of future health sector demand and supply. A baseline scenario with disaggregated need and supply data for the targeted health professionals per region and setting (urban or rural informed the identification of challenges related to the availability and distribution of the workforce between 2014 and 2024. Subsequently, the health labor market framework was used to identify interventions to improve the availability and distribution of the health workforce. These interventions were included in the supply side modeling, in order to create a “policy rich” scenario B which allowed for analysis of their potential impact. Results: In the Republic of Guinea, only 44% of the nurses and 18% of the midwives required for maternal and neonatal health services are currently available. If Guinea continues on its current path without scaling up recruitment efforts, the total stock of HRH employed by the public sector will decline by 15% between 2014 and 2024, while HRH needs will grow by 22% due to demographic trends. The high density of HRH in urban areas and the high number of auxiliary

  2. Financing universal health coverage--effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries.

    Science.gov (United States)

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-07-18

    How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995-2011. Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9.86 (95% CI 3.92-15.8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16.7, 9.16 to 24.3), but not for consumption taxes on goods and services (-$4.37, -12.9 to 4.11). In countries with low tax revenues (tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6.74 percentage points (95% CI 0.87-12.6) and the extent of financial coverage by 11.4 percentage points (5.51-17.2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework might accelerate progress toward achieving major

  3. Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition

    Science.gov (United States)

    Jamison, Dean T; Adeyi, Olusoji; Anand, Shuchi; Atun, Rifat; Bertozzi, Stefano; Bhutta, Zulfiqar; Binagwaho, Agnes; Black, Robert; Blecher, Mark; Bloom, Barry R; Brouwer, Elizabeth; Bundy, Donald A P; Chisholm, Dan; Cieza, Alarcos; Cullen, Mark; Danforth, Kristen; de Silva, Nilanthi; Debas, Haile T; Donkor, Peter; Dua, Tarun; Fleming, Kenneth A; Gallivan, Mark; Garcia, Patricia J; Gawande, Atul; Gaziano, Thomas; Gelband, Hellen; Glass, Roger; Glassman, Amanda; Gray, Glenda; Habte, Demissie; Holmes, King K; Horton, Susan; Hutton, Guy; Jha, Prabhat; Knaul, Felicia M; Kobusingye, Olive; Krakauer, Eric L; Kruk, Margaret E; Lachmann, Peter; Laxminarayan, Ramanan; Levin, Carol; Looi, Lai Meng; Madhav, Nita; Mahmoud, Adel; Mbanya, Jean Claude; Measham, Anthony; Medina-Mora, María Elena; Medlin, Carol; Mills, Anne; Mills, Jody-Anne; Montoya, Jaime; Norheim, Ole; Olson, Zachary; Omokhodion, Folashade; Oppenheim, Ben; Ord, Toby; Patel, Vikram; Patton, George C; Peabody, John; Prabhakaran, Dorairaj; Qi, Jinyuan; Reynolds, Teri; Ruacan, Sevket; Sankaranarayanan, Rengaswamy; Sepúlveda, Jaime; Skolnik, Richard; Smith, Kirk R; Temmerman, Marleen; Tollman, Stephen; Verguet, Stéphane; Walker, Damian G; Walker, Neff; Wu, Yangfeng; Zhao, Kun

    2018-01-01

    The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to

  4. Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.

    Science.gov (United States)

    Jamison, Dean T; Alwan, Ala; Mock, Charles N; Nugent, Rachel; Watkins, David; Adeyi, Olusoji; Anand, Shuchi; Atun, Rifat; Bertozzi, Stefano; Bhutta, Zulfiqar; Binagwaho, Agnes; Black, Robert; Blecher, Mark; Bloom, Barry R; Brouwer, Elizabeth; Bundy, Donald A P; Chisholm, Dan; Cieza, Alarcos; Cullen, Mark; Danforth, Kristen; de Silva, Nilanthi; Debas, Haile T; Donkor, Peter; Dua, Tarun; Fleming, Kenneth A; Gallivan, Mark; Garcia, Patricia J; Gawande, Atul; Gaziano, Thomas; Gelband, Hellen; Glass, Roger; Glassman, Amanda; Gray, Glenda; Habte, Demissie; Holmes, King K; Horton, Susan; Hutton, Guy; Jha, Prabhat; Knaul, Felicia M; Kobusingye, Olive; Krakauer, Eric L; Kruk, Margaret E; Lachmann, Peter; Laxminarayan, Ramanan; Levin, Carol; Looi, Lai Meng; Madhav, Nita; Mahmoud, Adel; Mbanya, Jean Claude; Measham, Anthony; Medina-Mora, María Elena; Medlin, Carol; Mills, Anne; Mills, Jody-Anne; Montoya, Jaime; Norheim, Ole; Olson, Zachary; Omokhodion, Folashade; Oppenheim, Ben; Ord, Toby; Patel, Vikram; Patton, George C; Peabody, John; Prabhakaran, Dorairaj; Qi, Jinyuan; Reynolds, Teri; Ruacan, Sevket; Sankaranarayanan, Rengaswamy; Sepúlveda, Jaime; Skolnik, Richard; Smith, Kirk R; Temmerman, Marleen; Tollman, Stephen; Verguet, Stéphane; Walker, Damian G; Walker, Neff; Wu, Yangfeng; Zhao, Kun

    2018-03-17

    The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to

  5. Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries.

    Science.gov (United States)

    Watkins, David A; Nugent, Rachel A

    2017-01-01

    Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low- and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC.

  6. Assessing the impact of privatizing public hospitals in three American states: implications for universal health coverage.

    Science.gov (United States)

    Villa, Stefano; Kane, Nancy

    2013-01-01

    Many countries with universal health systems have relied primarily on publicly-owned hospitals to provide acute care services to covered populations; however, many policymakers have experimented with expansion of the private sector for what they hope will yield more cost-effective care. The study provides new insight into the effects of hospital privatization in three American states (California, Florida, and Massachusetts) in the period 1994 to 2003, focusing on three aspects: 1) profitability; 2) productivity and efficiency; and 3) benefits to the community (particularly, scope of services offered, price level, and impact on charity care). For each variable analyzed, we compared the 3-year mean values pre- and postconversion. Pre- and postconversion changes in hospitals' performance were then compared with a nonequivalent comparison group of American public hospitals. The results of our study indicate that following privatization, hospitals increased operating margins, reduced their length of stay, and enjoyed higher occupancy, but at some possible cost to access to care for their communities in terms of higher price markups and loss of beneficial but unprofitable services. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  7. Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria.

    Science.gov (United States)

    Onoka, Chima A; Onwujekwe, Obinna E; Uzochukwu, Benjamin S; Ezumah, Nkoli N

    2013-06-13

    The National Health Insurance Scheme (NHIS) in Nigeria was launched in 2005 as part of efforts by the federal government to achieve universal coverage using financial risk protection mechanisms. However, only 4% of the population, and mainly federal government employees, are currently covered by health insurance and this is primarily through the Formal Sector Social Health Insurance Programme (FSSHIP) of the NHIS. This study aimed to understand why different state (sub-national) governments decided whether or not to adopt the FSSHIP for their employees. This study used a comparative case study approach. Data were collected through document reviews and 48 in-depth interviews with policy makers, programme managers, health providers, and civil servant leaders. Although the programme's benefits seemed acceptable to state policy makers and the intended beneficiaries (employees), the feasibility of employer contributions, concerns about transparency in the NHIS and the role of states in the FSSHIP, the roles of policy champions such as state governors and resistance by employees to making contributions, all influenced the decision of state governments on adoption. Overall, the power of state governments over state-level health reforms, attributed to the prevailing system of government that allows states to deliberate on certain national-level policies, enhanced by the NHIS legislation that made adoption voluntary, enabled states to adopt or not to adopt the program. The study demonstrates and supports observations that even when the content of a programme is generally acceptable, context, actor roles, and the wider implications of programme design on actor interests can explain decision on policy adoption. Policy implementers involved in scaling-up the NHIS programme need to consider the prevailing contextual factors, and effectively engage policy champions to overcome known challenges in order to encourage adoption by sub-national governments. Policy makers and

  8. An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS).

    Science.gov (United States)

    Marten, Robert; McIntyre, Diane; Travassos, Claudia; Shishkin, Sergey; Longde, Wang; Reddy, Srinath; Vega, Jeanette

    2014-12-13

    Brazil, Russia, India, China, and South Africa (BRICS) represent almost half the world's population, and all five national governments recently committed to work nationally, regionally, and globally to ensure that universal health coverage (UHC) is achieved. This analysis reviews national efforts to achieve UHC. With a broad range of health indicators, life expectancy (ranging from 53 years to 73 years), and mortality rate in children younger than 5 years (ranging from 10·3 to 44·6 deaths per 1000 livebirths), a review of progress in each of the BRICS countries shows that each has some way to go before achieving UHC. The BRICS countries show substantial, and often similar, challenges in moving towards UHC. On the basis of a review of each country, the most pressing problems are: raising insufficient public spending; stewarding mixed private and public health systems; ensuring equity; meeting the demands for more human resources; managing changing demographics and disease burdens; and addressing the social determinants of health. Increases in public funding can be used to show how BRICS health ministries could accelerate progress to achieve UHC. Although all the BRICS countries have devoted increased resources to health, the biggest increase has been in China, which was probably facilitated by China's rapid economic growth. However, the BRICS country with the second highest economic growth, India, has had the least improvement in public funding for health. Future research to understand such different levels of prioritisation of the health sector in these countries could be useful. Similarly, the role of strategic purchasing in working with powerful private sectors, the effect of federal structures, and the implications of investment in primary health care as a foundation for UHC could be explored. These issues could serve as the basis on which BRICS countries focus their efforts to share ideas and strategies. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme

    OpenAIRE

    Goudge, Jane; Alaba, Olufunke A.; Govender, Veloshnee; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F.

    2018-01-01

    Background Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for governme...

  10. Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

    NARCIS (Netherlands)

    Baltussen, R.; Jansen, M.P.M.; Mikkelsen, E.; Tromp, N.; Hontelez, J.; Bijlmakers, L.; Wilt, G.J. van der

    2016-01-01

    Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more

  11. Priority setting for universal health coverage: We need evidence-informed deliberative processes, not just more evidence on cost-effectiveness

    NARCIS (Netherlands)

    R. Baltussen (R.); Jansen, M.P. (Maarten P.); T.S. Mikkelsen; N. Tromp; J.A.C. Hontelez (Jan); Bijlmakers, L. (Leon); G.-J. van der Wilt (Gert-Jan)

    2016-01-01

    textabstractPriority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of

  12. Growth of health maintenance organisations in Nigeria and the potential for a role in promoting universal coverage efforts.

    Science.gov (United States)

    Onoka, Chima A; Hanson, Kara; Mills, Anne

    2016-08-01

    There has been growing interest in the potential for private health insurance (PHI) and private organisations to contribute to universal health coverage (UHC). Yet evidence from low and middle income countries remains very thin. This paper examines the evolution of health maintenance organisations (HMOs) in Nigeria, the nature of the PHI plans and social health insurance (SHI) programmes and their performance, and the implications of their business practices for providing PHI and UHC-related SHI programmes. An embedded case study design was used with multiple subunits of analysis (individual HMOs and the HMO industry) and mixed (qualitative and quantitative) methods, and the study was guided by the structure-conduct-performance paradigm that has its roots in the neo-classical theory of the firm. Quantitative data collection and 35 in-depth interviews were carried out between October 2012 to July 2013. Although HMOs first emerged in Nigeria to supply PHI, their expansion was driven by their role as purchasers in the government's national health insurance scheme that finances SHI programmes, and facilitated by a weak accreditation system. HMOs' characteristics distinguish the market they operate in as monopolistically competitive, and HMOs as multiproduct firms operating multiple risk pools through parallel administrative systems. The considerable product differentiation and consequent risk selection by private insurers promote inefficiencies. Where HMOs and similar private organisations play roles in health financing systems, effective regulatory institutions and mandates must be established to guide their behaviours towards attainment of public health goals and to identify and control undesirable business practices. Lessons are drawn for policy makers and programme implementers especially in those low and middle-income countries considering the use of private organisations in their health financing systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes

    NARCIS (Netherlands)

    Valentine, Nicole Britt; Bonsel, Gouke J

    Background Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are

  14. Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes

    NARCIS (Netherlands)

    N. Valentine (Nicole); G.J. Bonsel (Gouke)

    2016-01-01

    textabstractBackground: Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare

  15. Modelling the implications of moving towards universal coverage in Tanzania.

    Science.gov (United States)

    Borghi, Josephine; Mtei, Gemini; Ally, Mariam

    2012-03-01

    A model was developed to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. Three scenarios were considered: maintaining the current situation ('the status quo'); expanded health insurance coverage (the estimated maximum achievable coverage in the absence of premium subsidies, coverage restricted to those who can pay); universal coverage to all (government revenues used to pay the premiums for the poor). The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Under the status quo, financial protection is provided to 10% of the population through health insurance schemes, with the remaining population benefiting from subsidized user charges in public facilities. Seventy-six per cent of the population would benefit from financial protection through health insurance under the expanded coverage scenario, and 100% of the population would receive such protection through a mix of insurance cover and government funding under the universal coverage scenario. The expanded and universal coverage scenarios have a significant effect on utilization levels, especially for public outpatient care. Universal coverage would require an initial doubling in the proportion of GDP going to the public health system. Government health expenditure would increase to 18% of total government expenditure. The results are sensitive to the cost of health system strengthening, the level of real GDP growth, provider reimbursement rates and administrative costs. Promoting greater cross-subsidization between insurance schemes would provide sufficient resources to finance universal coverage. Alternately, greater tax funding for health could be generated through an increase in the rate of Value-Added Tax (VAT) or expanding the income tax base. The feasibility and sustainability of efforts to

  16. Could universal health care coverage restrict access? The mixed effects of universal coverage on minorities' receipt of obstetric care in northern Thailand

    Directory of Open Access Journals (Sweden)

    Stephanie M Koning, BS

    2014-05-01

    Funding: The British Embassy-Bangkok, the Canadian International Development Agency, pre-doctoral National Research Service Award Training Grant (T32 HS00023, PI: Smith, and National Institute of Child Health and Human Development Training Grant (T32 5T32AG000129-25, PD: Palloni.

  17. Toward Advanced Nursing Practice along with People-Centered Care Partnership Model for Sustainable Universal Health Coverage and Universal Access to Health.

    Science.gov (United States)

    Kamei, Tomoko; Takahashi, Keiko; Omori, Junko; Arimori, Naoko; Hishinuma, Michiko; Asahara, Kiyomi; Shimpuku, Yoko; Ohashi, Kumiko; Tashiro, Junko

    2017-01-30

    this study developed a people-centered care (PCC) partnership model for the aging society to address the challenges of social changes affecting people's health and the new role of advanced practice nurses to sustain universal health coverage. a people-centered care partnership model was developed on the basis of qualitative meta-synthesis of the literature and assessment of 14 related projects. The ongoing projects resulted in individual and social transformation by improving community health literacy and behaviors using people-centered care and enhancing partnership between healthcare providers and community members through advanced practice nurses. people-centered care starts when community members and healthcare providers foreground health and social issues among community members and families. This model tackles these issues, creating new values concerning health and forming a social system that improves quality of life and social support to sustain universal health care through the process of building partnership with communities. a PCC partnership model addresses the challenges of social changes affecting general health and the new role of advanced practice nurses in sustaining UHC. o estudo desenvolveu um modelo de parceria de cuidados centrados nas pessoas (CCP) para uma sociedade que está envelhecendo, com o fim de enfrentar os desafios das mudanças sociais que afetam a saúde das pessoas e o novo papel da prática avançada de enfermagem para sustentar a cobertura universal de saúde. um modelo de parceria de cuidados centrados nas pessoas foi desenvolvido com base na meta-síntese qualitativa da literatura e a avaliação de 14 projetos relacionados. Os projetos em curso resultaram na transformação individual e social, melhorando a alfabetização de saúde da comunidade e comportamentos que usam o cuidado centrado nas pessoas e aumentando a parceria entre os profissionais de saúde e membros da comunidade por meio da prática avançada de enfermagem

  18. Health Insurance In China: After Declining In The 1990s, Coverage Rates Rebounded To Near-Universal Levels By 2011.

    Science.gov (United States)

    Li, Yanping; Malik, Vasanti; Hu, Frank B

    2017-08-01

    We analyzed trends in rates of health insurance coverage in China in the period 1991-2011 and the association of health insurance with hypertension and diabetes based on data from eight waves of the China Health and Nutrition Survey. The rate of coverage fell from 32.3 percent in 1991 to 21.9 percent in 2000, rebounding to 49.7 percent in 2006 and then rapidly climbing to 94.7 percent in 2011. Our study indicated that neither the prevalence of diabetes nor that of hypertension was significantly associated with health insurance coverage. When patients were aware of their condition or disease, those with insurance had a significantly higher likelihood of treatment for diabetes and hypertension, compared to those without insurance. We observed an association between health insurance coverage and seeking preventive care and receiving medical treatment when patients were aware of their condition or disease. Project HOPE—The People-to-People Health Foundation, Inc.

  19. The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

    Science.gov (United States)

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

    2012-01-01

    This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

  20. Inequities in coverage of preventive child health interventions: the rural drinking water supply program and the universal immunization program in Rajasthan, India.

    Science.gov (United States)

    Mohan, Pavitra

    2005-02-01

    I assessed whether the Rural Drinking Water Supply Program (RDWSP) and the Universal Immunization Program (UIP) have achieved equitable coverage in Rajasthan, India, and explored program characteristics that affect equitable coverage of preventive health interventions. A total of 2460 children presenting at 12 primary health facilities in one district of Rajasthan were enrolled and classified into economic quartiles based on possession of assets. Immunization coverage and prime source of drinking water were compared across quartiles. A higher access to piped water by wealthier families (P< .001) was compensated by higher access to hand pumps by poorer families (P<.001), resulting in equal access to a safe source (P=.9). Immunization coverage was inequitable, favoring the wealthier children (P<.001). The RDWSP has achieved equitable coverage, while UIP coverage remains highly inequitable. Programs can make coverage more equitable by formulating explicit objectives to ensure physical access to all, promoting the intervention's demand by the poor, and enhancing the support and monitoring of frontline workers who deliver these interventions.

  1. Methods University Health System Can Use to Expand Medicaid Coverage to Uninsured Poor Parents with Medicaid Eligible Children: Policy Analysis

    National Research Council Canada - National Science Library

    McMahon, III, Robert T

    2006-01-01

    ... and the continuing reduction in local employer-sponsored insurance. The cost for providing health care to this population has fallen to Bexar County residents through local taxes in support of the county hospital, University Health System...

  2. Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China.

    Science.gov (United States)

    Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

    2017-06-02

    China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members

  3. 77 FR 16453 - Student Health Insurance Coverage

    Science.gov (United States)

    2012-03-21

    ... eliminating annual and lifetime dollar limits would result in dramatic premium hikes for student plans and.... Industry and university commenters noted that student health insurance coverage benefits typically... duplication of benefits and makes student plans more affordable. Industry commenters noted that student health...

  4. Financing Universal Coverage in Malaysia: a case study

    OpenAIRE

    Chua, Hong Teck; Cheah, Julius Chee Ho

    2012-01-01

    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this...

  5. Assessment of progress towards universal health coverage for people with disabilities in Afghanistan: a multilevel analysis of repeated cross-sectional surveys.

    Science.gov (United States)

    Trani, Jean-Francois; Kumar, Praveen; Ballard, Ellis; Chandola, Tarani

    2017-08-01

    Since 2002, Afghanistan has made much effort to achieve universal health coverage. According to the UN Sustainable Development Goal 3, target eight, the provision of quality care to all must include usually underserved groups, including people with disabilities. We investigated whether a decade of international investment in the Afghan health system has brought quality health care to this group. We used data from two representative household surveys, one done in 2005 and one in 2013, in 13 provinces of Afghanistan, that included questions about activity limitations and functioning difficulties, socioeconomic factors, perceived availability of health care, and experience with coverage of health-care needs. We used multilevel modelling and tests for interaction to investigate factors associated with differences in perception between timepoints and whether village remoteness affected changes in perception. The 2005 survey included 334 people, and the 2013 survey included 961 people. Mean age, employment, and asset levels of participants with disabilities increased slightly between 2005 and 2013, but the level of education decreased. Formal education and higher asset level were associated with improved availability of health care and positive experience with coverage of health-care needs, whereas being employed was only associated with the latter. Perceived availability of health care and positive experience with coverage of health-care needs significantly worsened in 2013 compared with in 2005 (227 [69%] perceived that services were available in 2005 vs 405 [44%] in 2013, pAfghanistan, particularly in remote areas. Health policy in Afghanistan will need to address attitudinal, social, and accessibility barriers to health care. Swedish International Development Agency. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

  6. Newborn health benefits or financial risk protection? An ethical analysis of a real-life dilemma in a setting without universal health coverage.

    Science.gov (United States)

    Onarheim, Kristine Husøy; Norheim, Ole Frithjof; Miljeteig, Ingrid

    2018-03-30

    High healthcare costs make illness precarious for both patients and their families' economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood. Using a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia and analyse the acceptability of limiting treatment for an ill newborn to protect against financial risk. We assess available evidence and ethical issues at stake and discuss the dilemma with respect to three priority setting criteria: health maximisation, priority to the worse-off and financial risk protection. Giving priority to health maximisation and extra priority to the worse-off suggests, in this particular case, that limiting treatment is not acceptable even if the total well-being gain from reduced financial risk is taken into account. Our conclusion depends on the facts of the case and the relative weight assigned to these criteria. However, there are problematic aspects with the premise of this dilemma. The most affected parties-the newborn, family members and health worker-cannot make free choices about whether to limit treatment or not, and we thereby accept deprivations of people's substantive freedoms. In settings where healthcare is financed largely out-of-pocket, families and health workers face tragic trade-offs. As countries move towards universal health coverage, financial risk protection for high-priority services is necessary to promote fairness, improve health and reduce poverty. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa.

    Science.gov (United States)

    Peltzer, Karl; Williams, Jennifer Stewart; Kowal, Paul; Negin, Joel; Snodgrass, James Josh; Yawson, Alfred; Minicuci, Nadia; Thiele, Liz; Phaswana-Mafuya, Nancy; Biritwum, Richard Berko; Naidoo, Nirmala; Chatterji, Somnath

    2014-01-01

    The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. This study provides a basis for further investigation of country-specific responses to UHC.

  8. Universal coverage of IVF pays off.

    Science.gov (United States)

    Vélez, M P; Connolly, M P; Kadoch, I-J; Phillips, S; Bissonnette, F

    2014-06-01

    What was the clinical and economic impact of universal coverage of IVF in Quebec, Canada, during the first calendar year of implementation of the public IVF programme? Universal coverage of IVF increased access to IVF treatment, decreased the multiple pregnancy rate and decreased the cost per live birth, despite increased costs per cycle. Public funding of IVF assures equality of access to IVF and decreases multiple pregnancies resulting from this treatment. Public IVF programmes usually mandate a predominant SET policy, the most effective approach for reducing the incidence of multiple pregnancies. This prospective comparative cohort study involved 7364 IVF cycles performed in Quebec during 2009 and 2011 and included an economic analysis. IVF cycles performed in the five centres offering IVF treatment in Quebec during 2009, before implementation of the public IVF programme, were compared with cycles performed at the same centres during 2011, the first full calendar year following implementation of the programme. Data were obtained from the Canadian Assisted Reproductive Technologies Register (CARTR). Comparisons were made between the two periods in terms of utilization, pregnancy rates, multiple pregnancy rates and costs. The number of IVF cycles performed in Quebec increased by 192% after the new policy was implemented. Elective single-embryo transfer was performed in 1.6% of the cycles during Period I (2009), and increased to 31.6% during Period II (2011) (P IVF programme increased government costs per IVF treatment cycle from CAD$3730 to CAD$4759. Despite increased costs per cycle, the efficiency defined by the cost per live birth, which factored in downstream health costs up to 1 year post delivery, decreased from CAD$49 517 to CAD$43 362 per baby conceived by either fresh and frozen cycles. The costs described in the economic model are likely an underestimate as they do not factor in many of the long-term costs that can occur after 1 year of age. The

  9. 76 FR 7767 - Student Health Insurance Coverage

    Science.gov (United States)

    2011-02-11

    ... Student Health Insurance Coverage AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION... health insurance coverage under the Public Health Service Act and the Affordable Care Act. The proposed rule would define ``student health insurance [[Page 7768

  10. State budget transfers to Health Insurance Funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in Eastern European high-income countries.

    Science.gov (United States)

    Vilcu, Ileana; Mathauer, Inke

    2016-01-15

    Many countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a "traditional" approach. The Eastern European high-income countries studied in this paper managed to avoid this potential pitfall by using state budget revenues to explicitly pay health insurance contributions on behalf of certain (vulnerable) population groups who have difficulties to pay these contributions themselves. The institutional design aspects of their government revenue transfer arrangements are analysed, as well as their impact on universal health coverage progress. This regional study is based on literature review and review of databases for the performance assessment. The analytical framework focuses on the following institutional design features: rules on eligibility for contribution exemption, financing and pooling arrangements, and purchasing arrangements and benefit package design. More commonalities than differences can be identified across countries: a broad range of groups eligible for exemption from payment of health insurance contributions, full state contributions on behalf of the exempted groups, mostly mandatory participation, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. In terms of performance, all countries have high total population coverage rates, but there are still challenges regarding financial protection and access to and utilization of health care services, especially for low income people. Overall, government revenue transfer arrangements to exempt vulnerable groups from contributions are one option to progress towards universal health coverage.

  11. Barriers to universal health coverage in Republic of Moldova: a policy analysis of formal and informal out-of-pocket payments.

    Science.gov (United States)

    Vian, Taryn; Feeley, Frank G; Domente, Silviu; Negruta, Ala; Matei, Andrei; Habicht, Jarno

    2015-08-11

    Universal Health Coverage seeks to assure that everyone can obtain the health services they need without financial hardship. Countries which rely heavily on out-of-pocket (OOP) payments, including informal payments (IP), to finance total health expenditures are not likely to achieve universal coverage. The Republic of Moldova is committed to promoting universal coverage, reducing inequities, and expanding financial protection. To achieve these goals, the country must reduce the proportion of total health expenditures paid by households. This study documents the extent of OOP payments and IP in Moldova, analyses trends over time, and identifies factors which may be driving these payments. The study includes analysis of household budget survey data and previous research and policy documents. The team also conducted a review of administrative law intended to control OOP payments and IPs. Focus groups, interviews, and a policy dialogue with key stakeholders were held to validate and discuss findings. OOP payments account for 45% of total health expenditures. Sixteen percent of outpatients and 30% of inpatients reporting that they made OOP payments when seeking care at a health facility in 2012, more than two-thirds of whom also reported paying for medicines at a pharmacy. Among those who paid anything, 36% of outpatients and 82% of inpatients reported paying informally, with the proportion increasing over time for inpatient care. Although many patients consider these payments to be gifts, around one-third of IPs appear to be forced, posing a threat to health care access. Patients perceive that payments are driven by the limited list of reimbursable medicines, a desire to receive better treatment, and fear or extortion. Providers suggested irrational prescribing and ordering of tests as drivers. Providers may believe that IPs are gifts and do not cause harm for patients and the health system in general. Efforts to expand financial protection should focus on reducing

  12. A community-based approach to non-communicable chronic disease management within a context of advancing universal health coverage in China: progress and challenges.

    Science.gov (United States)

    Xiao, Nanzi; Long, Qian; Tang, Xiaojun; Tang, Shenglan

    2014-01-01

    Paralleled with the rapid socio-economic development and demographic transition, an epidemic of non-communicable chronic diseases (NCDs) has emerged in China over the past three decades, resulting in increased disease and economic burdens. Over the past decade, with a political commitment of implementing universal health coverage, China has strengthened its primary healthcare system and increased investment in public health interventions. A community-based approach to address NCDs has been acknowledged and recognized as one of the most cost-effective solutions. Community-based strategies include: financial and health administrative support; social mobilization; community health education and promotion; and the use of community health centers in NCD detection, diagnosis, treatment, and patient management. Although China has made good progress in developing and implementing these strategies and policies for NCD prevention and control, many challenges remain. There are a lack of appropriately qualified health professionals at grass-roots health facilities; it is difficult to retain professionals at that level; there is insufficient public funding for NCD care and management; and NCD patients are economically burdened due to limited benefit packages covering NCD treatment offered by health insurance schemes. To tackle these challenges we propose developing appropriate human resource policies to attract greater numbers of qualified health professionals at the primary healthcare level; adjusting the service benefit packages to encourage the use of community-based health services; and increase government investment in public health interventions, as well as investing more on health insurance schemes.

  13. India in search of right Universal Health Coverage (UHC model: The risks of implementing UHC in the absence of political demand by the citizen

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2016-01-01

    Full Text Available Amid the global push for Universal Health Coverage (UHC, the agenda is being set for India′s health care. In the absence of a constitutional mandate, a national policy and citizen-led political demand for UHC, there exist specific risks in rushing toward its implementation in India. As the debate of UHC continues, the health-care delivery system in India is at cross roads. UHC in India could take two different trajectories. The first one takes India toward becoming "Global Bazaar" of morbidity and ill health, founded on the pillars of a vibrant rapidly multiplying healthcare industry. The other path takes India on a course of preventing wasteful, expensive health-care expenditure by maintaining healthy populations. A poor professional blood donor cannot become rich by selling his or her own blood beyond medically permissible levels; similarly, India cannot become a developed economy by  merely allowing exploitation of disease, illness, and morbidity of her citizen. It is the duty of the state and governments to protect individual citizen, population under consideration, as well as country′s economy from wasteful and potentially harmful expenditure incurred to address ill health. In the economic sense, any sensible UHC implementation mechanism would seek to regulate wasteful preventable health-care expenditure for the purpose of future economic stability and growth of the country. Due diligence toward safeguarding "public health in public interest," during the process of UHC implementation, is the need of the hour.

  14. India in search of right Universal Health Coverage (UHC) model: The risks of implementing UHC in the absence of political demand by the citizen.

    Science.gov (United States)

    Kumar, Raman; Roy, Pritam

    2016-01-01

    Amid the global push for Universal Health Coverage (UHC), the agenda is being set for India's health care. In the absence of a constitutional mandate, a national policy and citizen-led political demand for UHC, there exist specific risks in rushing toward its implementation in India. As the debate of UHC continues, the health-care delivery system in India is at cross roads. UHC in India could take two different trajectories. The first one takes India toward becoming "Global Bazaar" of morbidity and ill health, founded on the pillars of a vibrant rapidly multiplying healthcare industry. The other path takes India on a course of preventing wasteful, expensive health-care expenditure by maintaining healthy populations. A poor professional blood donor cannot become rich by selling his or her own blood beyond medically permissible levels; similarly, India cannot become a developed economy by merely allowing exploitation of disease, illness, and morbidity of her citizen. It is the duty of the state and governments to protect individual citizen, population under consideration, as well as country's economy from wasteful and potentially harmful expenditure incurred to address ill health. In the economic sense, any sensible UHC implementation mechanism would seek to regulate wasteful preventable health-care expenditure for the purpose of future economic stability and growth of the country. Due diligence toward safeguarding "public health in public interest," during the process of UHC implementation, is the need of the hour.

  15. Equity in health financing of Guangxi after China's universal health coverage: evidence based on health expenditure comparison in rural Guangxi Zhuang autonomous region from 2009 to 2013.

    Science.gov (United States)

    Qin, Xianjing; Luo, Hongye; Feng, Jun; Li, Yanning; Wei, Bo; Feng, Qiming

    2017-09-29

    Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. Our study

  16. The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study.

    Science.gov (United States)

    Cheng, Shou-Hsia; Chen, Chi-Chen; Tsai, Shu-Ling

    2012-10-01

    To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. The introduction of DRG payment resulted in a 10% decrease (pDRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme.

    Science.gov (United States)

    Goudge, Jane; Alaba, Olufunke A; Govender, Veloshnee; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F

    2018-01-04

    Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. Using a cross-sectional survey across four of South Africa's nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. A quarter of respondents remained uninsured, even higher among 20-29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/month with lowest benefits. By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over

  18. Revisiting policy on chronic HCV treatment under the Thai Universal Health Coverage: An economic evaluation and budget impact analysis.

    Science.gov (United States)

    Rattanavipapong, Waranya; Anothaisintawee, Thunyarat; Teerawattananon, Yot

    2018-01-01

    Thailand is encountering challenges to introduce the high-cost sofosbuvir for chronic hepatitis C treatment as part of the Universal Health Care's benefit package. This study was conducted in respond to policy demand from the Thai government to assess the value for money and budget impact of introducing sofosbuvir-based regimens in the tax-based health insurance scheme. The Markov model was constructed to assess costs and benefits of the four treatment options that include: (i) current practice-peginterferon alfa (PEG) and ribavirin (RBV) for 24 weeks in genotype 3 and 48 weeks for other genotypes; (ii) Sofosbuvir plus peginterferon alfa and ribavirin (SOF+PEG-RBV) for 12 weeks; (iii) Sofosbuvir and daclatasvir (SOF+DCV) for 12 weeks; (iv) Sofosbuvir and ledipasvir (SOF+LDV) for 12 weeks for non-3 genotypes and SOF+PEG-RBV for 12 weeks for genotype 3 infection. Given that policy options (ii) and (iii) are for pan-genotypic infection, the cost of genotype testing was applied only for policy options (i) and (iv). Results reveal that all sofosbuvir-based regimens had greater quality adjusted life years (QALY) gains compared with the current treatment, therefore associated with lower lifetime costs and more favourable health outcomes. Additionally, among the three regimens of sofosbuvir, SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype are the most cost-effective treatment option with the threshold of 160,000 THB per QALY gained. The results of this study had been used in policy discussion which resulted in the recent inclusion of SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype in the Thailand's benefit package.

  19. Towards universal health coverage: the role of within-country wealth-related inequality in 28 countries in sub-Saharan Africa.

    Science.gov (United States)

    Hosseinpoor, Ahmad Reza; Victora, Cesar G; Bergen, Nicole; Barros, Aluisio J D; Boerma, Ties

    2011-12-01

    To measure within-country wealth-related inequality in the health service coverage gap of maternal and child health indicators in sub-Saharan Africa and quantify its contribution to the national health service coverage gap. Coverage data for child and maternal health services in 28 sub-Saharan African countries were obtained from the 2000-2008 Demographic Health Survey. For each country, the national coverage gap was determined for an overall health service coverage index and select individual health service indicators. The data were then additively broken down into the coverage gap in the wealthiest quintile (i.e. the proportion of the quintile lacking a required health service) and the population attributable risk (an absolute measure of within-country wealth-related inequality). In 26 countries, within-country wealth-related inequality accounted for more than one quarter of the national overall coverage gap. Reducing such inequality could lower this gap by 16% to 56%, depending on the country. Regarding select individual health service indicators, wealth-related inequality was more common in services such as skilled birth attendance and antenatal care, and less so in family planning, measles immunization, receipt of a third dose of vaccine against diphtheria, pertussis and tetanus and treatment of acute respiratory infections in children under 5 years of age. The contribution of wealth-related inequality to the child and maternal health service coverage gap differs by country and type of health service, warranting case-specific interventions. Targeted policies are most appropriate where high within-country wealth-related inequality exists, and whole-population approaches, where the health-service coverage gap is high in all quintiles.

  20. Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand

    Directory of Open Access Journals (Sweden)

    Paibul Suriyawongpaisal

    2016-10-01

    Full Text Available Abstract Background Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Methods Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review, we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. Results The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. Conclusions We have identified 6 drivers of the copayment i.e., 1 perceived under payment, 2 unclear operational definitions of emergency conditions or 3 lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4 limited understanding by the service users of the policy-directed benefits, 5 weak regulatory mechanism as indicated by lack of information systems to trace private provider’s practices, and 6 ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies.

  1. Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand.

    Science.gov (United States)

    Suriyawongpaisal, Paibul; Aekplakorn, Wichai; Srithamrongsawat, Samrit; Srithongchai, Chaisit; Prasitsiriphon, Orawan; Tansirisithikul, Rassamee

    2016-10-21

    Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider's practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies.

  2. Financing universal coverage in Malaysia: a case study.

    Science.gov (United States)

    Chua, Hong Teck; Cheah, Julius Chee Ho

    2012-01-01

    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive

  3. Roundtable discussion at the UICC World Cancer Congress: looking toward the realization of universal health coverage for cancer in Asia.

    Science.gov (United States)

    Akaza, Hideyuki; Kawahara, Norie; Nozaki, Shinjiro; Sonoda, Shigeto; Fukuda, Takashi; Cazap, Eduardo; Trimble, Edward L; Roh, Jae Kyung; Hao, Xishan

    2015-01-01

    The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized a Roundtable Discussion as part of the official program of the UICC World Cancer Congress 2014 in Melbourne, Australia. The theme for the Roundtable Discussion was - Looking Toward the Realization of Universal Health Care (UHC) for Cancer in Asia - and it was held on December 5, 2014. The meeting was held based on the recognition that although each country may take a different path towards the realization of UHC, one point that is common to all is that cancer is projected to be the most difficult disease to address under the goals of UHC and that there is, therefore, an urgent and pressing need to come to a common understanding and awareness with regard to UHC concepts that are a priority component of a post-MDG development agenda. The presenters and participants addressed the issue of UHC for cancer in Asia from their various perspectives in academia and international organizations. Discussions covered the challenges to UHC in Asia, collaborative approaches by international organizations, the need for uniform and relevant data, ways to create an Asia Cancer Barometer that could be applied to all countries in Asia. The session concluded with the recognition that research on UHC in Asia should continue to be used as a tool for cancer cooperation in Asia and that the achievement of UHC would require research and input not only from the medical community, but from a broad sector of society in a multidisciplinary approach. Discussions on this issue will continue towards the Asia-Pacific Cancer Conference in Indonesia in August 2015.

  4. Regulating the for-profit private healthcare providers towards universal health coverage: A qualitative study of legal and organizational framework in Mongolia.

    Science.gov (United States)

    Tsevelvaanchig, Uranchimeg; Narula, Indermohan S; Gouda, Hebe; Hill, Peter S

    2018-01-01

    Regulating the behavior of private providers in the context of mixed health systems has become increasingly important and challenging in many developing countries moving towards universal health coverage including Mongolia. This study examines the current regulatory architecture for private healthcare in Mongolia exploring its role for improving accessibility, affordability, and quality of private care and identifies gaps in policy design and implementation. Qualitative research methods were used including documentary review, analysis, and in-depth interviews with 45 representatives of key actors involved in and affected by regulations in Mongolia's mixed health system, along with long-term participant observation. There has been extensive legal documentation developed regulating private healthcare, with specific organizations assigned to conduct health regulations and inspections. However, the regulatory architecture for healthcare in Mongolia is not optimally designed to improve affordability and quality of private care. This is not limited only to private care: important regulatory functions targeted to quality of care do not exist at the national level. The imprecise content and details of regulations in laws inviting increased political interference, governance issues, unclear roles, and responsibilities of different government regulatory bodies have contributed to failures in implementation of existing regulations. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Legislating health care coverage for the unemployed.

    Science.gov (United States)

    Palley, H A; Feldman, G; Gallner, I; Tysor, M

    1985-01-01

    Because the unemployed and their families are often likely to develop stress-related health problems, ensuring them access to health care is a public health issue. Congressional efforts thus far to legislate health coverage for the unemployed have proposed a system that recognizes people's basic need for coverage but has several limitations.

  6. Adopting Thai Diagnosis Related Group for Vietnam Universal Health Coverage: A Case of Ba Vi District Hospital

    Directory of Open Access Journals (Sweden)

    Pham Le Tuan, M.D., Ph.D.

    2015-09-01

    Full Text Available Objective: This studyaimedtoclassifyallhospitaldischargescoveredbyhealthinsurancesystem intodiagnosis relatedgroup (DRG to guideproviderpayment reforms of universalhealth coverage roadmap in Vietnam. Methods: Data from Ba Vi hospital from January to December 2012 were grouped into DRGs by Viet-DRG grouperversion1.0developedbasedon Thai-DRG version5methodologies. ThePearsoncorrelation(r wasused to assess the performance of Viet-DRG grouper as against Thai-DRG grouper. A 5-step trimming of individual inpatientdata to achieve thehighest correlations was performed. Results: Dataof12,220inpatientcases wereanalyzedbybothgroupers,84.4% of totalcases wereclassifiedinto 89 DRGs. Thefive mostcommon DRGs werevaginaldelivery withoutcomplicatingdiagnosis (14500; Respira- tory infection/inflammation, no complication and comorbidity (04520; Otitis media and URI, no complication andcomorbidity(03530; Viral illnessexceptdengue,child,nocomplicationandcomorbidity(18610; Bronchitis and asthma, no complication and comorbidity (04590. The performance of Viet-DRG grouper v1.0 compared with Thai-DRG grouper v5.0for 89 DRGs intermsof relative weights as of 0.4 andlength of stay as of 0.5. Conclusion: Validity of thefirst Viet-DRG was at moderate level compared to Thai-DRG due to the limitation ofdata availability andqualityat thehospital.

  7. Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

    Directory of Open Access Journals (Sweden)

    Rob Baltussen

    2016-11-01

    Full Text Available Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs in their strive for universal health coverage (UHC. However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of ‘evidence-informed deliberative processes’ as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning (‘core’ criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection and learning among local stakeholders (‘contextual’ criteria. We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.

  8. Towards universal health coverage in India: a historical examination of the genesis of Rashtriya Swasthya Bima Yojana - The health insurance scheme for low-income groups.

    Science.gov (United States)

    Virk, A K; Atun, R

    2015-06-01

    Many low- and middle-income countries have introduced State-funded health programmes for vulnerable groups as part of global efforts to universalise health coverage. Similarly, India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, a publicly-funded national health insurance scheme for people below the poverty line. The authors explore the RSBY's genesis and early development in order to understand its conceptualisation and design principles and thereby establish a baseline for assessing RSBY's performance in the future. Qualitative case study of the RSBY in Delhi. This paper presents results from documentary analysis and semi-structured interviews with senior-level policymakers including the former Labour Minister, central government officials and affiliates, and technical specialists from the World Bank and GIZ. With national priorities focused on broader economic development goals, the RSBY was conceptualised as a social investment in worker productivity and future economic growth in India. Hence, efficiency, competition, and individual choice rather than human needs or egalitarian access were overriding concerns for RSBY designers. This measured approach was strongly reflected in RSBY's financing and benefit structure. Hence, the programme's focus on only the 'poorest' (BPL) among the poor. Similarly, only costlier forms of care, secondary treatments in hospitals, which policymakers felt were more likely to have catastrophic financial consequences for users were covered. This paper highlights the risks of a narrow approach driven by developmental considerations alone. Expanding access and improving financial protection in India and elsewhere requires a more balanced approach and evidence-informed health policies that are guided by local morbidity and health spending patterns. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  9. Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh-an estimation of financial risk protection of universal health coverage.

    Science.gov (United States)

    Khan, Jahangir A M; Ahmed, Sayem; Evans, Timothy G

    2017-10-01

    The Sustainable Development Goals target to achieve Universal Health Coverage (UHC), including financial risk protection (FRP) among other dimensions. There are four indicators of FRP, namely incidence of catastrophic health expenditure (CHE), mean positive catastrophic overshoot, incidence of impoverishment and increase in the depth of poverty occur for high out-of-pocket (OOP) healthcare spending. OOP spending is the major payment strategy for healthcare in most low-and-middle-income countries, such as Bangladesh. Large and unpredictable health payments can expose households to substantial financial risk and, at their most extreme, can result in poverty. The aim of this study was to estimate the impact of OOP spending on CHE and poverty, i.e. status of FRP for UHC in Bangladesh. A nationally representative Household Income and Expenditure Survey 2010 was used to determine household consumption expenditure and health-related spending in the last 30 days. Mean CHE headcount and its concentration indices (CI) were calculated. The propensity of facing CHE for households was predicted by demographic and socioeconomic characteristics. The poverty headcount was estimated using 'total household consumption expenditure' and such expenditure without OOP payments for health in comparison with the poverty-line measured by cost of basic need. In absolute values, a pro-rich distribution of OOP payment for healthcare was found in urban and rural Bangladesh. At the 10%-threshold level, in total 14.2% of households faced CHE with 1.9% overshoot. 16.5% of the poorest and 9.2% of the richest households faced CHE. An overall pro-poor distribution was found for CHE (CI = -0.064) in both urban and rural households, while the former had higher CHE incidences. The poverty headcount increased by 3.5% (5.1 million individuals) due to OOP payments. Reliance on OOP payments for healthcare in Bangladesh should be reduced for poverty alleviation in urban and rural Bangladesh in order to

  10. Impact of universal health coverage on suicide risk in newly diagnosed cancer patients: Population-based cohort study from 1985 to 2007 in Taiwan.

    Science.gov (United States)

    Lin, Po-Hsien; Liao, Shih-Cheng; Chen, I-Ming; Kuo, Po-Hsiu; Shan, Jia-Chi; Lee, Ming-Been; Chen, Wei J

    2017-11-01

    National Health Insurance (NHI), launched in 1995 in Taiwan, lightens patient's financial burdens but its effect on the suicide risk in cancer patients is unclear. We aimed to investigate the impacts of the NHI on the suicide in newly diagnosed cancer patients. We identified patients with newly diagnosed cancer from the nationwide Taiwan Cancer Registration from 1985 to 2007, and ascertained suicide deaths from the national database of registered deaths between 1985 and 2009. Standardized mortality ratio (SMR) of suicide risk among patients with cancer was calculated, and the suicide risk ratios were examined by gender, age group, and prognosis. For the 916 337 registered cancer patients with 4 300 953 person-years, 2 543 died by suicide, with a suicide rate of 59.1 per 100 000 person-years. Compared to the general population, cancer patients had an SMR of 2.47 for suicide, with a higher figure for males (2.73), age 45 to 64 (2.89), and cancer of poor prognosis (3.19). The suicide risk was highest in the first 2 years after the initial diagnosis. Comparing the cohorts of the period before (1985 to 1992) and after (1996 to 2007) the launch of NHI, we saw a reduction in the SMR within the first 2 years after cancer diagnosis (20%), with more prominent reduction for females (29%), age under 45 (69%), and cancer of good prognosis (33%). A universal health coverage relieving both physical and psychological distress may account for the post-NHI reduction of immediate suicide risk in patients of newly diagnosed cancer. Copyright © 2017 John Wiley & Sons, Ltd.

  11. 42 CFR 440.330 - Benchmark health benefits coverage.

    Science.gov (United States)

    2010-10-01

    ...) Federal Employees Health Benefit Plan Equivalent Coverage (FEHBP—Equivalent Health Insurance Coverage). A... coverage. Health benefits coverage that is offered and generally available to State employees in the State... 42 Public Health 4 2010-10-01 2010-10-01 false Benchmark health benefits coverage. 440.330 Section...

  12. Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990-2010: a longitudinal analysis.

    Science.gov (United States)

    Maruthappu, Mahiben; Watkins, Johnathan; Noor, Aisyah Mohd; Williams, Callum; Ali, Raghib; Sullivan, Richard; Zeltner, Thomas; Atun, Rifat

    2016-08-13

    The global economic crisis has been associated with increased unemployment and reduced public-sector expenditure on health care (PEH). We estimated the effects of changes in unemployment and PEH on cancer mortality, and identified how universal health coverage (UHC) affected these relationships. For this longitudinal analysis, we obtained data from the World Bank and WHO (1990-2010). We aggregated mortality data for breast cancer in women, prostate cancer in men, and colorectal cancers in men and women, which are associated with survival rates that exceed 50%, into a treatable cancer class. We likewise aggregated data for lung and pancreatic cancers, which have 5 year survival rates of less than 10%, into an untreatable cancer class. We used multivariable regression analysis, controlling for country-specific demographics and infrastructure, with time-lag analyses and robustness checks to investigate the relationship between unemployment, PEH, and cancer mortality, with and without UHC. We used trend analysis to project mortality rates, on the basis of trends before the sharp unemployment rise that occurred in many countries from 2008 to 2010, and compared them with observed rates. Data were available for 75 countries, representing 2.106 billion people, for the unemployment analysis and for 79 countries, representing 2.156 billion people, for the PEH analysis. Unemployment rises were significantly associated with an increase in all-cancer mortality and all specific cancers except lung cancer in women. By contrast, untreatable cancer mortality was not significantly linked with changes in unemployment. Lag analyses showed significant associations remained 5 years after unemployment increases for the treatable cancer class. Rerunning analyses, while accounting for UHC status, removed the significant associations. All-cancer, treatable cancer, and specific cancer mortalities significantly decreased as PEH increased. Time-series analysis provided an estimate of more than

  13. Health Technology Assessment: Global Advocacy and Local Realities; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness”

    Directory of Open Access Journals (Sweden)

    Kalipso Chalkidou

    2017-04-01

    Full Text Available Cost-effectiveness analysis (CEA can help countries attain and sustain universal health coverage (UHC, as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values, whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low- and middle-income countries (LMICs, such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities.

  14. Priority Setting for Universal Health Coverage: We Need to Focus Both on Substance and on Process; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, not Just More Evidence on Cost-Effectiveness”

    Directory of Open Access Journals (Sweden)

    Jeremy A. Lauer

    2017-10-01

    Full Text Available In an editorial published in this journal, Baltussen et al argue that information on cost-effectiveness is not sufficient for priority setting for universal health coverage (UHC, a claim which is correct as far as it goes. However, their focus on the procedural legitimacy of ‘micro’ priority setting processes (eg, decisions concerning the reimbursement of specific interventions, and their related assumption that values for priority setting are determined only at this level, leads them to ignore the relevance of higher level, ‘macro’ priority setting processes, for example, consultations held by World Health Organization (WHO Member States and other global stakeholders that have resulted in widespread consensus on the principles of UHC. Priority setting is not merely about discrete choices, nor should the focus be exclusively (or even mainly on improving the procedural elements of micro priority setting processes. Systemic activities that shape the health system environment, such as strategic planning, as well as the substantive content of global policy instruments, are critical elements for priority setting for UHC.

  15. Conceptualising the lack of health insurance coverage.

    Science.gov (United States)

    Davis, J B

    2000-01-01

    This paper examines the lack of health insurance coverage in the US as a public policy issue. It first compares the problem of health insurance coverage to the problem of unemployment to show that in terms of the numbers of individuals affected lack of health insurance is a problem comparable in importance to the problem of unemployment. Secondly, the paper discusses the methodology involved in measuring health insurance coverage, and argues that the current method of estimation of the uninsured underestimates the extent that individuals go without health insurance. Third, the paper briefly introduces Amartya Sen's functioning and capabilities framework to suggest a way of representing the extent to which individuals are uninsured. Fourth, the paper sketches a means of operationalizing the Sen representation of the uninsured in terms of the disability-adjusted life year (DALY) measure.

  16. A road map for universal coverage: finding a pass through the financial mountains.

    Science.gov (United States)

    Sessions, Samuel Y; Lee, Philip R

    2008-04-01

    Government already pays for more than half of U.S. health care costs, and nearly all universal health insurance proposals assume continued government involvement through tax subsidies and other means. The question of what specific taxes could be used to finance universal coverage is, however, seldom carefully examined, in part due to efforts by health care reform proponents to downplay tax issues. In this article we undertake such an examination. We argue that the challenges of relying on taxes for universal coverage are even greater than is generally appreciated, but that they can nevertheless be met. A proposal to fund a universal health insurance voucher system with a value-added tax illustrates issues that would arise for tax-financed plans in general and provides a broad framework for a bipartisan approach to universal coverage. We discuss significant problems that such an approach would face and suggest solutions. We outline a long-term political and legislative strategy for enacting universal coverage that draws upon precedents set by comparable legislative initiatives, including tax reform and Medicare. The results are an improved understanding of the relationship between systemic health care finance reform and taxation and a politically realistic plan for universal coverage that employs undisguised taxes.

  17. [Coverage by health insurance or discount cards: a household survey in the coverage area of the Family Health Strategy].

    Science.gov (United States)

    Fontenelle, Leonardo Ferreira; Camargo, Maria Beatriz Junqueira de; Bertoldi, Andréa Dâmaso; Gonçalves, Helen; Maciel, Ethel Leonor Noia; Barros, Aluísio J D

    2017-10-26

    This study was designed to assess the reasons for health insurance coverage in a population covered by the Family Health Strategy in Brazil. We describe overall health insurance coverage and according to types, and analyze its association with health-related and socio-demographic characteristics. Among the 31.3% of persons (95%CI: 23.8-39.9) who reported "health insurance" coverage, 57.0% (95%CI: 45.2-68.0) were covered only by discount cards, which do not offer any kind of coverage for medical care, but only discounts in pharmacies, clinics, and hospitals. Both for health insurance and discount cards, the most frequently cited reasons for such coverage were "to be on the safe side" and "to receive better care". Both types of coverage were associated statistically with age (+65 vs. 15-24 years: adjusted odds ratios, aOR = 2.98, 95%CI: 1.28-6.90; and aOR = 3.67; 95%CI: 2.22-6.07, respectively) and socioeconomic status (additional standard deviation: aOR = 2.25, 95%CI: 1.62-3.14; and aOR = 1.96, 95%CI: 1.34-2.97). In addition, health insurance coverage was associated with schooling (aOR = 7.59, 95%CI: 4.44-13.00) for complete University Education and aOR = 3.74 (95%CI: 1.61-8.68) for complete Secondary Education, compared to less than complete Primary Education. Meanwhile, neither health insurance nor discount card was associated with health status or number of diagnosed diseases. In conclusion, studies that aim to assess private health insurance should be planned to distinguish between discount cards and formal health insurance.

  18. Health Technology Assessment: Global Advocacy and Local Realities Comment on "Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness".

    Science.gov (United States)

    Chalkidou, Kalipso; Li, Ryan; Culyer, Anthony J; Glassman, Amanda; Hofman, Karen J; Teerawattananon, Yot

    2016-08-29

    Cost-effectiveness analysis (CEA) can help countries attain and sustain universal health coverage (UHC), as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values), whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low- and middle-income countries (LMICs), such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  19. Universal coverage reforms in the USA: From Obamacare through Trump.

    Science.gov (United States)

    Rice, Thomas; Unruh, Lynn Y; van Ginneken, Ewout; Rosenau, Pauline; Barnes, Andrew J

    2018-05-22

    Since the election of Donald Trump as President, momentum towards universal health care coverage in the United States has stalled, although efforts to repeal the Affordable Care Act (ACA) in its entirety failed. The ACA resulted in almost a halving of the percentage of the population under age 65 who are uninsured. In lieu of total repeal, the Republican-led Congress repealed the individual mandate to purchase health insurance, beginning in 2019. Moreover, the Trump administration is using its administrative authority to undo many of the requirements in the health insurance exchanges. Partly as a result, premium increases for the most popular plans will rise an average of 34% in 2018 and are likely to rise further after the mandate repeal goes into effect. Moreover, the administration is proposing other changes that, in providing states with more flexibility, may lead to the sale of cheaper and less comprehensive policies. In this volatile environment it is difficult to anticipate what will occur next. In the short-term there is proposed compromise legislation, where Republicans agree to provide funding for the cost-sharing subsidies if the Democrats agree to increase state flexibility in some areas and provide relief to small employers. Much will depend on the 2018 and 2020 elections. In the meantime, the prospects are that the number of uninsured will grow. Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

  20. [Neonatal screening - the challenge of an universal and effective coverage].

    Science.gov (United States)

    Botler, Judy; Camacho, Luiz Antônio Bastos; da Cruz, Marly Marques; George, Pâmela

    2010-03-01

    Newborn screening programs (NSP) aim to detect carriers of several congenital diseases among asymptomatic infants in order to warrant effective intervention. Specimen collection is the first step of a process that should be done in an universal and timely manner. A review of coverage and time of collection was done in NSP of several countries. The search was made in various sources, from 1998 to 2008, with "neonatal screening" and "coverage" as key words. The lack of a typical study design did not allow to the rigor required for a systematic review. Data were grouped in macro-regions. Canada had coverage of 71% in 2006 while the European coverage was of 69% in 2004, with data of 38 countries. In Asia and Pacific region, there were data of 19 countries. In Middle East and North Africa, there were data of 4 countries. In Latin America, the coverage was 49% in 2005, with data of 14 countries. In Brazil, coverage was 80%. Twelve reports had information about timeliness. The conclusion is that epidemiological transition has contributed to NSP success. Developed regions had more universal and timelier collection. In Brazil, government initiative increased access to the NSP, but late collections lead to the need of educational actions and participation of professional organizations in developing specific guidelines definition.

  1. 42 CFR 457.410 - Health benefits coverage options.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Health benefits coverage options. 457.410 Section 457.410 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... State Plan Requirements: Coverage and Benefits § 457.410 Health benefits coverage options. (a) Types of...

  2. Broader health coverage is good for the nation's health: evidence from country level panel data.

    Science.gov (United States)

    Moreno-Serra, Rodrigo; Smith, Peter C

    2015-01-01

    Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries.

  3. Worker Sorting, Taxes and Health Insurance Coverage

    OpenAIRE

    Kevin Lang; Hong Kang

    2007-01-01

    We develop a model in which firms hire heterogeneous workers but must offer all workers insurance benefits under similar terms. In equilibrium, some firms offer free health insurance, some require an employee premium payment and some do not offer insurance. Making the employee contribution pre-tax lowers the cost to workers of a given employee premium and encourages more firms to charge. This increases the offer rate, lowers the take-up rate, increases (decreases) coverage among high (low) de...

  4. Street-level workers' inadequate knowledge and application of exemption policies in Burkina Faso jeopardize the achievement of universal health coverage: evidence from a cross-sectional survey.

    Science.gov (United States)

    Ridde, Valéry; Leppert, Gerald; Hien, Hervé; Robyn, Paul Jacob; De Allegri, Manuela

    2018-01-08

    instruments can influence their effective implementation. Methods for remunerating health workers and health centres also need to be adapted to ensure equity measures are applied to achieve universal healthcare.

  5. The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh.

    Science.gov (United States)

    Huda, Tanvir M; Tahsina, Tazeen; El Arifeen, Shams; Dibley, Michael J

    2016-01-01

    Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.

  6. The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh

    Directory of Open Access Journals (Sweden)

    Tanvir M. Huda

    2016-02-01

    Full Text Available Introduction: Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. Objectives: This study examines mortality differentials in children of different age groups by key social determinants of health (SDH including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities, and other geographical contextual factors (area of residence, road conditions. Design: We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. Results: The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. Conclusion: The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.

  7. Democratic candidates call for change in the health care system: wider use of home and community-based care, chronic disease management, universal coverage, and greater use of telehealth.

    Science.gov (United States)

    Marsh, Aaron G

    2008-10-01

    Senator Barack Obama, the Democratic candidate for president, and Senator Joe Biden, the party's candidate for vice president, have made health care reform a central pillar of their campaign. The Democrats want to target the 12 percent of Americans who are responsible for 69 percent of health care costs. Such individuals generally have multiple and complex health care problems, which if left untreated, require them to seek care in hospital emergency rooms which are vastly overcrowded. In order to solve the problem, they believe first that universal coverage along the lines of the Federal Government Employees' health plan is necessary, followed by a shift away from institutionally-based care, making home and community-based care, which integrates telehealth and other technologies, the norm. The party's platform includes this committment to help solve the problem of long-term care, which affects not only the nation's 35 million elderly, but increasingly will affect the 78 million baby boomers who are entering their retirement years.

  8. Racial Disparities in Access to Care Under Conditions of Universal Coverage.

    Science.gov (United States)

    Siddiqi, Arjumand A; Wang, Susan; Quinn, Kelly; Nguyen, Quynh C; Christy, Antony Dennis

    2016-02-01

    Racial disparities in access to regular health care have been reported in the U.S., but little is known about the extent of disparities in societies with universal coverage. To investigate the extent of racial disparities in access to care under conditions of universal coverage by observing the association between race and regular access to a doctor in Canada. Racial disparities in access to a regular doctor were calculated using the largest available source of nationally representative data in Canada--the Canadian Community Health Survey. Surveys from 2000-2010 were analyzed in 2014. Multinomial regression analyses predicted odds of having a regular doctor for each racial group compared to whites. Analyses were stratified by immigrant status--Canadian-born versus shorter-term immigrant versus longer-term immigrants--and controlled for sociodemographics and self-rated health. Racial disparities in Canada, a country with universal coverage, were far more muted than those previously reported in the U.S. Only among longer-term Latin American immigrants (OR=1.90, 95% CI=1.45, 2.08) and Canadian-born Aboriginals (OR=1.34, 95% CI=1.22, 1.47) were significant disparities noted. Among shorter-term immigrants, all Asians were more likely than whites, and among longer-term immigrants, South Asians were more like than whites, to have a regular doctor. Universal coverage may have a major impact on reducing racial disparities in access to health care, although among some subgroups, other factors may also play a role above and beyond health insurance. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  9. Coverage matters: insurance and health care

    National Research Council Canada - National Science Library

    Board on Health Care Services Staff; Institute of Medicine Staff; Institute of Medicine; National Academy of Sciences

    2001-01-01

    ...? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters...

  10. Treatment-Seeking for Tuberculosis-Suggestive Symptoms: A Reflection on the Role of Human Agency in the Context of Universal Health Coverage in Malawi.

    Directory of Open Access Journals (Sweden)

    Moses Kumwenda

    Full Text Available Tuberculosis (TB is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men's well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-density locales of urban Blantyre, Malawi. Data were collected in March 2011 -March 2012 using focus group discussions, of which eight (mixed sex = two; female only = three; male only = three were with 74 ordinary community members, and two (both mixed sex were with 20 health workers; and in-depth interviews with 20 TB patients (female = 14 and 20 un-investigated chronic coughers (female = eight. The research process employed a modified version of grounded theory. Data were coded using a coding scheme that was initially generated from the study aims and subsequently progressively amended to incorporate concepts emerging during the analysis. Coded data were retrieved, re-read, and broken down and reconnected iteratively to generate themes. A myriad of problems were described for health systems at the primary health care level, centring largely on shortages of resources (human, equipment, and drugs and unprofessional conduct by health care providers. Participants consistently

  11. High combined individual and neighborhood socioeconomic status correlated with better survival of patients with lymphoma in post-rituximab era despite universal health coverage

    Directory of Open Access Journals (Sweden)

    Chung-Lin Hung

    2016-12-01

    After adjusting for patient characteristics, treatment modalities, and hospital characteristics, HL patients with high individual SES in advantaged neighborhoods showed a decreased risk of mortality (HR 0.33, 95%, CI 0.10–0.99. NHL patients with high individual SES in advantaged neighborhoods showed a moderate decreased risk of death (HR 0.62; 95% CI 0.51–0.75, compared to those with low SES in disadvantaged neighborhoods. In the future, public health strategies and welfare policies must continue to focus on this vulnerable group.

  12. 76 FR 46677 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of...

    Science.gov (United States)

    2011-08-03

    ... Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services... regulations published July 19, 2010 with respect to group health plans and health insurance coverage offered... plans, and health insurance issuers providing group health insurance coverage. The text of those...

  13. Insurance Coverage and Whither Thou Goest for Health Info

    Data.gov (United States)

    U.S. Department of Health & Human Services — Authors of Insurance Coverage and Whither Thou Goest for Health Information in 2012, recently published in Volume 4, Issue 4 of the Medicare and Medicaid Research...

  14. CHIP premiums, health status, and the insurance coverage of children.

    Science.gov (United States)

    Marton, James; Talbert, Jeffery C

    2010-01-01

    This study uses the introduction of premiums into Kentucky's Children's Health Insurance Program (KCHIP) to examine whether the enrollment impact of new premiums varies by child health type. We also examine the extent to which children find alternative coverage after premium nonpayment. Public insurance claims data suggest that those with chronic health conditions are less likely to leave public coverage. We find little evidence of a differential impact of premiums on enrollment among the chronically ill. Our survey of nonpayers shows that 56% of responding families found alternative private or public health coverage for their children after losing CHIP.

  15. Examining levels, distribution and correlates of health insurance coverage in Kenya.

    Science.gov (United States)

    Kazungu, Jacob S; Barasa, Edwine W

    2017-09-01

    To examine the levels, inequalities and factors associated with health insurance coverage in Kenya. We analysed secondary data from the Kenya Demographic and Health Survey (KDHS) conducted in 2009 and 2014. We examined the level of health insurance coverage overall, and by type, using an asset index to categorise households into five socio-economic quintiles with quintile 5 (Q5) being the richest and quintile 1 (Q1) being the poorest. The high-low ratio (Q5/Q1 ratio), concentration curve and concentration index (CIX) were employed to assess inequalities in health insurance coverage, and logistic regression to examine correlates of health insurance coverage. Overall health insurance coverage increased from 8.17% to 19.59% between 2009 and 2014. There was high inequality in overall health insurance coverage, even though this inequality decreased between 2009 (Q5/Q1 ratio of 31.21, CIX = 0.61, 95% CI 0.52-0.0.71) and 2014 (Q5/Q1 ratio 12.34, CIX = 0.49, 95% CI 0.45-0.52). Individuals that were older, employed in the formal sector; married, exposed to media; and male, belonged to a small household, had a chronic disease and belonged to rich households, had increased odds of health insurance coverage. Health insurance coverage in Kenya remains low and is characterised by significant inequality. In a context where over 80% of the population is in the informal sector, and close to 50% live below the national poverty line, achieving high and equitable coverage levels with contributory and voluntary health insurance mechanism is problematic. Kenya should consider a universal, tax-funded mechanism that ensures revenues are equitably and efficiently collected, and everyone (including the poor and those in the informal sector) is covered. © 2017 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

  16. Duplicate Health Insurance Coverage: Determinants of Variation Across States

    OpenAIRE

    Luft, Harold S.; Maerki, Susan C.

    1982-01-01

    Although it is recognized that many people have duplicate private health insurance coverage, either through separate purchase or as health benefits in multi-earner families, there has been little analysis of the factors determining duplicate coverage rates. A new data source, the Survey of Income and Education, offers a comparison with the only previous source of state level data, the estimates from the Health Insurance Association of America. The R2 between the two sets is only .3 and certai...

  17. Awareness and Coverage of the National Health Insurance Scheme ...

    African Journals Online (AJOL)

    Sub- national levels possess a high degree of autonomy in a number of sectors including health. It is important to assess the level of coverage of the scheme among the formal sector workers in Nigeria as a proxy to gauge the extent of coverage of the scheme and derive suitable lessons that could be used in its expansion.

  18. Massachusetts health reform: employer coverage from employees' perspective.

    Science.gov (United States)

    Long, Sharon K; Stockley, Karen

    2009-01-01

    The national health reform debate continues to draw on Massachusetts' 2006 reform initiative, with a focus on sustaining employer-sponsored insurance. This study provides an update on employers' responses under health reform in fall 2008, using data from surveys of working-age adults. Results show that concerns about employers' dropping coverage or scaling back benefits under health reform have not been realized. Access to employer coverage has increased, as has the scope and quality of their coverage as assessed by workers. However, premiums and out-of-pocket costs have become more of an issue for employees in small firms.

  19. The equity impact of the universal coverage policy: lessons from Thailand.

    Science.gov (United States)

    Prakongsai, Phusit; Limwattananon, Supon; Tangcharoensathien, Viroj

    2009-01-01

    This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health. The standard methods proposed by O'Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys. General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment before UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular, the functioning of primary healthcare (PHC) at the district level serves as a "pro-poor hub" in translating policy into practice and equity outcomes. The Thai health financing reforms have been accompanied by nationwide extension of PHC coverage, mandatory rural health service by new graduates and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation and comprehensive monitoring and evaluation are essential to successful system-level reforms.

  20. Exploring the relationship between population density and maternal health coverage

    Directory of Open Access Journals (Sweden)

    Hanlon Michael

    2012-11-01

    Full Text Available Abstract Background Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. Methods We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total. Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score’s calculation discounts a nation’s uninhabited territory under the assumption those areas are irrelevant to service delivery. Results We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Conclusions Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations’ Millennial Development Goals.

  1. Women's Magazines' Coverage of Smoking Related Health Hazards.

    Science.gov (United States)

    Kessler, Lauren

    1989-01-01

    Examines the extent to which women's magazines with a strong interest in health covered various health hazards associated with smoking. Finds that six major women's magazines have virtually no coverage of smoking and cancer. Suggests that self-censorship may have helped determine editorial content more than pressure from tobacco companies. (RS)

  2. Determinants of the demand for health insurance coverage

    NARCIS (Netherlands)

    K.P.M. Winssen van (Kayleigh)

    2017-01-01

    markdownabstractThe health insurance density in the Netherlands is among the highest in the world. This is shown by the fact that, in 2016, only 12 per cent of the Dutch insured opted for a reduction of health insurance coverage in the form of a voluntary deductible, while, at the same time, 84 per

  3. Coverage matters: insurance and health care

    National Research Council Canada - National Science Library

    Board on Health Care Services Staff; Institute of Medicine Staff; Institute of Medicine; National Academy of Sciences

    2001-01-01

    ...: Insurance and Health Care , explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced...

  4. Disparities in Private Health Insurance Coverage of Skilled Care

    Directory of Open Access Journals (Sweden)

    Stacey A. Tovino

    2017-10-01

    Full Text Available This article compares and contrasts public and private health insurance coverage of skilled medical rehabilitation, including cognitive rehabilitation, physical therapy, occupational therapy, speech-language pathology, and skilled nursing services (collectively, skilled care. As background, prior scholars writing in this area have focused on Medicare coverage of skilled care and have challenged coverage determinations limiting Medicare coverage to beneficiaries who are able to demonstrate improvement in their conditions within a specific period of time (the Improvement Standard. By and large, these scholars have applauded the settlement agreement approved on 24 January 2013, by the U.S. District Court for the District of Vermont in Jimmo v. Sebelius (Jimmo, as well as related motions, rulings, orders, government fact sheets, and Medicare program manual statements clarifying that Medicare covers skilled care that is necessary to prevent or slow a beneficiary’s deterioration or to maintain a beneficiary at his or her maximum practicable level of function even though no further improvement in the beneficiary’s condition is expected. Scholars who have focused on beneficiaries who have suffered severe brain injuries, in particular, have framed public insurance coverage of skilled brain rehabilitation as an important civil, disability, and educational right. Given that approximately two-thirds of Americans with health insurance are covered by private health insurance and that many private health plans continue to require their insureds to demonstrate improvement within a short period of time to obtain coverage of skilled care, scholarship assessing private health insurance coverage of skilled care is important but noticeably absent from the literature. This article responds to this gap by highlighting state benchmark plans’ and other private health plans’ continued use of the Improvement Standard in skilled care coverage decisions and

  5. Primary care practice and health professional determinants of immunisation coverage.

    Science.gov (United States)

    Grant, Cameron C; Petousis-Harris, Helen; Turner, Nikki; Goodyear-Smith, Felicity; Kerse, Ngaire; Jones, Rhys; York, Deon; Desmond, Natalie; Stewart, Joanna

    2011-08-01

    To identify primary care factors associated with immunisation coverage. A survey during 2005-2006 of a random sample of New Zealand primary care practices, with over-sampling of practices serving indigenous children. An immunisation audit was conducted for children registered at each practice. Practice characteristics and the knowledge and attitudes of doctors, nurses and caregivers were measured. Practice immunisation coverage was defined as the percentage of registered children from 6 weeks to 23 months old at each practice who were fully immunised for age. Associations of practice, doctor, nurse and caregiver factors with practice immunisation coverage were determined using multiple regression analyses. One hundred and twenty-four (61%) of 205 eligible practices were recruited. A median (25th-75th centile) of 71% (57-77%) of registered children at each practice was fully immunised. In multivariate analyses, immunisation coverage was higher at practices with no staff shortages (median practice coverage 76% vs 67%, P = 0.004) and where doctors were confident in their immunisation knowledge (72% vs 67%, P= 0.005). Coverage was lower if the children's parents had received information antenatally, which discouraged immunisation (67% vs 73%, P = 0.008). Coverage decreased as socio-economic deprivation of the registered population increased (P < 0.001) and as the children's age (P = 0.001) and registration age (P = 0.02) increased. CONCLUSIONS Higher immunisation coverage is achieved by practices that establish an early relationship with the family and that are adequately resourced with stable and confident staff. Immunisation promotion should begin antenatally. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  6. Falling through the Coverage Cracks: How Documentation Status Minimizes Immigrants' Access to Health Care.

    Science.gov (United States)

    Joseph, Tiffany D

    2017-10-01

    Recent policy debates have centered on health reform and who should benefit from such policy. Most immigrants are excluded from the 2010 Affordable Care Act (ACA) due to federal restrictions on public benefits for certain immigrants. But, some subnational jurisdictions have extended coverage options to federally ineligible immigrants. Yet, less is known about the effectiveness of such inclusive reforms for providing coverage and care to immigrants in those jurisdictions. This article examines the relationship between coverage and health care access for immigrants under comprehensive health reform in the Boston metropolitan area. The article uses data from interviews conducted with a total of 153 immigrants, health care professionals, and immigrant and health advocacy organization employees under the Massachusetts and ACA health reforms. Findings indicate that respondents across the various stakeholder groups perceive that immigrants' documentation status minimizes their ability to access health care even when they have health coverage. Specifically, respondents expressed that intersecting public policies, concerns that using health services would jeopardize future legalization proceedings, and immigrants' increased likelihood of deportation en route to medical appointments negatively influenced immigrants' health care access. Thus, restrictive federal policies and national-level anti-immigrant sentiment can undermine inclusive subnational policies in socially progressive places. Copyright © 2017 by Duke University Press.

  7. Does the Market Choose Optimal Health Insurance Coverage

    NARCIS (Netherlands)

    Boone, J.

    2013-01-01

    Abstract Consumers, when buying health insurance, do not know the exact value of each treatment that they buy coverage for. This leads them to overvalue some treatments and undervalue others. We show that the insurance market cannot correct these mistakes. This causes research labs to overinvest in

  8. Use of performance metrics for the measurement of universal coverage for maternal care in Mexico.

    Science.gov (United States)

    Serván-Mori, Edson; Contreras-Loya, David; Gomez-Dantés, Octavio; Nigenda, Gustavo; Sosa-Rubí, Sandra G; Lozano, Rafael

    2017-06-01

    This study provides evidence for those working in the maternal health metrics and health system performance fields, as well as those interested in achieving universal and effective health care coverage. Based on the perspective of continuity of health care and applying quasi-experimental methods to analyse the cross-sectional 2009 National Demographic Dynamics Survey (n = 14 414 women), we estimated the middle-term effects of Mexico's new public health insurance scheme, Seguro Popular de Salud (SPS) (vs women without health insurance) on seven indicators related to maternal health care (according to official guidelines): (a) access to skilled antenatal care (ANC); (b) timely ANC; (c) frequent ANC; (d) adequate content of ANC; (e) institutional delivery; (f) postnatal consultation and (g) access to standardized comprehensive antenatal and postnatal care (or the intersection of the seven process indicators). Our results show that 94% of all pregnancies were attended by trained health personnel. However, comprehensive access to ANC declines steeply in both groups as we move along the maternal healthcare continuum. The percentage of institutional deliveries providing timely, frequent and adequate content of ANC reached 70% among SPS women (vs 64.7% in the uninsured), and only 57.4% of SPS-affiliated women received standardized comprehensive care (vs 53.7% in the uninsured group). In Mexico, access to comprehensive antenatal and postnatal care as defined by Mexican guidelines (in accordance to WHO recommendations) is far from optimal. Even though a positive influence of SPS on maternal care was documented, important challenges still remain. Our results identified key bottlenecks of the maternal healthcare continuum that should be addressed by policy makers through a combination of supply side interventions and interventions directed to social determinants of access to health care. © The Author 2017. Published by Oxford University Press in association with The

  9. Health care financing in Nigeria: Implications for achieving universal ...

    African Journals Online (AJOL)

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms.

  10. Estimated effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada.

    Science.gov (United States)

    Morgan, Steven G; Li, Winny; Yau, Brandon; Persaud, Nav

    2017-02-27

    Canada's universal health care system does not include universal coverage of prescription drugs. We sought to estimate the effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada. We used administrative and market research data to estimate the 2015 shares of the volume and cost of prescriptions filled in the community setting that were for 117 drugs on a model list of essential medicines for Canada. We compared prices of these essential medicines in Canada with prices in the United States, Sweden and New Zealand. We estimated the cost of adding universal public drug coverage of these essential medicines based on anticipated effects on medication use and pricing. The 117 essential medicines on the model list accounted for 44% of all prescriptions and 30% of total prescription drug expenditures in 2015. Average prices of generic essential medicines were 47% lower in the US, 60% lower in Sweden and 84% lower in New Zealand; brand-name drugs were priced 43% lower in the US. Estimated savings from universal public coverage of these essential medicines was $4.27 billion per year (range $2.72 billion to $5.83 billion; 28% reduction) for patients and private drug plan sponsors, at an incremental government cost of $1.23 billion per year (range $373 million to $1.98 billion; 11% reduction). Our analysis showed that adding universal public coverage of essential medicines to the existing public drug plans in Canada could address most of Canadians' pharmaceutical needs and save billions of dollars annually. Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned. © 2017 Canadian Medical Association or its licensors.

  11. Unmanaged care: towards moral fairness in health care coverage.

    Science.gov (United States)

    Hoffman, Sharona

    2003-01-01

    Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.

  12. 45 CFR 148.122 - Guaranteed renewability of individual health insurance coverage.

    Science.gov (United States)

    2010-10-01

    ... insurance coverage. 148.122 Section 148.122 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET... health insurance coverage. (a) Applicability. This section applies to all health insurance coverage in...

  13. [Strategies to improve influenza vaccination coverage in Primary Health Care].

    Science.gov (United States)

    Antón, F; Richart, M J; Serrano, S; Martínez, A M; Pruteanu, D F

    2016-04-01

    Vaccination coverage reached in adults is insufficient, and there is a real need for new strategies. To compare strategies for improving influenza vaccination coverage in persons older than 64 years. New strategies were introduced in our health care centre during 2013-2014 influenza vaccination campaign, which included vaccinating patients in homes for the aged as well as in the health care centre. A comparison was made on vaccination coverage over the last 4 years in 3 practices of our health care centre: P1, the general physician vaccinated patients older than 64 that came to the practice; P2, the general physician systematically insisted in vaccination in elderly patients, strongly advising to book appointments, and P3, the general physician did not insist. These practices looked after P1: 278; P2: 320; P3: 294 patients older than 64 years. Overall/P1/P2/P3 coverages in 2010: 51.2/51.4/55/46.9% (P=NS), in 2011: 52.4/52.9/53.8/50.3% (P=NS), in 2012: 51.9/52.5/55.3/47.6% (P=NS), and in 2013: 63.5/79.1/59.7/52.7 (P=.000, P1 versus P2 and P3; P=NS between P2 and P3). Comparing the coverages in 2012-2013 within each practice P1 (P=.000); P2 (P=.045); P3 (P=.018). In P2 and P3 all vaccinations were given by the nurses as previously scheduled. In P3, 55% of the vaccinations were given by the nurses, 24.1% by the GP, 9.7% rejected vaccination, and the remainder did not come to the practice during the vaccination period (October 2013-February 2014). The strategy of vaccinating in the homes for the aged improved the vaccination coverage by 5% in each practice. The strategy of "I've got you here, I jab you here" in P1 improved the vaccination coverage by 22%. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January -- June 2013

    Science.gov (United States)

    ... from 2010 to 2013 were also evaluated using logistic regression analysis. State-specific health insurance estimates are ... coverage options; compare health insurance plans based on cost, benefits, and other important features; choose a plan; ...

  15. Public Health Policy in Support of Insurance Coverage for Smoking Cessation Treatments.

    Science.gov (United States)

    Schwartz, Robert; Haji, Farzana; Babayan, Alexey; Longo, Christopher; Ferrence, Roberta

    2017-05-01

    Insurance coverage for evidence-based smoking cessation treatments (SCTs) promotes uptake and reduces smoking rates. Published studies in this area are based in the US where employers are the primary source of health insurance. In Ontario, Canada, publicly funded healthcare does not cover SCTs, but it can be supplemented with employer-sponsored benefit plans. This study explores factors affecting the inclusion/exclusion of smoking cessation (SC) benefits. In total, 17 interviews were conducted with eight employers (auto, retail, banking, municipal and university industries), four health insurers, two government representatives and three advisors/consultants. Overall, SCT coverage varied among industries; it was inconsistently restrictive and SCT differed by coverage amount and length of use. Barriers impeding coverage included the lack of the following: Canadian-specific return on investment (ROI), SC cost information, employer demand, government regulations/incentives and employee awareness of and demand. A Canadian evidence-based calculation of ROI for SC coupled with government incentives and public education may be needed to promote uptake of SCT coverage by employers. Copyright © 2017 Longwoods Publishing.

  16. [Universalization of health or of social security?].

    Science.gov (United States)

    Levy-Algazi, Santiago

    2011-01-01

    This article presents an analysis of the architecture of Mexico's health system based on the main economic problem, failing to achieve a GDP growth rate to increase real wages and give workers in formal employment coverage social security. This analysis describes the relationship between social security of the population and employment status of it (either formal or informal employment) and the impact that this situation poses to our health system. Also, it ends with a reform proposal that will give all workers the same social rights, ie to grant universal social security.

  17. Dynamics of domain coverage of the protein sequence universe

    Science.gov (United States)

    2012-01-01

    Background The currently known protein sequence space consists of millions of sequences in public databases and is rapidly expanding. Assigning sequences to families leads to a better understanding of protein function and the nature of the protein universe. However, a large portion of the current protein space remains unassigned and is referred to as its “dark matter”. Results Here we suggest that true size of “dark matter” is much larger than stated by current definitions. We propose an approach to reducing the size of “dark matter” by identifying and subtracting regions in protein sequences that are not likely to contain any domain. Conclusions Recent improvements in computational domain modeling result in a decrease, albeit slowly, in the relative size of “dark matter”; however, its absolute size increases substantially with the growth of sequence data. PMID:23157439

  18. Dynamics of domain coverage of the protein sequence universe

    Directory of Open Access Journals (Sweden)

    Rekapalli Bhanu

    2012-11-01

    Full Text Available Abstract Background The currently known protein sequence space consists of millions of sequences in public databases and is rapidly expanding. Assigning sequences to families leads to a better understanding of protein function and the nature of the protein universe. However, a large portion of the current protein space remains unassigned and is referred to as its “dark matter”. Results Here we suggest that true size of “dark matter” is much larger than stated by current definitions. We propose an approach to reducing the size of “dark matter” by identifying and subtracting regions in protein sequences that are not likely to contain any domain. Conclusions Recent improvements in computational domain modeling result in a decrease, albeit slowly, in the relative size of “dark matter”; however, its absolute size increases substantially with the growth of sequence data.

  19. Market reform and universal coverage: avoid market failure.

    Science.gov (United States)

    Enthoven, A

    1993-02-01

    Determining the marketing mix for hospitals, especially those in transition, will require critical analysis to guard against market failure. Managed competition requires careful planning and awareness of pricing components in a free-market situation. Alain Enthoven, writing for the Jackson Hole Group, proposes establishment of a new national system of sponsor organizations--Health Insurance Purchasing Cooperatives--to function as a collective purchasing agent on behalf of small employers and individuals.

  20. Using stakeholder analysis to support moves towards universal coverage: lessons from the SHIELD project.

    Science.gov (United States)

    Gilson, Lucy; Erasmus, Ermin; Borghi, Jo; Macha, Janet; Kamuzora, Peter; Mtei, Gemini

    2012-03-01

    Stakeholder analysis is widely recommended as a tool for gathering insights on policy actor interests in, positions on, and power to influence, health policy issues. Such information is recognized to be critical in developing viable health policy proposals, and is particularly important for new health care financing proposals that aim to secure universal coverage (UC). However, there remain surprisingly few published accounts of the use of stakeholder analysis in health policy development generally, and health financing specifically, and even fewer that draw lessons from experience about how to do and how to use such analysis. This paper, therefore, aims to support those developing or researching UC reforms to think both about how to conduct stakeholder analysis, and how to use it to support evidence-informed pro-poor health policy development. It presents practical lessons and ideas drawn from experience of doing stakeholder analysis around UC reforms in South Africa and Tanzania, combined with insights from other relevant material. The paper has two parts. The first presents lessons of experience for conducting a stakeholder analysis, and the second, ideas about how to use the analysis to support policy design and the development of actor and broader political management strategies. Comparison of experience across South Africa and Tanzania shows that there are some commonalities concerning which stakeholders have general interests in UC reform. However, differences in context and in reform proposals generate differences in the particular interests of stakeholders and their likely positioning on reform proposals, as well as in their relative balance of power. It is, therefore, difficult to draw cross-national policy comparisons around these specific issues. Nonetheless, the paper shows that cross-national policy learning is possible around the approach to analysis, the factors influencing judgements and the implications for, and possible approaches to, management

  1. Global costs and benefits of reaching universal coverage of sanitation and drinking-water supply.

    Science.gov (United States)

    Hutton, Guy

    2013-03-01

    Economic evidence on the cost and benefits of sanitation and drinking-water supply supports higher allocation of resources and selection of efficient and affordable interventions. The study aim is to estimate global and regional costs and benefits of sanitation and drinking-water supply interventions to meet the Millennium Development Goal (MDG) target in 2015, as well as to attain universal coverage. Input data on costs and benefits from reviewed literature were combined in an economic model to estimate the costs and benefits, and benefit-cost ratios (BCRs). Benefits included health and access time savings. Global BCRs (Dollar return per Dollar invested) were 5.5 for sanitation, 2.0 for water supply and 4.3 for combined sanitation and water supply. Globally, the costs of universal access amount to US$ 35 billion per year for sanitation and US$ 17.5 billion for drinking-water, over the 5-year period 2010-2015 (billion defined as 10(9) here and throughout). The regions accounting for the major share of costs and benefits are South Asia, East Asia and sub-Saharan Africa. Improved sanitation and drinking-water supply deliver significant economic returns to society, especially sanitation. Economic evidence should further feed into advocacy efforts to raise funding from governments, households and the private sector.

  2. The need for consumer behavior analysis in health care coverage decisions.

    Science.gov (United States)

    Thompson, A M; Rao, C P

    1990-01-01

    Demographic analysis has been the primary form of analysis connected with health care coverage decisions. This paper reviews past demographic research and shows the need to use behavioral analyses for health care coverage policy decisions. A behavioral model based research study is presented and a case is made for integrated study into why consumers make health care coverage decisions.

  3. 78 FR 54996 - Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under...

    Science.gov (United States)

    2013-09-09

    ... Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer... credit to help individuals and families afford health insurance coverage purchased through an Affordable... or group health insurance coverage offered by an employer to the employee that is (1) a governmental...

  4. Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA.

    Science.gov (United States)

    Winetrobe, H; Rice, E; Rhoades, H; Milburn, N

    2016-03-01

    Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Remaining missed opportunities of child survival in Peru: modelling mortality impact of universal and equitable coverage of proven interventions.

    Science.gov (United States)

    Tam, Yvonne; Huicho, Luis; Huayanay-Espinoza, Carlos A; Restrepo-Méndez, María Clara

    2016-10-04

    Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru. We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence. Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade. Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030.

  6. Remaining missed opportunities of child survival in Peru: modelling mortality impact of universal and equitable coverage of proven interventions

    Directory of Open Access Journals (Sweden)

    Yvonne Tam

    2016-10-01

    Full Text Available Abstract Background Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru. Methods We used the Lives Saved Tool (LiST to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban–rural residence. Results Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade. Conclusions Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030.

  7. Strategies for expanding health insurance coverage in vulnerable populations.

    Science.gov (United States)

    Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

    2014-11-26

    Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that

  8. College/University Presidents and Crisis Communications: Interpretive Content Analysis of Newspaper Coverage in the Northeast

    Science.gov (United States)

    DiManno, Dorria L.

    2010-01-01

    Higher education institutions are under increased scrutiny from various constituencies. Frequently, external perceptions of a college or university are based on the image and actions of its president, known to those outside the institution primarily through coverage in the mass media. Support for an institution may depend heavily on these…

  9. Hospital Coding Practice, Data Quality, and DRG-Based Reimbursement under the Thai Universal Coverage Scheme

    Science.gov (United States)

    Pongpirul, Krit

    2011-01-01

    In the Thai Universal Coverage scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group (DRG) reimbursement. Questionable quality of the submitted DRG codes has been of concern whereas knowledge about hospital coding practice has been lacking. The objectives of this thesis are (1) To explore hospital coding…

  10. Coverage and inequalities in maternal and child health interventions in Afghanistan

    Directory of Open Access Journals (Sweden)

    Nadia Akseer

    2016-09-01

    Full Text Available Abstract Background Afghanistan has made considerable gains in improving maternal and child health and survival since 2001. However, socioeconomic and regional inequities may pose a threat to reaching universal coverage of health interventions and further health progress. We explored coverage and socioeconomic inequalities in key life-saving reproductive, maternal, newborn and child health (RMNCH interventions at the national level and by region in Afghanistan. We also assessed gains in child survival through scaling up effective community-based interventions across wealth groups. Methods Using data from the Afghanistan Multiple Indicator Cluster Survey (MICS 2010/11, we explored 11 interventions that spanned all stages of the continuum of care, including indicators of composite coverage. Asset-based wealth quintiles were constructed using standardised methods, and absolute inequalities were explored using wealth quintile (Q gaps (Q5-Q1 and the slope index of inequality (SII, while relative inequalities were assessed with ratios (Q5/Q1 and the concentration index (CIX. The lives saved tool (LiST modeling used to estimate neonatal and post-neonatal deaths averted from scaling up essential community-based interventions by 90 % coverage by 2025. Analyses considered the survey design characteristics and were conducted via STATA version 12.0 and SAS version 9.4. Results Our results underscore significant pro-rich socioeconomic absolute and relative inequalities, and mass population deprivation across most all RMNCH interventions studied. The most inequitable are antenatal care with a skilled attendant (ANCS, skilled birth attendance (SBA, and 4 or more antenatal care visits (ANC4 where the richest have between 3.0 and 5.6 times higher coverage relative to the poor, and Q5-Q1 gaps range from 32 % - 65 %. Treatment of sick children and breastfeeding interventions are the most equitably distributed. Across regions, inequalities were highest in the

  11. A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage Scheme

    Directory of Open Access Journals (Sweden)

    Winch Peter J

    2011-04-01

    Full Text Available Abstract Background In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Methods Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large, location (urban/rural, and type (public/private. Results Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1 Discharge Summarization, 2 Completeness Checking, 3 Diagnosis and Procedure Coding, 4 Code Checking, 5 Relative Weight Challenging, 6 Coding Report, and 7 Internal Audit. The hospital coding practice can be affected by at least five main factors: 1 Internal Dynamics, 2 Management Context, 3 Financial Dependency, 4 Resource and Capacity, and 5 External Factors. Conclusions Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors.

  12. A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage scheme.

    Science.gov (United States)

    Pongpirul, Krit; Walker, Damian G; Winch, Peter J; Robinson, Courtland

    2011-04-08

    In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large), location (urban/rural), and type (public/private). Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1) Discharge Summarization, 2) Completeness Checking, 3) Diagnosis and Procedure Coding, 4) Code Checking, 5) Relative Weight Challenging, 6) Coding Report, and 7) Internal Audit. The hospital coding practice can be affected by at least five main factors: 1) Internal Dynamics, 2) Management Context, 3) Financial Dependency, 4) Resource and Capacity, and 5) External Factors. Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors.

  13. Marginalization and health service coverage among indigenous, rural, and urban populations: a public health problem in Mexico.

    Science.gov (United States)

    Roldán, José; Álvarez, Marsela; Carrasco, María; Guarneros, Noé; Ledesma, José; Cuchillo-Hilario, Mario; Chávez, Adolfo

    2017-12-01

      Marginalization is a significant issue in Mexico, involving a lack of access to health services with differential impacts on Indigenous, rural and urban populations. The objective of this study was to understand Mexico’s public health problem across three population areas, Indigenous, rural and urban, in relation to degree of marginalization and health service coverage.   The sampling universe of the study consisted of 107 458 geographic locations in the country. The study was retrospective, comparative and confirmatory. The study applied analysis of variance, parametric and non-parametric, correlation and correspondence analyses.   Significant differences were identified between the Indigenous, rural and urban populations with respect to their level of marginalization and access to health services. The most affected area was Indigenous, followed by rural areas. The sector that was least affected was urban.   Although health coverage is highly concentrated in urban areas in Mexico, shortages are mostly concentrated in rural areas where Indigenous groups represent the extreme end of marginalization and access to medical coverage. Inadequate access to health services in the Indigenous and rural populations throws the gravity of the public health problem into relief.

  14. Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

    Science.gov (United States)

    Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara

    2016-05-01

    Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. Project HOPE—The People-to-People Health Foundation, Inc.

  15. [Extension of health coverage and community based health insurance schemes in Africa: Myths and realities].

    Science.gov (United States)

    Boidin, B

    2015-02-01

    This article tackles the perspectives and limits of the extension of health coverage based on community based health insurance schemes in Africa. Despite their strong potential contribution to the extension of health coverage, their weaknesses challenge their ability to play an important role in this extension. Three limits are distinguished: financial fragility; insufficient adaptation to characteristics and needs of poor people; organizational and institutional failures. Therefore lessons can be learnt from the limits of the institutionalization of community based health insurance schemes. At first, community based health insurance schemes are to be considered as a transitional but insufficient solution. There is also a stronger role to be played by public actors in improving financial support, strengthening health services and coordinating coverage programs.

  16. Barriers to Enrollment in Health Coverage in Colorado.

    Science.gov (United States)

    Martin, Laurie T; Bharmal, Nazleen; Blanchard, Janice C; Harvey, Melody; Williams, Malcolm

    2015-03-20

    As part of the implementation of the Affordable Care Act, Colorado has expanded Medicaid and also now operates its own health insurance exchange for individuals (called Connect for Health Colorado). As of early 2014, more than 300,000 Coloradans have newly enrolled in Medicaid or health insurance through Connect for Health Colorado, but there also continues to be a diverse mix of individuals in Colorado who remain eligible for but not enrolled in either private insurance or Medicaid. The Colorado Health Foundation commissioned the RAND Corporation to conduct a study to better understand why these individuals are not enrolled in health insurance coverage and to develop recommendations for how Colorado can strengthen its outreach and enrollment efforts during the next open enrollment period, which starts in November 2014. RAND conducted focus groups with uninsured and newly insured individuals across the state and interviews with local stakeholders responsible for enrollment efforts in their regions. The authors identified 11 commonly cited barriers, as well as several that were specific to certain regions or populations (such as young adults and seasonal workers). Collectively, these barriers point to a set of four priority recommendations that stakeholders in Colorado may wish to consider: (1) Support and expand localized outreach and tailored messaging; (2) Strengthen marketing and messaging to be clear, focused on health benefits of insurance (rather than politics and mandates), and actionable; (3) Improve the clarity and transparency of insurance and health care costs and enrollment procedures; and (4) Revisit the two-stage enrollment process and improve Connect for Health Colorado website navigation and technical support.

  17. 2009–2010 Seasonal Influenza Vaccination Coverage Among College Students From 8 Universities in North Carolina

    Science.gov (United States)

    Poehling, Katherine A.; Blocker, Jill; Ip, Edward H.; Peters, Timothy R.; Wolfson, Mark

    2012-01-01

    Objective We sought to describe the 2009–2010 seasonal influenza vaccine coverage of college students. Participants 4090 college students from eight North Carolina universities participated in a confidential, web-based survey in October-November 2009. Methods Associations between self-reported 2009–2010 seasonal influenza vaccination and demographic characteristics, campus activities, parental education, and email usage were assessed by bivariate analyses and by a mixed-effects model adjusting for clustering by university. Results Overall, 20% of students (range 14%–30% by university) reported receiving 2009–2010 seasonal influenza vaccine. Being a freshman, attending a private university, having a college-educated parent, and participating in academic clubs/honor societies predicted receipt of influenza vaccine in the mixed-effects model. Conclusions The self-reported 2009–2010 influenza vaccine coverage was one-quarter of the 2020 Healthy People goal (80%) for healthy persons 18–64 years of age. College campuses have the opportunity to enhance influenza vaccine coverage among its diverse student populations. PMID:23157195

  18. Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention.

    Directory of Open Access Journals (Sweden)

    Knut Lönnroth

    2014-09-01

    Full Text Available Tuberculosis (TB remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.

  19. Strategies for expanding health insurance coverage in vulnerable populations

    Science.gov (United States)

    Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

    2014-01-01

    Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Selection criteria Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA

  20. 75 FR 34537 - Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a...

    Science.gov (United States)

    2010-06-17

    ... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... and Insurance Oversight, Department of Health and Human Services. ACTION: Interim final rules with...

  1. 75 FR 34571 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Science.gov (United States)

    2010-06-17

    ... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

  2. 75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Science.gov (United States)

    2010-11-17

    ... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...

  3. University students' mental health: Aksaray University example

    Directory of Open Access Journals (Sweden)

    Rezzan Gündoğdu

    2013-11-01

    Full Text Available This study examines whether mental health scores of the university students differ based on gender, whether they study in their ideal majors, whether they are contended with their majors, economic condition perceived and perceptions on employment opportunity after graduation. The sample group of the study constituted 3492 students comprising 2037 female students and 1455 male students attending Faculty of Education (634, Engineering Faculty (1582, Economic and Administrative Sciences Faculty (1097, Faculty of Science and Letters (762, Medical Vocational College (540, Physical Training and Sports College (443 and Aksaray Vocational College (1452 of Aksaray University in 2010-2011 Academic Year. Symptom Checklist (SCL 90-R developed by Deragotis, (1983; eg Öner, 1997 has been used to collect data on mental health level of the students involved in the study. Statistical analysis of the data collected has been carried out using t Test, One-way Analysis of Variance (ANOVA. Significant differences have been found in students in terms of independent variants according to the general symptom average score and numerous sub-scale scores.

  4. 75 FR 27141 - Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age...

    Science.gov (United States)

    2010-05-13

    ... Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age 26 Under... Information and Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage...

  5. 75 FR 41787 - Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive...

    Science.gov (United States)

    2010-07-19

    ... Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive Services... Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage offered in...

  6. Individual health insurance within the family : can subsidies promote family coverage?

    OpenAIRE

    Kanika Kapur; M. Susan Marquis; José J. Escarce

    2007-01-01

    This paper examines the role of price in health insurance coverage decisions within the family to guide policy in promoting whole family coverage. We analyze the factors that affect individual health insurance coverage among families, and explore family decisions about whom to cover and whom to leave uninsured. The analysis uses household data from California combined with abstracted individual health plan benefit and premium data. We find that premium subsidies for individual insurance would...

  7. Health insurance coverage among women in Indonesia's major cities: A multilevel analysis.

    Science.gov (United States)

    Christiani, Yodi; Byles, Julie E; Tavener, Meredith; Dugdale, Paul

    2017-03-01

    We examined women's access to health insurance in Indonesia. We analyzed IFLS-4 data of 1,400 adult women residing in four major cities. Among this population, the health insurance coverage was 24%. Women who were older, involved in paid work, and with higher education had greater access to health insurance (p health insurance across community levels (Median Odds Ratios = 3.40). Given the importance of health insurance for women's health, strategies should be developed to expand health insurance coverage among women in Indonesia, including the disparities across community levels. Such problems might also be encountered in other developing countries with low health insurance coverage.

  8. Determinants of Health Insurance Coverage among People Aged 45 and over in China: Who Buys Public, Private and Multiple Insurance

    Science.gov (United States)

    Jin, Yinzi; Hou, Zhiyuan; Zhang, Donglan

    2016-01-01

    Background China is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China. Methods We used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance. Results In 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16–0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24–1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage. Conclusion The migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance. PMID:27564320

  9. 77 FR 42417 - Federal Employees Health Benefits Program Coverage for Certain Firefighters

    Science.gov (United States)

    2012-07-19

    ... men and women the opportunity to obtain health insurance coverage will help them to protect themselves... professions, Hostages, Iraq, Kuwait, Lebanon, Military personnel, Reporting and recordkeeping requirements...

  10. Cigarette advertising and media coverage of smoking and health.

    Science.gov (United States)

    Warner, K E

    1985-02-07

    In the US, media coverage of the health hazards of cigarette smoking is consored by the tobacco industry. Tobacco companies, which in 1983 alone spent US$2.5 billion on smoking promtion, are a major source of advertising revenue for many media organizations. As a result media organizations frequently refuse to publish antismoking information, tent to tone down coverage of antismoking news events, and often refuse to accept antismoking advertisements. In a 1983 "Newsweek" supplement on personal health, prepared by the American Medical Association, only 4 sentences were devoted to the negative effects of smoking. A spokesman for the association reported that "Newsweek" editors refused to allow the association to use the forum to present a strong antismoking message. In 1984 a similar type of health supplement, published by "Time," failed to mention smoking at all. An examination of 10 major women's magazines revealed that between 1967-79, 4 of the magazines published no articles about the hazards of smoking and only 8 such articles appeared in the other 6 magazines. All of these magazines carried smoking advertisements. During the same time period, 2 magazines, which refused to publish cigarette ads, published a total of 16 articles on the hazards of smoking. Small magazines which publish antismoking articles are especially vulnerable to pressure from the tobacco industry. For example, the tobacco industry canceled all its ads in "Mother Jones" after the magazine printed 2 antismoking articles. 22 out of 36 magazines refused to run antismoking advertisements when they were requested to do so. Due to poor media coverage, th public's knowledge of the hazards of smoking is deficient. Recent surveys found that 2/3 of the public did not know that smoking could cause heart attacks, and 1/2 of the respondents did not know that smoking is the major cause of lung cancer. An analysis of time trends in cigarette smoking indicates that the public does respond to antismoking

  11. Child health security in China: a survey of child health insurance coverage in diverse areas of the country.

    Science.gov (United States)

    Xiong, Juyang; Hipgrave, David; Myklebust, Karoline; Guo, Sufang; Scherpbier, Robert W; Tong, Xuetao; Yao, Lan; Moran, Andrew E

    2013-11-01

    China embarked on an ambitious health system reform in 2009, and pledged to achieve universal health insurance coverage by 2020. However, there are gaps in access to healthcare for some children in China. We assessed health insurance status and associated variables among children under five in twelve communities in 2010: two urban community health centers and two rural township health centers in each of three municipalities located in China's distinctly different East, Central and Western regions. Information on demographic and socio-economic variables and children's insurance status was gathered from parents or caregivers of all children enrolled in local health programs, and others recruited from the local communities. Only 62% of 1131 children assessed were insured. This figure did not vary across geographic regions, but urban children were less likely to be insured than rural children. In multivariate analysis, infants were 2.44 times more likely to be uninsured than older children and children having at least one migrant parent were 1.90 times more likely to be uninsured than those living with non-migrant parents. Low maternal education was also associated with being uninsured. Gaps in China's child health insurance coverage might be bridged if newborns are automatically covered from birth, and if insurance is extended to all urban migrant children, regardless of the family's residential registration status and size. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. 75 FR 41726 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of...

    Science.gov (United States)

    2010-07-19

    ... Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient... and health insurance coverage in the group and individual markets under provisions of the Patient... plans and group health insurance issuers for plan years beginning on or after September 23, 2010. These...

  13. Experiencia del Ministerio de Salud en la implementación de las brigadas de médicos especialistas en las zonas de Aseguramiento Universal en Perú, 2009-2010 Implementation of medical specialists brigades in the areas of Universal Health coverage: the peruvian Ministry of Health experience, 2009-2010

    Directory of Open Access Journals (Sweden)

    Violeta Barzola-Cordero

    2011-06-01

    Full Text Available Perú tiene alto grado de inequidad reflejado en la distribución de morbilidad-mortalidad, concordante con la inaccesibilidad a atención de salud y déficit de recursos humanos, especialmente en zonas alejadas de la capital. El Ministerio de Salud de Perú, reconociendo el derecho de toda la población a salud de calidad, inició el Aseguramiento Universal en Salud (AUS, en este marco, incrementó el acceso a atención especializada en zonas pilotos del AUS, mediante brigadas de médicos especialistas. Este artículo ofrece una aproximación a esta estrategia; presenta los procesos de gestión e implementación, hace un análisis cuantitativo con indicadores de producción/eficiencia, y brinda una mirada cualitativa desde la perspectiva de los brigadistas. Sus principales conclusiones inciden en la falta de gestión eficaz y eficiente, traducida en ausencia de: metas de producción, planes de trabajo, trabajo coparticipativo con actores locales, monitoreo y supervisión efectivos, reincidente escasez de recursos humanos y tecnológicos, y elevados costos.Peru has a high degree of inequity reflected in the distribution of morbidity and mortality, consistent with the inaccessibility to health care and human resource gap, especially in remote areas of the capital. The Peruvian Ministry of Health, recognizing the right of all people to quality health care, initiated the Universal Health Insurance (AUS, and in this context, increased access to specialized care in pilot AUS areas by brigades of specialist doctors. This article offers an approach to this strategy presents the management and implementation processes, a quantitative analysis with indicators of output / efficiency, and provides a qualitative look from the perspective of the members of the brigades. Its main findings reflect the lack of effective and efficient management, translated in the absence of: production goals, work plans, working partnerships with local stakeholders, monitoring

  14. From universal health insurance to universal healthcare? The shifting health policy landscape in Ireland since the economic crisis.

    Science.gov (United States)

    Burke, Sara Ann; Normand, Charles; Barry, Sarah; Thomas, Steve

    2016-03-01

    Ireland experienced one of the most severe economic crises of any OECD country. In 2011, a new government came to power amidst unprecedented health budget cuts. Despite a retrenchment in the ability of health resources to meet growing need, the government promised a universal, single-tiered health system, with access based solely on medical need. Key to this was introducing universal free GP care by 2015 and Universal Health Insurance from 2016 onwards. Delays in delivering universal access and a new health minister in 2014 resulted in a shift in language from 'universal health insurance' to 'universal healthcare'. During 2014 and 2015, there was an absence of clarity on what government meant by universal healthcare and divergence in policy measures from their initial intent of universalism. Despite the rhetoric of universal healthcare, years of austerity resulted in poorer access to essential healthcare and little extension of population coverage. The Irish health system is at a critical juncture in 2015, veering between a potential path to universal healthcare and a system, overwhelmed by years of austerity, which maintains the status quo. This papers assesses the gap between policy intent and practice and the difficulties in implementing major health system reform especially while emerging from an economic crisis. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  15. Coverage for Gender-Affirming Care: Making Health Insurance Work for Transgender Americans.

    Science.gov (United States)

    Padula, William V; Baker, Kellan

    2017-08-01

    Many transgender Americans continue to remain uninsured or are underinsured because of payers' refusal to cover medically necessary, gender-affirming healthcare services-such as hormone therapy, mental health counseling, and reconstructive surgeries. Coverage refusal results in higher costs and poor health outcomes among transgender people who cannot access gender-affirming care. Research into the value of health insurance coverage for gender-affirming care for transgender individuals shows that the health benefits far outweigh the costs of insuring transition procedures. Although the Affordable Care Act explicitly protects health insurance for transgender individuals, these laws are being threatened; therefore, this article reviews their importance to transgender-inclusive healthcare coverage.

  16. Workplace Accommodations for Pregnant Employees: Associations With Women's Access to Health Insurance Coverage After Childbirth.

    Science.gov (United States)

    Jou, Judy; Kozhimannil, Katy B; Blewett, Lynn A; McGovern, Patricia M; Abraham, Jean M

    2016-06-01

    This study evaluates the associations between workplace accommodations for pregnancy, including paid and unpaid maternity leave, and changes in women's health insurance coverage postpartum. Secondary analysis using Listening to Mothers III, a national survey of women ages 18 to 45 years who gave birth in U.S. hospitals during 2011 to 2012 (N = 700). Compared with women without access to paid maternity leave, women with access to paid leave were 0.4 times as likely to lose private health insurance coverage, 0.3 times as likely to lose public health coverage, and 0.3 times as likely to become uninsured after giving birth. Workplace accommodations for pregnant employees are associated with health insurance coverage via work continuity postpartum. Expanding protections for employees during pregnancy and after childbirth may help reduce employee turnover, loss of health insurance coverage, and discontinuity of care.

  17. Proposed regulations could limit access to affordable health coverage for workers' children and family members.

    Science.gov (United States)

    Jacobs, Ken; Graham-Squire, Dave; Roby, Dylan H; Kominski, Gerald F; Kinane, Christina M; Needleman, Jack; Watson, Greg; Gans, Daphna

    2011-12-01

    Key Findings. The Patient Protection and Affordable Care Act (ACA) is designed to offer premium subsidies to help eligible individuals and their families purchase insurance coverage when affordable job-based coverage is not available. However, the law is unclear on how this affordability protection is applied in those instances where self-only coverage offered by an employer is affordable but family coverage is not. Regulations recently proposed by the Department of the Treasury would make family members ineligible for subsidized coverage in the exchange if an employee is offered affordable self-only coverage by an employer, even if family coverage is unaffordable. This could have significant financial consequences for low- and moderate-income families that fall in this gap. Using an alternative interpretation of the law could allow the entire family to enter the exchange when family coverage is unaffordable, which would broaden access to coverage. However, this option has been cited as cost prohibitive. In this brief we consider a middle ground alternative that would base eligibility for the individual worker on the cost of self-only coverage, but would use the additional cost to the employee for family coverage as the basis for determining affordability and eligibility for subsidies for the remaining family members. We find that: Under the middle ground alternative scenario an additional 144,000 Californians would qualify for and use premium subsidies in the California Health Benefit Exchange, half of whom are children. Less than 1 percent of those with employer-based coverage would move to subsidized coverage in the California Health Benefit Exchange as a result of having unaffordable coverage on the job.

  18. Don't Discount Societal Value in Cost-Effectiveness Comment on "Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness".

    Science.gov (United States)

    Hall, William

    2017-01-14

    As healthcare resources become increasingly scarce due to growing demand and stagnating budgets, the need for effective priority setting and resource allocation will become ever more critical to providing sustainable care to patients. While societal values should certainly play a part in guiding these processes, the methodology used to capture these values need not necessarily be limited to multi-criterion decision analysis (MCDA)-based processes including 'evidence-informed deliberative processes.' However, if decision-makers intend to not only incorporates the values of the public they serve into decisions but have the decisions enacted as well, consideration should be given to more direct involvement of stakeholders. Based on the examples provided by Baltussen et al, MCDA-based processes like 'evidence-informed deliberative processes' could be one way of achieving this laudable goal. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  19. Newspaper coverage of youth and tobacco: implications for public health.

    Science.gov (United States)

    Smith, Katherine Clegg; Wakefield, Melanie

    2006-01-01

    The presentation of smoking as a "youth" issue is a powerful component of current tobacco-control efforts. Agenda setting theory demonstrates that the media serve as a potent forum in which the consideration and presentation of perspectives of social problems take place. This analysis of 643 U.S. youth-focused newspaper articles examines the messages being conveyed to the public and policymakers through coverage of tobacco issues focused on youth. Data illustrate that the issue of youth tobacco use is newsworthy but also suggest that youth-focused issues garner little commentary coverage. Rather, straightforward reports of "feel good" stories dominate the coverage, and youth-focused articles tend to conceptualize the problem of tobacco as being one of a need for greater individual-level education rather than structural or policy changes.

  20. Extending health insurance coverage to the informal sector: Lessons from a private micro health insurance scheme in Lagos, Nigeria.

    Science.gov (United States)

    Peterson, Lauren; Comfort, Alison; Hatt, Laurel; van Bastelaer, Thierry

    2018-04-15

    As a growing number of low- and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria. Study methods included a survey of microfinance clients, key informant interviews, and a review of administrative records. Demographic, health care seeking, and willingness-to-pay data suggested that microfinance clients, particularly women, could benefit from a comprehensive MHI plan that improved access to health care and reduced out-of-pocket spending on health services. However, administrative data revealed declining enrollment, and key informant interviews further suggested low use of the health insurance plan. Key implementation challenges, including changes to mandatory enrollment requirements, insufficient client education and marketing, misaligned incentives, and weak back-office systems, undermined enrollment and use of the plan. Mandatory MHI plans, intended to mitigate adverse selection and facilitate private insurers' entry into new markets, present challenges for covering informal sector workers, including when distributed through agents such as a microfinance bank. Properly aligning the incentives of the insurer and the agent are critical to effectively distribute and service insurance. Further, an urban environment presents unique challenges for distributing MHI, addressing client perceptions of health insurance, and meeting their health care needs. Copyright © 2018 John Wiley & Sons, Ltd.

  1. 42 CFR 457.80 - Current State child health insurance coverage and coordination.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Current State child health insurance coverage and... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies...

  2. Health insurance coverage and its impact on medical cost: observations from the floating population in China.

    Directory of Open Access Journals (Sweden)

    Yinjun Zhao

    Full Text Available China has the world's largest floating (migrant population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population.A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost.82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost.For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost.

  3. Health Insurance Coverage and Its Impact on Medical Cost: Observations from the Floating Population in China

    Science.gov (United States)

    Zhao, Yinjun; Kang, Bowei; Liu, Yawen; Li, Yichong; Shi, Guoqing; Shen, Tao; Jiang, Yong; Zhang, Mei; Zhou, Maigeng; Wang, Limin

    2014-01-01

    Background China has the world's largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population. Methods A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost. Results 82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost. Conclusion For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost. PMID:25386914

  4. Does Health Insurance Coverage Lead to Better Health and Educational Outcomes? Evidence from Rural China. NBER Working Paper No. 16417

    Science.gov (United States)

    Chen, Yuyu; Jin, Ginger Zhe

    2010-01-01

    Many governments advocate nationwide health insurance coverage but the effects of such a program are less known in developing countries. We use part of the 2006 China Agricultural Census (CAC) to examine whether the recent health insurance coverage in rural China has affected children mortality, pregnancy mortality, and the school enrollment of…

  5. 42 CFR 440.335 - Benchmark-equivalent health benefits coverage.

    Science.gov (United States)

    2010-10-01

    ...) Aggregate actuarial value. Benchmark-equivalent coverage is health benefits coverage that has an aggregate... planning services and supplies and other appropriate preventive services, as designated by the Secretary... State for purposes of comparison in establishing the aggregate actuarial value of the benchmark...

  6. Assessing Measurement Error in Medicare Coverage From the National Health Interview Survey

    Science.gov (United States)

    Gindi, Renee; Cohen, Robin A.

    2012-01-01

    Objectives Using linked administrative data, to validate Medicare coverage estimates among adults aged 65 or older from the National Health Interview Survey (NHIS), and to assess the impact of a recently added Medicare probe question on the validity of these estimates. Data sources Linked 2005 NHIS and Master Beneficiary Record and Payment History Update System files from the Social Security Administration (SSA). Study design We compared Medicare coverage reported on NHIS with “benchmark” benefit records from SSA. Principal findings With the addition of the probe question, more reports of coverage were captured, and the agreement between the NHIS-reported coverage and SSA records increased from 88% to 95%. Few additional overreports were observed. Conclusions Increased accuracy of the Medicare coverage status of NHIS participants was achieved with the Medicare probe question. Though some misclassification remains, data users interested in Medicare coverage as an outcome or correlate can use this survey measure with confidence. PMID:24800138

  7. Health workers and vaccination coverage in developing countries: an econometric analysis.

    Science.gov (United States)

    Anand, Sudhir; Bärnighausen, Till

    2007-04-14

    Vaccine-preventable diseases cause more than 1 million deaths among children in developing countries every year. Although health workers are needed to do vaccinations, the role of human resources for health as a determinant of vaccination coverage at the population level has not been investigated. Our aim was to test whether health worker density was positively associated with childhood vaccination coverage in developing countries. We did cross-country multiple regression analyses with coverage of three vaccinations--measles-containing vaccine (MCV); diphtheria, tetanus, and pertussis (DTP3); and poliomyelitis (polio3)--as dependent variables. Aggregate health worker density was an independent variable in one set of regressions; doctor and nurse densities were used separately in another set. We controlled for national income per person, female adult literacy, and land area. Health worker density was significantly associated with coverage of all three vaccinations (MCV p=0.0024; DTP3 p=0.0004; polio3 p=0.0008). However, when the effects of doctors and nurses were assessed separately, we found that nurse density was significantly associated with coverage of all three vaccinations (MCV p=0.0097; DTP3 p=0.0083; polio3 p=0.0089), but doctor density was not (MCV p=0.7953; DTP3 p=0.7971; polio3 p=0.7885). Female adult literacy was positively associated, and land area negatively associated, with vaccination coverage. National income per person had no effect on coverage. A higher density of health workers (nurses) increases the availability of vaccination services over time and space, making it more likely that children will be vaccinated. After controlling for other determinants, the level of income does not contribute to improved immunisation coverage. Health workers can be a major constraining factor on vaccination coverage in developing countries.

  8. Pricing of drugs with heterogeneous health insurance coverage.

    Science.gov (United States)

    Ferrara, Ida; Missios, Paul

    2012-03-01

    In this paper, we examine the role of insurance coverage in explaining the generic competition paradox in a two-stage game involving a single producer of brand-name drugs and n quantity-competing producers of generic drugs. Independently of brand loyalty, which some studies rely upon to explain the paradox, we show that heterogeneity in insurance coverage may result in higher prices of brand-name drugs following generic entry. With market segmentation based on insurance coverage present in both the pre- and post-entry stages, the paradox can arise when the two types of drugs are highly substitutable and the market is quite profitable but does not have to arise when the two types of drugs are highly differentiated. However, with market segmentation occurring only after generic entry, the paradox can arise when the two types of drugs are weakly substitutable, provided, however, that the industry is not very profitable. In both cases, that is, when market segmentation is present in the pre-entry stage and when it is not, the paradox becomes more likely to arise as the market expands and/or insurance companies decrease deductibles applied on the purchase of generic drugs. Copyright © 2012 Elsevier B.V. All rights reserved.

  9. Australian print news media coverage of sweet, non-alcoholic drinks sends mixed health messages.

    Science.gov (United States)

    Bonfiglioli, Catriona; Hattersley, Libby; King, Lesley

    2011-08-01

    This study aimed to analyse the contribution of Australian print news coverage to the public profile of sweet, non-alcoholic beverages. News media portrayal of health contributes to individuals' decision-making. The focus on sugar-sweetened beverages reflects their contribution to excessive energy intake. One year's coverage of sweet, non-alcoholic beverages by major Australian newspapers was analysed using content and frame analysis. Research questions addressed which sweet drinks are most prominently covered, what makes sweet drinks newsworthy and how are the health aspects of sweet drinks framed? Fruit juice was the most widely covered sweet drink, closely followed by carbonated, sugar-sweetened soft drinks. Overall coverage was positively oriented towards sweet drinks, with fruit juice primarily portrayed as having health benefits. Some coverage mentioned risks of sweet drinks, such as obesity, tooth decay, metabolic syndrome and heart attack. Sweet drinks often enjoy positive coverage, with their health benefits and harms central to their ability to attract journalists' attention. However, the mix of coverage may be contributing to consumer confusion about whether it is safe and/or healthy to consume sweet non-alcoholic drinks. Framing of sweet drinks as healthy may undermine efforts to encourage individuals to avoid excess consumption of energy-dense drinks which offer few or minimal health benefits. © 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.

  10. Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico.

    Directory of Open Access Journals (Sweden)

    Sergio Bautista-Arredondo

    2014-01-01

    Full Text Available Objective. Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Materials and methods. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Results. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Conclusions. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

  11. [Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico].

    Science.gov (United States)

    Bautista-Arredondo, Sergio; Serván-Mori, Edson; Colchero, M Arantxa; Ramírez-Rodríguez, Baruch; Sosa-Rubí, Sandra G

    2014-01-01

    Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

  12. User experience with a health insurance coverage and benefit-package access: implications for policy implementation towards expansion in Nigeria.

    Science.gov (United States)

    Mohammed, Shafiu; Aji, Budi; Bermejo, Justo Lorenzo; Souares, Aurelia; Dong, Hengjin; Sauerborn, Rainer

    2016-04-01

    Developing countries are devising strategies and mechanisms to expand coverage and benefit-package access for their citizens through national health insurance schemes (NHIS). In Nigeria, the scheme aims to provide affordable healthcare services to insured-persons and their dependants. However, inclusion of dependants is restricted to four biological children and a spouse per user. This study assesses the progress of implementation of the NHIS in Nigeria, relating to coverage and benefit-package access, and examines individual factors associated with the implementation, according to users' perspectives. A retrospective, cross-sectional survey was done between October 2010 and March 2011 in Kaduna state and 796 users were randomly interviewed. Questions regarding coverage of immediate-family members and access to benefit-package for treatment were analysed. Indicators of coverage and benefit-package access were each further aggregated and assessed by unit-weighted composite. The additive-ordinary least square regression model was used to identify user factors that may influence coverage and benefit-package access. With respect to coverage, immediate-dependants were included for 62.3% of the users, and 49.6 rated this inclusion 'good' (49.6%). In contrast, 60.2% supported the abolishment of the policy restriction for non-inclusion of enrolees' additional children and spouses. With respect to benefit-package access, 82.7% of users had received full treatments, and 77.6% of them rated this as 'good'. Also, 14.4% of users had been refused treatments because they could not afford them. The coverage of immediate-dependants was associated with age, sex, educational status, children and enrolment duration. The benefit-package access was associated with types of providers, marital status and duration of enrolment. This study revealed that coverage of family members was relatively poor, while benefit-package access was more adequate. Non-inclusion of family members could

  13. Health insurance tax credits, the earned income tax credit, and health insurance coverage of single mothers.

    Science.gov (United States)

    Cebi, Merve; Woodbury, Stephen A

    2014-05-01

    The Omnibus Budget Reconciliation Act of 1990 enacted a refundable tax credit for low-income working families who purchased health insurance coverage for their children. This health insurance tax credit (HITC) existed during tax years 1991, 1992, and 1993, and was then rescinded. A difference-in-differences estimator applied to Current Population Survey data suggests that adoption of the HITC, along with accompanying increases in the Earned Income Tax Credit (EITC), was associated with a relative increase of about 4.7 percentage points in the private health insurance coverage of working single mothers with high school or less education. Also, a difference-in-difference-in-differences estimator, which attempts to net out the possible influence of the EITC increases but which requires strong assumptions, suggests that the HITC was responsible for about three-quarters (3.6 percentage points) of the total increase. The latter estimate implies a price elasticity of health insurance take-up of -0.42. Copyright © 2013 John Wiley & Sons, Ltd.

  14. Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems.

    Directory of Open Access Journals (Sweden)

    David L Rosen

    Full Text Available Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA. We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18-64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827 had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the "coverage gap" and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services.

  15. Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems.

    Science.gov (United States)

    Rosen, David L; Grodensky, Catherine A; Holley, Tara K

    2016-01-01

    Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18-64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827) had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the "coverage gap" and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services.

  16. 78 FR 17313 - Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage...

    Science.gov (United States)

    2013-03-21

    ... health insurance issuer conditions eligibility on any employee's (part-time or full-time) having... the contracting provisions of the Federal Employee Health Benefits Program (FEHBP). OPM has... estimate that 4.1 million new employees receive group health insurance coverage through private sector...

  17. 77 FR 67743 - Federal Employees Health Benefits Program Coverage for Certain Intermittent Employees

    Science.gov (United States)

    2012-11-14

    ... employees who work on intermittent schedules eligible to be enrolled in a health benefits plan under the... put their health and safety at risk in order to assist those who have been affected by the storm... health insurance coverage based on the potentially diverse work schedules of intermittent employees...

  18. [Between evidence and negligence: coverage and invisibilityof health topics in the Portuguese printed media].

    Science.gov (United States)

    Cavaca, Aline Guio; Vasconcellos-Silva, Paulo Roberto; Ferreira, Patrícia; Nunes, João Arriscado

    2015-11-01

    The scope of this study is to conduct an assessment of the media coverage and dissemination of health issues in Portugal in order to problematize the aspects of coverage and invisibility of health topics and establish the themes neglected in media coverage. To achieve this, the coverage on health issues in the Portuguese daily newspaper Público was compared with the epidemiological context regarding health priorities and the perceptions of key players on media dissemination and the themes that are relevant to the Portuguese population. The results showed that the recurrent health-associated themes do not deal with diseases per se, but with the politics and economics of health and medication. The themes neglected in media coverage identified in the Portuguese context include: communicable diseases, such as hepatitis and tuberculosis; issues related to mental health and suicide; and ailments and social consequences associated with the economic crisis that has beset Portugal recently. From the standpoint of the people interviewed, other neglected diseases include hemochromatosis and other rare diseases. In tandem with this, the study highlights the well covered media themes that revolve around the lives and activities of celebrities, which are exhaustively aired in the communication media in the country.

  19. The impact of the macroeconomy on health insurance coverage: evidence from the Great Recession.

    Science.gov (United States)

    Cawley, John; Moriya, Asako S; Simon, Kosali

    2015-02-01

    This paper investigates the impact of the macroeconomy on the health insurance coverage of Americans using panel data from the Survey of Income and Program Participation for 2004-2010, a period that includes the Great Recession of 2007-2009. We find that a one percentage point increase in the state unemployment rate is associated with a 1.67 percentage point (2.12%) reduction in the probability that men have health insurance; this effect is strongest among college-educated, white, and older (50-64 years old) men. For women and children, health insurance coverage is not significantly correlated with the unemployment rate, which may be the result of public health insurance acting as a social safety net. Compared with the previous recession, the health insurance coverage of men is more sensitive to the unemployment rate, which may be due to the nature of the Great Recession. Copyright © 2013 John Wiley & Sons, Ltd.

  20. 77 FR 8725 - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under...

    Science.gov (United States)

    2012-02-15

    ... regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by... plans and group health insurance issuers on April 16, 2012. FOR FURTHER INFORMATION CONTACT: Amy Turner... addition, information from HHS on private health insurance for consumers can be found on the CMS Web site...

  1. Capping the tax exclusion for employment-based health coverage: implications for employers and workers.

    Science.gov (United States)

    Fronstin, Paul

    2009-01-01

    HEALTH CARE TAX CAP: With health reform a major priority of the new 111th Congress and President Barack Obama, this Issue Briefexamines the administrative and implementation issues that arise from one of the major reform proposals: Capping the exclusion of employment-based health coverage from workers' taxable income. The amount that employers contribute toward workers' health coverage is generally excluded, without limit, from workers' taxable income. In addition, workers whose employers sponsor flexible spending accounts are able to pay out-of-pocket expenses with pretax dollars. Employers can also make available a premium conversion arrangement, which allows workers to pay their share of the premium for employment-based coverage with pretax dollars. In 2005, a presidential advisory board concluded that limiting the amount of tax-preferred health coverage could lower overall private-sector health spending. The panel recommended a cap on the amount of employment-based health coverage individuals can exclude from their income tax, as a way to reduce health spending. In his 2008 "Call to Action" for health care reform, Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, states that "Congress should explore ways to restructure the current tax incentives to encourage more efficient spending on health and to target our tax dollars more effectively and fairly." While a tax cap on health coverage sounds simple, for many employers, it could be difficult to administer and results would vary by employer based on the type of health benefit plan, the size and demographics of their work force, and even where the workers live. The change would be especially difficult for self-insured employers that do not pay insurance premiums, since they would have to set the "premium equivalent" for each worker. This would not only be costly for employers, depending upon the requirements set out by law, but could also create fairness and tax issues for many affected workers

  2. Predictors of hepatitis A vaccine coverage among university students in Korea.

    Science.gov (United States)

    Park, Seungmi; Choi, Jeong Sil

    2016-01-01

    To investigate the status of hepatitis A vaccination, knowledge, and health beliefs among university students in Korea and identify factors influencing their hepatitis A vaccination rate. A self-reporting survey was conducted with 367 university students in Korea via descriptive survey. Data were collected on demographics, status of hepatitis A vaccination, knowledge, and health beliefs. The hepatitis A vaccination rate was 23.4%. The hepatitis A vaccination rate was significantly higher in those who had a general awareness about the hepatitis A (odds ratio [OR] = 3.56, P = 0.003), those with some overseas travel experience (OR = 2.64, P = 0.025), those perceiving the benefits of hepatitis A vaccination (OR = 1.66, P = 0.023), and those perceiving barriers (inversed) to hepatitis A vaccination (OR = 1.95, P = 0.011). To promote hepatitis A vaccination among university students, information and education should be provided to improve their health beliefs. In addition, this demographic should be a major target population for hepatitis A vaccination. This study's results suggest that the development of national promotional campaigns and hepatitis A vaccination programs based on predictors of the vaccination rate are needed. © 2015 Japan Academy of Nursing Science.

  3. Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists.

    Science.gov (United States)

    van Katwyk, Sasha; Jin, Ya-Ping; Trope, Graham E; Buys, Yvonne; Masucci, Lisa; Wedge, Richard; Flanagan, John; Brent, Michael H; El-Defrawy, Sherif; Tu, Hong Anh; Thavorn, Kednapa

    2017-09-01

    Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. International portability of health-cost coverage : concepts and experience

    OpenAIRE

    Werding, Martin; McLennan, Stuart

    2011-01-01

    Social insurance and other arrangements for funding health-care benefits often establish long-term relationships, effectively providing insurance against lasting changes in an individual's health status, engaging in burden-smoothing over the life cycle, and entailing additional elements of redistribution. International portability regarding this type of cover is, therefore, difficult to es...

  5. Improving health insurance coverage in Ghana : a case study

    NARCIS (Netherlands)

    Kotoh, A.M.

    2013-01-01

    Ghana is one of the first sub-Saharan African countries to introduce national health insurance to ensure more equity in access to health care. The response of the population has been disappointing, however. This study describes and examines an experiment with so called 'problem-solving groups' that

  6. Increasing health insurance coverage through an extended Federal Employees Health Benefits Program.

    Science.gov (United States)

    Fuchs, B C

    2001-01-01

    The Federal Employees Health Benefits Program (FEHBP) could be combined with health insurance tax credits to extend coverage to the uninsured. An extended FEHBP, or "E-FEHBP," would be open to all individuals who were not covered through work or public programs and who also were eligible for the tax credits on the basis of income. E-FEHBP also would be open to employees of very small firms, regardless of their eligibility for tax credits. Most plans available to FEHBP participants would be required to offer enrollment to E-FEHBP participants, although premiums would be rated separately. High-risk individuals would be diverted to a separate high-risk pool, the cost of which would be subsidized by the federal government. E-FEHBP would be administered by the states, or if a state declined, by an entity that contracted with the Office of Personnel Management. While E-FEHBP would provide group insurance to people who otherwise could not get it, premiums could exceed the tax-credit amount and some people still might find the coverage unaffordable.

  7. Health insurance coverage and impact: a survey in three cities in China.

    Science.gov (United States)

    Fang, Kuangnan; Shia, BenChang; Ma, Shuangge

    2012-01-01

    China has one of the world's largest health insurance systems, composed of government-run basic health insurance and commercial health insurance. The basic health insurance has undergone system-wide reform in recent years. Meanwhile, there is also significant development in the commercial health insurance sector. A phone call survey was conducted in three major cities in China in July and August, 2011. The goal was to provide an updated description of the effect of health insurance on the population covered. Of special interest were insurance coverage, gross and out-of-pocket medical cost and coping strategies. Records on 5,097 households were collected. Analysis showed that smaller households, higher income, lower expense, presence of at least one inpatient treatment and living in rural areas were significantly associated with a lower overall coverage rate. In the separate analysis of basic and commercial health insurance, similar factors were found to have significant associations. Higher income, presence of chronic disease, presence of inpatient treatment, higher coverage rates and living in urban areas were significantly associated with higher gross medical cost. A similar set of factors were significantly associated with higher out-of-pocket cost. Households with lower income, inpatient treatment, higher commercial insurance coverage, and living in rural areas were significantly more likely to pursue coping strategies other than salary. The surveyed cities and surrounding rural areas had socioeconomic status far above China's average. However, there was still a need to further improve coverage. Even for households with coverage, there was considerable out-of-pocket medical cost, particularly for households with inpatient treatments and/or chronic diseases. A small percentage of households were unable to self-finance out-of-pocket medical cost. Such observations suggest possible targets for further improving the health insurance system.

  8. "Aging Out" of Dependent Coverage and the Effects on US Labor Market and Health Insurance Choices.

    Science.gov (United States)

    Dahlen, Heather M

    2015-11-01

    I examined how labor market and health insurance outcomes were affected by the loss of dependent coverage eligibility under the Patient Protection and Affordable Care Act (ACA). I used National Health Interview Survey (NHIS) data and regression discontinuity models to measure the percentage-point change in labor market and health insurance outcomes at age 26 years. My sample was restricted to unmarried individuals aged 24 to 28 years and to a period of time before the ACA's individual mandate (2011-2013). I ran models separately for men and women to determine if there were differences based on gender. Aging out of this provision increased employment among men, employer-sponsored health insurance offers for women, and reports that health insurance coverage was worse than it was 1 year previously (overall and for young women). Uninsured rates did not increase at age 26 years, but there was an increase in the purchase of non-group health coverage, indicating interest in remaining insured after age 26 years. Many young adults will turn to state and federal health insurance marketplaces for information about health coverage. Because young adults (aged 18-29 years) regularly use social media sites, these sites could be used to advertise insurance to individuals reaching their 26th birthdays.

  9. Health Insurance without Single Crossing : Why Healthy People have High Coverage

    NARCIS (Netherlands)

    Boone, J.; Schottmuller, C.

    2011-01-01

    Standard insurance models predict that people with high (health) risks have high insurance coverage. It is empirically documented that people with high income have lower health risks and are better insured. We show that income differences between risk types lead to a violation of single crossing in

  10. Expanding Health Coverage for Vulnerable Groups in India

    OpenAIRE

    Nagpal, Somil

    2013-01-01

    India's health sector continues to be challenged by overall low levels of public financing, entrenched accountability issues in the public delivery system, and the persistent dominance of out-of-pocket spending. In this context, this case study describes three recent initiatives introduced by the central and state governments in India, aimed at addressing some of these challenges and improving the availability of and access to health services, particularly for the poor and vulnerable groups i...

  11. Universal Hepatitis B Vaccination Coverage in Children and Adolescents with Intellectual Disabilities

    Science.gov (United States)

    Lin, Jin-Ding; Lin, Pei-Ying; Lin, Lan-Ping

    2010-01-01

    There is little information of hepatitis B vaccination coverage for people with intellectual disabilities (ID). The present paper aims to examine the completed hepatitis B vaccination coverage rate and its determinants of children and adolescents with ID in Taiwan. A cross-sectional questionnaire survey, with the entire response participants was…

  12. The Children's Health Insurance Program Reauthorization Act Evaluation Findings on Children's Health Insurance Coverage in an Evolving Health Care Landscape.

    Science.gov (United States)

    Harrington, Mary E

    2015-01-01

    The Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIP's future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA. Since CHIP started in 1997, millions of lower-income children have secured health insurance coverage and needed care, reducing the financial burdens and stress on their families. States made substantial progress in simplifying enrollment and retention. When implemented optimally, Express Lane Eligibility has the potential to help cover more of the millions of eligible children who remain uninsured. Children move frequently between Medicaid and CHIP, and many experienced a gap in coverage with this transition. CHIP enrollees had good access to care. For nearly every health care access, use, care, and cost measure examined, CHIP enrollees fared better than uninsured children. Access in CHIP was similar to private coverage for most measures, but financial burdens were substantially lower and access to weekend and nighttime care was not as good. The Affordable Care Act coverage options have the potential to reduce uninsured rates among children, but complex transition issues must first be resolved to ensure families have access to affordable coverage, leading many stakeholders to recommend funding for CHIP be continued. Copyright © 2015 Academic Pediatric Association. All rights reserved.

  13. The role of insurance in the achievement of universal coverage within a developing country context: South Africa as a case study.

    Science.gov (United States)

    van den Heever, Alex M

    2012-01-01

    Achieving universal coverage as an objective needs to confront the reality of multiple mechanisms, with healthcare financing and provision occurring in both public and private settings. South Africa has both large and mature public and private health systems offering useful insights into how they can be effectively harmonized to optimise coverage. Private healthcare in South Africa has also gone through many phases and regulatory regimes which, through careful review, can help identify potential policy frameworks that can optimise their ability to deepen coverage in a manner that complements the basic coverage of public arrangements. Using South Africa as a case study, this review examines whether private health systems are susceptible to regulation and therefore able to support an extension and deepening of coverage when complementing a pre-existing publicly funded and delivered health system? The approach involves a review of different stages in the development of the South African private health system and its response to policy changes. The focus is on the time-bound characteristics of the health system and associated policy responses and opportunities. A distinction is consequently made between the early, largely unregulated, phases of development and more mature phases with alternative regulatory regimes. The private health system in South Africa has played an important supplementary role in achieving universal coverage throughout its history, but more especially in the post-Apartheid period. However, the quality of this role has been erratic, influenced predominantly by policy vacillation.The private system expanded rapidly during the 1980s mainly due to the pre-existence of a mature health insurance system and a weakening public hospital system which could accommodate and facilitate an increased demand for private hospital services. This growth served to expand commercial interest in health insurance, in the form of regulated medical schemes, which until

  14. The commercial health insurance industry in an era of eroding employer coverage.

    Science.gov (United States)

    Robinson, James C

    2006-01-01

    This paper analyzes the commercial health insurance industry in an era of weakening employer commitment to providing coverage and strengthening interest by public programs to offer coverage through private plans. It documents the willingness of the industry to accept erosion of employment-based enrollment rather than to sacrifice earnings, the movement of Medicaid beneficiaries into managed care, and the distribution of market shares in the employment-based, Medicaid, and Medicare markets. The profitability of the commercial health insurance industry, exceptionally strong over the past five years, will henceforth be linked to the budgetary cycles and political fluctuations of state and federal governments.

  15. Health physics coverage during the 1993 Maralinga geophysical investigations

    International Nuclear Information System (INIS)

    Holland, B.

    1994-01-01

    Between September and November 1993 geophysical examinations of various types were carried out at Maralinga. These examinations were intended to provide information for the planning of strategies for the planning of strategies for the clean up of most contaminated areas at Maralinga. Approximately 40 people were involved in the project at different times, with the majority working inside controlled areas where Plutonium-239, Americium-241 or Uranium-238 contamination was present. Health physics procedures and monitoring programs were put in place to minimise the radiation exposure to the work force. These procedures and programs were similar to those which might be found in a number of different stations. However, the location and nature of the work did lead to the need for some slightly different solutions to routine Health Physics problems. This paper, and poster presentation, describes the procedures and programs used at Maralinga and indicates their effectiveness. 1 ref

  16. Health physics coverage during the 1993 Maralinga geophysical investigations

    International Nuclear Information System (INIS)

    Holland, B.

    1994-01-01

    Between September and November 1993 geophysical examinations of various types were carried out at Maralinga. These examinations were intended to provide information for the planning of strategies for the clean up of most contaminated areas at Maralinga. Approximately 40 people were involved in the project at different times, with the majority working inside controlled areas where Plutonium-239, Americium-241 or Uranium-238 contamination was present. Health physics procedures and monitoring programs were put in place to minimise the radiation exposure to the work force. These procedures and programs were similar to those which might be found in a number of different stations. However, the location and nature of the work did lead to the need for some slightly different solutions to routine Health Physics problems. This paper, and the poster presentation, describes the procedures and programs used at maralinga and indicates their effectiveness

  17. [Potential coverage and real coverage of ambulatory health care services in the state of Mexico. The case of 3 marginal communities in Atenco and Chalco].

    Science.gov (United States)

    Nájera-Aguilar, P; Infante-Castañeda, C

    1990-01-01

    Less than a third of the non-insured population studied through a sample in the State of Mexico was covered by the Institute of Health of the State of México. This low coverage was observed in spite the fact that health services were available within 2 kilometer radius. 33 per cent of the non-insured preferred to utilize other services within their own community, and 24 per cent of them traveled to bigger localities to receive care. These results suggest that to attain adequate coverage, utilization patterns should be investigated so that health services can meet the needs of the target population.

  18. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia.

    Science.gov (United States)

    Vilcu, Ileana; Probst, Lilli; Dorjsuren, Bayarsaikhan; Mathauer, Inke

    2016-10-04

    Many low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage (UHC), especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund. This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries. The purpose is to assess the institutional design features of government subsidized health insurance type arrangements for vulnerable and informally employed population groups and to explore how these features contribute to UHC progress. This regional study is based on a literature search to collect country information on the specific institutional design features of such subsidization arrangements and data related to UHC progress indicators, i.e. population coverage, financial protection and access to care. The institutional design analysis focuses on eligibility rules, targeting and enrolment procedures; financing arrangements; the pooling architecture; and benefit entitlements. Such financing arrangements currently exist in 8 countries with a total of 14 subsidization schemes. The most frequent groups covered are the poor, older persons and children. Membership in these arrangements is mostly mandatory as is full subsidization. An integrated pool for both the subsidized and the contributors exists in half of the countries, which is one of the most decisive features for equitable access and financial protection. Nonetheless, in most schemes, utilization rates of the subsidized are higher compared to the uninsured, but still lower compared to insured formal sector employees. Total population coverage rates, as well as a higher share of the subsidized in the total insured population are related with broader eligibility criteria. Overall, government subsidized health

  19. A cross sectional study at subcentre level reflecting need for improving coverage of maternal health services

    Directory of Open Access Journals (Sweden)

    Geetu Singh

    2015-03-01

    Full Text Available Background: A Health Sub-centre is the most peripheral and first point of contact between the primary health care system and the community. It is imperative to get insight into their functioning which were established with the objectives of minimizing the hardships of the rural people. Objective: To study the coverages of maternal services at subcentres in district Jhansi. Material & Methods: A cross-sectional study was conducted with sample of 20 subcentres in the district Jhansi from June 2012 to July 2013. Various records of the Health workers were examined for maternal health services coverages and noted down on a pre-designed questionnaire. Results: Present study showed that currently married pregnant women aged 15-49 years registered for ANC were 72.1%. Women who received antenatal check-up in first trimester in subcentres were around 50%. Women who received 3 or more antenatal visits were only 29% in study. Meager 3.6% women received IFA for 100 days or more. Similarly women with full antenatal check-up were only 3%. In current study it was found that family planning coverages for female Sterilization was 60% but male Sterilization was just 0.5%. Conclusion: Higher emphasis needs to be given for better coverage of all maternal services. There should be provision for improvement of competence, confidence and motivation of health workers to ensure full range of maternal care activities specified under NRHM program.

  20. Can investments in health systems strategies lead to changes in immunization coverage?

    Science.gov (United States)

    Brenzel, Logan

    2014-04-01

    National immunization programs in developing countries have made major strides to immunize the world's children, increasing full coverage to 83% of children. However, the World Health Organization estimates that 22 million children less than five years of age are left unvaccinated, and coverage levels have been plateauing for nearly a decade. This paper describes the evidence on factors contributing to low vaccination uptake, and describes the connection between these factors and the documented strategies and interventions that can lead to changes in immunization outcomes. The author suggests that investments in these areas may contribute more effectively to immunization coverage and also have positive spill-over benefits for health systems. The paper concludes that while some good quality evidence exists of what works and may contribute to immunization outcomes, the quality of evidence needs to improve and major gaps need to be addressed.

  1. Breast Health Services: Accuracy of Benefit Coverage Information in the Individual Insurance Marketplace.

    Science.gov (United States)

    Hamid, Mariam S; Kolenic, Giselle E; Dozier, Jessica; Dalton, Vanessa K; Carlos, Ruth C

    2017-04-01

    The aim of this study was to determine if breast health coverage information provided by customer service representatives employed by insurers offering plans in the 2015 federal and state health insurance marketplaces is consistent with Patient Protection and Affordable Care Act (ACA) and state-specific legislation. One hundred fifty-eight unique customer service numbers were identified for insurers offering plans through the federal marketplace, augmented with four additional numbers representing the Connecticut state-run exchange. Using a standardized patient biography and the mystery-shopper technique, a single investigator posed as a purchaser and contacted each number, requesting information on breast health services coverage. Consistency of information provided by the representative with the ACA mandates (BRCA testing in high-risk women) or state-specific legislation (screening ultrasound in women with dense breasts) was determined. Insurer representatives gave BRCA test coverage information that was not consistent with the ACA mandate in 60.8% of cases, and 22.8% could not provide any information regarding coverage. Nearly half (48.1%) of insurer representatives gave coverage information about ultrasound screening for dense breasts that was not consistent with state-specific legislation, and 18.5% could not provide any information. Insurance customer service representatives in the federal and state marketplaces frequently provide inaccurate coverage information about breast health services that should be covered under the ACA and state-specific legislation. Misinformation can inadvertently lead to the purchase of a plan that does not meet the needs of the insured. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  2. Do more health insurance options lead to higher wages? Evidence from states extending dependent coverage.

    Science.gov (United States)

    Dillender, Marcus

    2014-07-01

    Little is known about how health insurance affects labor market decisions for young adults. This is despite the fact that expanding coverage for people in their early 20s is an important component of the Affordable Care Act. This paper studies how having an outside source of health insurance affects wages by using variation in health insurance access that comes from states extending dependent coverage to young adults. Using American Community Survey and Census data, I find evidence that extending health insurance to young adults raises their wages. The increases in wages can be explained by increases in human capital and the increased flexibility in the labor market that comes from people no longer having to rely on their own employers for health insurance. The estimates from this paper suggest the Affordable Care Act will lead to wage increases for young adults. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Universal health insurance through incentives reform.

    Science.gov (United States)

    Enthoven, A C; Kronick, R

    1991-05-15

    Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

  4. Competing health policies: insurance against universal public systems

    Directory of Open Access Journals (Sweden)

    Asa Ebba Cristina Laurell

    2016-01-01

    Full Text Available Objectives: This article analyzes the content and outcome of ongoing health reforms in Latin America: Universal Health Coverage with Health Insurance, and the Universal and Public Health Systems. It aims to compare and contrast the conceptual framework and practice of each and verify their concrete results regarding the guarantee of the right to health and access to required services. It identifies a direct relationship between the development model and the type of reform. The neoclassical-neoliberal model has succeeded in converting health into a field of privatized profits, but has failed to guarantee the right to health and access to services, which has discredited the governments. The reform of the progressive governments has succeeded in expanding access to services and ensuring the right to health, but faces difficulties and tensions related to the permanence of a powerful, private, industrial-insurance medical complex and persistence of the ideologies about medicalized 'good medicine'. Based on these findings, some strategies to strengthen unique and supportive public health systems are proposed.

  5. Barriers and facilitators to influenza vaccination and vaccine coverage in a cohort of health care personnel.

    Science.gov (United States)

    Naleway, Allison L; Henkle, Emily M; Ball, Sarah; Bozeman, Sam; Gaglani, Manjusha J; Kennedy, Erin D; Thompson, Mark G

    2014-04-01

    Annual influenza vaccination is recommended for health care personnel (HCP). We describe influenza vaccination coverage among HCP during the 2010-2011 season and present reported facilitators of and barriers to vaccination. We enrolled HCP 18 to 65 years of age, working full time, with direct patient contact. Participants completed an Internet-based survey at enrollment and the end of influenza season. In addition to self-reported data, we collected information about the 2010-2011 influenza vaccine from electronic employee health and medical records. Vaccination coverage was 77% (1,307/1,701). Factors associated with higher vaccination coverage include older age, being married or partnered, working as a physician or dentist, prior history of influenza vaccination, more years in patient care, and higher job satisfaction. Personal protection was reported as the most important reason for vaccination followed closely by convenience, protection of patients, and protection of family and friends. Concerns about perceived vaccine safety and effectiveness and low perceived susceptibility to influenza were the most commonly reported barriers to vaccination. About half of the unvaccinated HCP said they would have been vaccinated if required by their employer. Influenza vaccination in this cohort was relatively high but still fell short of the recommended target of 90% coverage for HCP. Addressing concerns about vaccine safety and effectiveness are possible areas for future education or intervention to improve coverage among HCP. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  6. Measuring coverage in MNCH: a validation study linking population survey derived coverage to maternal, newborn, and child health care records in rural China.

    Directory of Open Access Journals (Sweden)

    Li Liu

    Full Text Available Accurate data on coverage of key maternal, newborn, and child health (MNCH interventions are crucial for monitoring progress toward the Millennium Development Goals 4 and 5. Coverage estimates are primarily obtained from routine population surveys through self-reporting, the validity of which is not well understood. We aimed to examine the validity of the coverage of selected MNCH interventions in Gongcheng County, China.We conducted a validation study by comparing women's self-reported coverage of MNCH interventions relating to antenatal and postnatal care, mode of delivery, and child vaccinations in a community survey with their paper- and electronic-based health care records, treating the health care records as the reference standard. Of 936 women recruited, 914 (97.6% completed the survey. Results show that self-reported coverage of these interventions had moderate to high sensitivity (0.57 [95% confidence interval (CI: 0.50-0.63] to 0.99 [95% CI: 0.98-1.00] and low to high specificity (0 to 0.83 [95% CI: 0.80-0.86]. Despite varying overall validity, with the area under the receiver operating characteristic curve (AUC ranging between 0.49 [95% CI: 0.39-0.57] and 0.90 [95% CI: 0.88-0.92], bias in the coverage estimates at the population level was small to moderate, with the test to actual positive (TAP ratio ranging between 0.8 and 1.5 for 24 of the 28 indicators examined. Our ability to accurately estimate validity was affected by several caveats associated with the reference standard. Caution should be exercised when generalizing the results to other settings.The overall validity of self-reported coverage was moderate across selected MNCH indicators. However, at the population level, self-reported coverage appears to have small to moderate degree of bias. Accuracy of the coverage was particularly high for indicators with high recorded coverage or low recorded coverage but high specificity. The study provides insights into the accuracy of

  7. Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities.

    Science.gov (United States)

    Cronk, Ryan; Bartram, Jamie

    2018-04-01

    Safe environmental conditions and the availability of standard precaution items are important to prevent and treat infection in health care facilities (HCFs) and to achieve Sustainable Development Goal (SDG) targets for health and water, sanitation, and hygiene. Baseline coverage estimates for HCFs have yet to be formed for the SDGs; and there is little evidence describing inequalities in coverage. To address this, we produced the first coverage estimates of environmental conditions and standard precaution items in HCFs in low- and middle-income countries (LMICs); and explored factors associated with low coverage. Data from monitoring reports and peer-reviewed literature were systematically compiled; and information on conditions, service levels, and inequalities tabulated. We used logistic regression to identify factors associated with low coverage. Data for 21 indicators of environmental conditions and standard precaution items were compiled from 78 LMICs which were representative of 129,557 HCFs. 50% of HCFs lack piped water, 33% lack improved sanitation, 39% lack handwashing soap, 39% lack adequate infectious waste disposal, 73% lack sterilization equipment, and 59% lack reliable energy services. Using nationally representative data from six countries, 2% of HCFs provide all four of water, sanitation, hygiene, and waste management services. Statistically significant inequalities in coverage exist between HCFs by: urban-rural setting, managing authority, facility type, and sub-national administrative unit. We identified important, previously undocumented inequalities and environmental health challenges faced by HCFs in LMICs. The information and analyses provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources. Copyright © 2018 The Authors. Published by Elsevier GmbH.. All rights reserved.

  8. Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003

    Directory of Open Access Journals (Sweden)

    Collins Charles D

    2007-03-01

    Full Text Available Abstract Background In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS and Labour Insurance Scheme (LIS to the new Urban Employee Basic Health Insurance Scheme (BHIS. Methods This paper uses data from the National Health Services Surveys of 1998 and 2003 to examine the impact of the reform on population coverage. Particular attention is paid to coverage in terms of gender, age, employment status, and income levels. Following a description of the data between the two years, the paper will discuss the relationship between the insurance reform and the growing inequities in population coverage. Results An examination of the data reveals a number of key points: a The overall coverage of the newly established scheme has decreased from 1998 to 2003. b The proportion of the urban population without any type of health insurance arrangement remained almost the same between 1998 and 2003 in spite of the aim of the 1997 reform to increase the population coverage. c Higher levels of participation in mainstream insurance schemes (i.e. GIS-LIS and BHIS were identified among older age groups, males and high income groups. In some cases, the inequities in the system are increasing. d There has been an increase in coverage of the urban population by non-mainstream health insurance schemes, including non-commercial and commercial ones. The paper discusses three important issues in relation to urban insurance coverage: institutional diversity in the forms of insurance, labour force policy and the non-mainstream forms of commercial and non-commercial forms of insurance. Conclusion The paper concludes that the huge economic development and expansion has not resulted in a reduced disparity in

  9. A Study Of Universal Immunization Coverage During Last Five Years In Resettlement Colonies Of Delhi

    Directory of Open Access Journals (Sweden)

    Salhotra V S

    1999-01-01

    Full Text Available Research Question: Is there any difference in immunization coverage in resettlement colonies of Delhi during past five years? Objectives: 1. To study the immunization coverage levels of children over a period of five years. 2. To observe changes in the coverage levels of different years, if any. Study design: Cross-sectional study. Setting: Khichripur, Kalyanpuri, Kalyanpuri, Trilokpuri and Himmatpuri- four resettlement colonies of trans-Yamuna area of Delhi. Participants: 1500 children belonging to five age-groups i.e. birth-1 yr., 1-2 yrs., 2-3 yrs, and 4-5 yrs. Methods: Verification of child’s immunization from immunization card and interview of mother if immunization car was not available. Study period: May1997 to March1998 Results: Immunization with individual vaccines and immunization status of the children peaked in 1995-96 but started falling thereafter due to fall in ICE activities.

  10. Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems

    OpenAIRE

    Rosen, David L.; Grodensky, Catherine A.; Holley, Tara K.

    2016-01-01

    Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative samp...

  11. 'Where Are All the Men?' A Post-Structural Feminist Analysis of a University's Sexual Health Seminar

    Science.gov (United States)

    Quinlan, Margaret M.; Bute, Jennifer J.

    2013-01-01

    Set against the background of efforts to promote sexuality education and sexual health in a university setting, this paper focuses on a sexual health seminar offered at a midwestern US university. Using a post-structural feminist framework, we analysed discourses from qualitative surveys, newspaper coverage and participant observation. We argue…

  12. The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans.

    Science.gov (United States)

    Li, Xiaoxue; Ye, Jinqi

    2017-09-01

    This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Financial incentives and coverage of child health interventions: a systematic review and meta-analysis.

    Science.gov (United States)

    Bassani, Diego G; Arora, Paul; Wazny, Kerri; Gaffey, Michelle F; Lenters, Lindsey; Bhutta, Zulfiqar A

    2013-01-01

    Financial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years. We conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available. Our searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health

  14. Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam

    Directory of Open Access Journals (Sweden)

    Hoang Van Minh

    2016-02-01

    Full Text Available Introduction: Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH, termed ‘barriers’. Methods: Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15–49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383 was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1 antenatal care, 2 skilled birth attendants, and 3 child death in the previous 15 years. Independent predictor variables were: 1 low education (incomplete secondary education, 2 lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs and 95% confidence intervals (95% CI were used to report regression results. Results: In Vietnam, about 54% of women aged 15–49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14

  15. The cigarette advertising broadcast ban and magazine coverage of smoking and health.

    Science.gov (United States)

    Warner, K E; Goldenhar, L M

    1989-01-01

    At the time of the cigarette broadcast advertising ban, which took effect in 1971, cigarette manufacturers rapidly shifted advertising expenditures from the broadcast media to the print media. In the last year of broadcast advertising and the first year of the ban, cigarette ad expenditures in a sample of major national magazines increased by 49 and then 131 percent in constant dollars. From an 11-year period preceding the ban to an 11-year period following it, these magazines decreased their coverage of smoking and health by 65 percent, an amount that is statistically significantly greater than decreases found in magazines that did not carry cigarette ads and in two major newspapers. This finding adds to evidence that media dependent on cigarette advertising have restricted their coverage of smoking and health. This may have significant implications for public health, as well as raising obvious concerns about the integrity of the profession of journalism.

  16. Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009

    OpenAIRE

    Liu, Jinan; Shi, Lizheng; Meng, Qingyue; Khan, M Mahmud

    2012-01-01

    Abstract Introduction China introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China. Methods The China Health and Nutrition Survey (CHNS) data ...

  17. The use of mediation analysis to assess the effects of a behaviour change communication strategy on bed net ideation and household universal coverage in Tanzania.

    Science.gov (United States)

    Ricotta, Emily E; Boulay, Marc; Ainslie, Robert; Babalola, Stella; Fotheringham, Megan; Koenker, Hannah; Lynch, Matthew

    2015-01-21

    SBCC campaigns are designed to act on cognitive, social and emotional factors at the individual or community level. The combination of these factors, referred to as 'ideation', play a role in determining behaviour by reinforcing and confirming decisions about a particular health topic. This study introduces ideation theory and mediation analysis as a way to evaluate the impact of a malaria SBCC campaign in Tanzania, to determine whether exposure to a communication programme influenced universal coverage through mediating ideational variables. A household survey in three districts where community change agents (CCAs) were active was conducted to collect information on ITN use, number of ITNs in the household, and perceptions about ITN use and ownership. Variables relating to attitudes and beliefs were combined to make 'net ideation'. Using an ideational framework, a mediation analysis was conducted to see the impact exposure to a CCA only, mass media and community (M & C) messaging only, or exposure to both, had on household universal coverage, through the mediating variable net ideation. All three levels of exposure (CCA, M & C messaging, or exposure to both) were significantly associated with increased net ideation (CCA: 0.283, 95% CI: 0.136-0.429, p-value: mediation analysis is an applicable new tool to assess SBCC campaigns. Ideation as a mediator of the effects of communication exposure on household universal coverage has implications for designing SBCC to support both mass and continuous distribution efforts, since both heavily rely on consumer participation to obtain and maintain ITNs. Such systems can be strengthened by SBCC programming, generating demand through improving social norms about net ownership and use, perceived benefits of nets, and other behavioural constructs.

  18. Medicare Coverage Database

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD...

  19. Reducing Young Adults' Health Care Spending through the ACA Expansion of Dependent Coverage.

    Science.gov (United States)

    Chen, Jie; Vargas-Bustamante, Arturo; Novak, Priscilla

    2017-10-01

    To estimate health care expenditure trends among young adults ages 19-25 before and after the 2010 implementation of the Affordable Care Act (ACA) provision that extended eligibility for dependent private health insurance coverage. Nationally representative Medical Expenditure Panel Survey data from 2008 to 2012. We conducted repeated cross-sectional analyses and employed a difference-in-differences quantile regression model to estimate health care expenditure trends among young adults ages 19-25 (the treatment group) and ages 27-29 (the control group). Our results show that the treatment group had 14 percent lower overall health care expenditures and 21 percent lower out-of-pocket payments compared with the control group in 2011-2012. The overall reduction in health care expenditures among young adults ages 19-25 in years 2011-2012 was more significant at the higher end of the health care expenditure distribution. Young adults ages 19-25 had significantly higher emergency department costs at the 10th percentile in 2011-2012. Differences in the trends of costs of private health insurance and doctor visits are not statistically significant. Increased health insurance enrollment as a consequence of the ACA provision for dependent coverage has successfully reduced spending and catastrophic expenditures, providing financial protections for young adults. © Health Research and Educational Trust.

  20. Healthy Universities: Mapping Health-Promotion Interventions

    Science.gov (United States)

    Sarmiento, Juan Pablo

    2017-01-01

    Purpose: The purpose of this paper is to map out and characterize existing health-promotion initiatives at Florida International University (FIU) in the USA in order to inform decision makers involved in the development of a comprehensive and a long-term healthy university strategy. Design/methodology/approach: This study encompasses a narrative…

  1. News media coverage of trans fat: health risks and policy responses.

    Science.gov (United States)

    Jarlenski, Marian; Barry, Colleen L

    2013-01-01

    Prior research indicates that the news media play a critical role in transmitting information to the public about the most pressing public health problems, and framing attributions about who in society is responsible for solving these problems. In this article, we use content analysis methods to study the agenda-setting and framing functions of the news media in shaping perceptions about the health risks posed by trans fat in the U.S. diet. A census of news stories focusing on trans fat was collected from the two largest circulation U.S. newspapers and three major television networks from 1998 to 2008 (N = 156). The content of news coverage was analyzed using a 23-item instrument. Findings indicated that the news media served an important agenda-setting role in educating the public about the presence of trans fat in the U.S. diet and describing the health risks these foods pose. In addition, results indicate that news media coverage framed attributions of responsibility for solving the problem of trans fat in the food supply. News stories noting the heart disease risks of trans fat were significantly more likely to mention governmental responses aimed at curbing consumption than news coverage that did not note these health risks.

  2. Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform.

    Science.gov (United States)

    Palmisano, Donald J; Emmons, David W; Wozniak, Gregory D

    2004-05-12

    Recent reports showing an increase in the number of uninsured individuals in the United States have given heightened attention to increasing health insurance coverage. The American Medical Association (AMA) has proposed a system of tax credits for the purchase of individually owned health insurance and enhancements to individual and group health insurance markets as a means of expanding coverage. Individually owned insurance would enable people to maintain coverage without disruption to existing patient-physician relationships, regardless of changes in employers or in work status. The AMA's plan would empower individuals to choose their health plan and give patients and their physicians more control over health care choices. Employers could continue to offer employment-based coverage, but employees would not be limited to the health plans offered by their employer. With a tax credit large enough to make coverage affordable and the ability to choose their own coverage, consumers would dramatically transform the individual and group health insurance markets. Health insurers would respond to the demands of individual consumers and be more cautious about increasing premiums. Insurers would also tailor benefit packages and develop new forms of coverage to better match the preferences of individuals and families. The AMA supports the development of new health insurance markets through legislative and regulatory changes to foster a wider array of high-quality, affordable plans.

  3. Change in challenging times: a plan for extending and improving health coverage.

    Science.gov (United States)

    Lambrew, Jeanne M; Podesta, John D; Shaw, Teresa L

    2005-01-01

    Some speculate that Americans are neither politically capable of nor morally committed to solving the health system problems. We disagree. We propose a plan that insures all and improves the value and cost-effectiveness of health care by knitting together employer-sponsored insurance and Medicaid; promoting prevention, research, and information technology; and financing its investments through a dedicated value-added tax. By prioritizing practicality, fairness, and responsibility, the plan aims to avoid ideological battles and prevent fear of major change. By emphasizing the moral imperative for change, especially relative to other options on the policy agenda, it aims to create momentum for expanding and improving health coverage for all.

  4. National health expenditure projections: modest annual growth until coverage expands and economic growth accelerates.

    Science.gov (United States)

    Keehan, Sean P; Cuckler, Gigi A; Sisko, Andrea M; Madison, Andrew J; Smith, Sheila D; Lizonitz, Joseph M; Poisal, John A; Wolfe, Christian J

    2012-07-01

    For 2011-13, US health spending is projected to grow at 4.0 percent, on average--slightly above the historically low growth rate of 3.8 percent in 2009. Preliminary data suggest that growth in consumers' use of health services remained slow in 2011, and this pattern is expected to continue this year and next. In 2014, health spending growth is expected to accelerate to 7.4 percent as the major coverage expansions from the Affordable Care Act begin. For 2011 through 2021, national health spending is projected to grow at an average rate of 5.7 percent annually, which would be 0.9 percentage point faster than the expected annual increase in the gross domestic product during this period. By 2021, federal, state, and local government health care spending is projected to be nearly 50 percent of national health expenditures, up from 46 percent in 2011, with federal spending accounting for about two-thirds of the total government share. Rising government spending on health care is expected to be driven by faster growth in Medicare enrollment, expanded Medicaid coverage, and the introduction of premium and cost-sharing subsidies for health insurance exchange plans.

  5. Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage

    DEFF Research Database (Denmark)

    Eaton, Jeffrey W; Menzies, Nicolas A; Stover, John

    2014-01-01

    therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage. METHODS: We used several independent mathematical models in four settings-South Africa (generalised...... epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)-to assess the potential health benefits......, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μ...

  6. Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts.

    Science.gov (United States)

    Sabik, Lindsay M; Lie, Reidar K

    2008-01-01

    It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is "accountability for reasonableness." We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients' rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks.

  7. Toward better access to health insurance coverage for U.S. retirees in Mexico.

    Science.gov (United States)

    Warner, D C; Jahnke, L R

    2001-01-01

    Many retirees from the United States of America have limited health insurance coverage while living in Mexico. Medicare and Medicaid benefits are not portable to other countries and Medigap (private insurance that supplements Medicare) is very limited. This causes economic and medical hardships and serves as a barrier to retirement to Mexico. Increasing numbers of U.S. retirees will be interested in moving to Mexico in the future because of the climate, the culture, and the lower cost of living. The numbers are increasing as a result of several factors such as aging "baby boomers" and the rapidly growing Mexican-origin population in the U.S.A. who are citizens or permanent residents but would like to return to their communities of origin after working in the U.S.A. There are several policy initiatives that could provide opportunities for improving health insurance coverage for these retirees that could be cost-effective.

  8. Limited take-up of health coverage tax credits: a challenge to future tax credit design.

    Science.gov (United States)

    Dorn, Stan; Varon, Janet; Pervez, Fouad

    2005-10-01

    The Trade Act of 2002 created federal tax credits to subsidize health coverage for certain early retirees and workers displaced by international trade. Though small, this program offers the opportunity to learn how to design future tax credits for larger groups of uninsured. During September 2004, the most recent month for which there are data about all forms of Trade Act credits, roughly 22 percent of eligible individuals received credits. The authors find that health insurance tax credits are more likely to reach their target populations if such credits: 1) limit premium costs for the low-income uninsured and do not require full premium payments while applications are pending; 2) provide access to coverage that beneficiaries value, including care for preexisting conditions; 3) are combined with outreach that uses easily understandable, multilingual materials and proactive enrollment efforts; and 4) feature a simple application process involving one form filed with one agency.

  9. Toward Better Access to Health Insurance Coverage for U.S. Retirees in Mexico

    OpenAIRE

    Warner David C.; Jahnke Lauren R.

    2001-01-01

    Many retirees from the United States of America have limited health insurance coverage while living in Mexico. Medicare and Medicaid benefits are not portable to other countries and Medigap (private insurance that supplements Medicare) is very limited. This causes economic and medical hardships and serves as a barrier to retirement to Mexico. Increasing numbers of U.S. retirees will be interested in moving to Mexico in the future because of the climate, the culture, and the lower cost of livi...

  10. Solidarity and cost management: Swiss citizens' reasons for priorities regarding health insurance coverage.

    Science.gov (United States)

    Schindler, Mélinée; Danis, Marion; Goold, Susan D; Hurst, Samia A

    2018-04-14

    Approaches to priority-setting for scarce resources have shifted to public deliberation as trade-offs become more difficult. We report results of a qualitative analysis of public deliberation in Switzerland, a country with high health-care costs, an individual health insurance mandate and a strong tradition of direct democracy with frequent votes related to health care. We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex health-care allocation decisions into easily understandable choices, for use in Switzerland. We conducted focus groups in twelve Swiss cities, recruiting from a range of socio-economic backgrounds in the three language regions. Participants developed strategic arguments based on the importance of basic coverage for all, and of cost-benefit evaluation. They also expressed arguments relying on a principle of solidarity, in particular the importance of protection for vulnerable groups, and on the importance of medical care. They struggled with the place of personal responsibility in coverage decisions. In commenting on the exercise, participants found the degree of consensus despite differing opinions surprising and valuable. The Swiss population is particularly attentive to the costs of health care and means of reducing these costs. Swiss citizens are capable of making trade-offs and setting priorities for complex health issues. © 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.

  11. MENTAL HEALTH AND UNIVERSITY STUDENTS: SURVEY

    OpenAIRE

    Woodgate, Roberta

    2014-01-01

    We want to learn from university students about your experiences and perspectives on mental health and well-being in the context of being a student. Your input can help us develop evidence-based intervention programs that can help address the mental health needs of students. This survey should take 15-20 minutes to complete.

  12. Do Socioeconomic Inequalities in Neonatal Mortality Reflect Inequalities in Coverage of Maternal Health Services? Evidence from 48 Low- and Middle-Income Countries.

    Science.gov (United States)

    McKinnon, Britt; Harper, Sam; Kaufman, Jay S

    2016-02-01

    To examine socioeconomic and health system determinants of wealth-related inequalities in neonatal mortality rates (NMR) across 48 low- and middle-income countries. We used data from Demographic and Health Surveys conducted between 2006 and 2012. Absolute and relative inequalities for NMR and coverage of antenatal care, facility-based delivery, and Caesarean delivery were measured using the Slope Index of Inequality and Relative Index of Inequality, respectively. Meta-regression was used to assess whether variation in the magnitude of NMR inequalities was associated with inequalities in coverage of maternal health services, and whether country-level economic and health system factors were associated with mean NMR and socioeconomic inequality in NMR. Of the three maternal health service indicators examined, the magnitude of socioeconomic inequality in NMR was most strongly related to inequalities in antenatal care. NMR inequality was greatest in countries with higher out-of-pocket health expenditures, more doctors per capita, and a higher adolescent fertility rate. Determinants of lower mean NMR (e.g., higher government health expenditures and a greater number of nurses/midwives per capita) differed from factors associated with lower NMR inequality. Reducing the financial burden of maternal health services and achieving universal coverage of antenatal care may contribute to a reduction in socioeconomic differences in NMR. Further investigation of the mechanisms contributing to these cross-national associations seems warranted.

  13. One-fifth of nonelderly Californians do not have access to job-based health insurance coverage.

    Science.gov (United States)

    Lavarreda, Shana Alex; Cabezas, Livier

    2010-11-01

    Lack of job-based health insurance does not affect just workers, but entire families who depend on job-based coverage for their health care. This policy brief shows that in 2007 one-fifth of all Californians ages 0-64 who lived in households where at least one family member was employed did not have access to job-based coverage. Among adults with no access to job-based coverage through their own or a spouse's job, nearly two-thirds remained uninsured. In contrast, the majority of children with no access to health insurance through a parent obtained public health insurance, highlighting the importance of such programs. Low-income, Latino and small business employees were more likely to have no access to job-based insurance. Provisions enacted under national health care reform (the Patient Protection and Affordable Care Act of 2010) will aid some of these populations in accessing health insurance coverage.

  14. Health insurance coverage, neonatal mortality and caesarean section deliveries: an analysis of vital registration data in Colombia.

    Science.gov (United States)

    Houweling, Tanja A J; Arroyave, Ivan; Burdorf, Alex; Avendano, Mauricio

    2017-05-01

    Low-income and middle-income countries have introduced different health insurance schemes over the past decades, but whether different schemes are associated with different neonatal outcomes is yet unknown. We examined the association between the health insurance coverage scheme and neonatal mortality in Colombia. We used Colombian national vital registration data, including all live births (2 506 920) and neonatal deaths (17 712) between 2008 and 2011. We used Poisson regression models to examine the association between health insurance coverage and the neonatal mortality rate (NMR), distinguishing between women insured via the contributory scheme (40% of births, financed through payroll and employer's contributions), government subsidised insurance (47%) and the uninsured (11%). NMR was lower among babies born to mothers in the contributory scheme (6.13/1000) than in the subsidised scheme (7.69/1000) or the uninsured (8.38/1000). Controlling for socioeconomic and demographic factors, NMRs remained higher for those in the subsidised scheme (OR 1.09, 95% CI 1.05 to 1.14) and the uninsured (OR 1.16, 95% CI 1.10 to 1.23) compared to those in the contributory scheme. These differences increased in models that additionally controlled for caesarean section (C-section) delivery. This increase was due to the higher fraction of C-section deliveries among women in the contributory scheme (49%, compared to 34% for the subsidised scheme and 28% for the uninsured). Health insurance through the contributory system is associated with lower neonatal mortality than insurance through the subsidised system or lack of insurance. Universal health insurance may not be sufficient to close the gap in newborn mortality between socioeconomic groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009

    Directory of Open Access Journals (Sweden)

    Liu Jinan

    2012-08-01

    Full Text Available Abstract Introduction China introduced the urban resident basic medical insurance (URBMI in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS for rural residents in 2003 and the basic health insurance scheme (BHIS for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China. Methods The China Health and Nutrition Survey (CHNS data of 2006 and 2009 were used to create the concentration curve and the concentration index. GEE logistic regression was used to model the health insurance coverage as dependent variable and household income per capita as independent variable, controlling for individuals' age, gender, marital status, educational attainment, employment status, year 2009 (Y2009, household size, retirement status, and geographic variations. The change in the income-related inequality in 2009 was estimated using the interaction term of income*Y2009. Results In 2006, 49.7% (4,712/9,476 respondents had health insurance: 13.4% with BHIS and 28.4% with NCMS. In 2009, 90.8% (8,964/9,863 had health insurance: 10.1% with URBMI, 18.3% with BHIS, and 57.6% with NCMS. The BHIS, URBMI, and NCMS programs had different patterns of population coverage over 10 income deciles. The concentration index was 0.15 in 2006 and 0.04 in 2009. The dominance test showed that the concentration curves were significantly different between 2006 and 2009 (p  Discussions Comparing 2009 to 2006, the income inequality in health insurance coverage was largely corrected in China through rapid expansion of CHNS in rural areas and initiation of URBMI in urban areas.

  16. Health insurance coverage and racial disparities in breast reconstruction after mastectomy.

    Science.gov (United States)

    Shippee, Tetyana P; Kozhimannil, Katy B; Rowan, Kathleen; Virnig, Beth A

    2014-01-01

    Breast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities. We used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics. Minority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity. Insurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings-which reveal persistent health care disparities not explained by patient health status-should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  17. Mental health among students of pedagogical universities

    Directory of Open Access Journals (Sweden)

    Malinauskas R.

    2010-06-01

    Full Text Available This article deals with questions of mental health among students of pedagogical universities. There were analysed differences in the level of mental health among sporting and non-sporting students. Two methods were used in the inquiry. Stepanov's questionnaire was used to estimate the level of mental health, Gundarov's questionnaire was used to evaluate psychical satisfaction. The sample consisted of 263 sporting students (athletes and 288 non-sporting students. Results have shown that the level of mental health among sporting students was higher than the level of mental health among non-sporting students.

  18. Mandatory universal drug plan, access to health care and health: Evidence from Canada.

    Science.gov (United States)

    Wang, Chao; Li, Qing; Sweetman, Arthur; Hurley, Jeremiah

    2015-12-01

    This paper examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public health care system with free physician and hospital services. Using the Canadian National Population Health Survey from 1994 to 2003 and implementing a difference-in-differences estimation strategy, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization. Findings from quantile regressions suggest that there was a large improvement in the health status of less healthy individuals. Further analysis by pre-policy drug insurance status and the presence of chronic conditions reveals a marked increase in the probability of taking medication and visiting a general practitioner among the previously uninsured and those with a chronic condition. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. [HPV prophylactic vaccine coverage in France: Results of a survey among high school and university students in Marseilles' area].

    Science.gov (United States)

    Sabiani, L; Bremond, A; Mortier, I; Lecuyer, M; Boubli, L; Carcopino, X

    2012-04-01

    To assess HPV prophylactic vaccine coverage among French high school and university students as well as their level of education about this vaccine. An anonymous survey was conducted among 2500 high school and university students from the area of Marseilles, France, from December 2009 to April 2010. A total of 2018 questionnaires were collected (80.7% participation rate). Mean age of participants was 20 years (range, 15-45 years). Only 671 (35.4%) participants reported having been vaccinated against HPV, of whom 510 (73.4%) had completed the three injections scheme. Practice of cytological cervical cancer screening was not significantly influenced by vaccination status. Thus, 578 (45.2%) participants who had not been vaccinated already had had a cervical cytology performed, versus 295 (43.3%) vaccinated ones (P=0.445). Among those not being vaccinated, 671 (49.8%) fulfilled criteria for a catch-up vaccination, of whom only 325 (48.4%) agreed for such a catch-up. Main reasons given for refusal for a catch-up vaccination were the lack of information about HPV vaccine and fear of side effects. In total, 1722 (90%) considered themselves as educated about the HPV vaccine. Source of education was attributed to doctors and media by 54.4% and 53.7% of participants, respectively. Educational role attributed to school and university was poor (3.4%). Despite apparent satisfactory level of education, HPV prophylactic vaccine coverage among high school and university students appears to be insufficient. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  20. Sexual behaviours and preconception health in Italian university students

    Directory of Open Access Journals (Sweden)

    Andrea Poscia

    2015-06-01

    Full Text Available INTRODUCTION: Risky sexual behaviours have been recognized as a threat for sexual and reproductive health. AIM: This article shows the results of the "Sportello Salute Giovani" project ("Youth Health Information Desk" in relation to determining how a large sample of university students in Italy cope with preconception health, especially in the domains of sexual transmitted infections (STIs, fertility and vaccination preventable disease. METHODS: Twentythree questions of the "Sportello Salute Giovani" survey about sexual behaviour and reproductive health were analysed. Besides, results were stratified for sex, age class and socio-economic status. RESULTS: 19.7% of students have had first sexual intercourse before age 15. 21.8% of female students used emergency contraception. 66.4% of the 74.0% sexual active students reported using contraceptives, but about 32% of them used methods ineffective against STIs. A general low coverage for rubella, measles and mumps vaccination was revealed. 63.7% of men and 30.9% of woman never had urologic or gynaecological examinations. DISCUSSION: Overall, young adults in Italy are not still enough sensitized on fertility and preconception care. High schools and universities should increase awareness towards preservation of male and female fertility and preconception care.

  1. Uninsured Migrants: Health Insurance Coverage and Access to Care Among Mexican Return Migrants.

    Science.gov (United States)

    Wassink, Joshua

    2018-01-01

    Despite an expansive body of research on health and access to medical care among Mexican immigrants in the United States, research on return migrants focuses primarily on their labor market mobility and contributions to local development. Motivated by recent scholarship that documents poor mental and physical health among Mexican return migrants, this study investigates return migrants' health insurance coverage and access to medical care. I use descriptive and multivariate techniques to analyze data from the 2009 and 2014 rounds of Mexico's National Survey of Demographic Dynamics (ENADID, combined n=632,678). Analyses reveal a large and persistent gap between recent return migrants and non-migrants, despite rising overall health coverage in Mexico. Multivariate analyses suggest that unemployment among recent arrivals contributes to their lack of insurance. Relative to non-migrants, recently returned migrants rely disproportionately on private clinics, pharmacies, self-medication, or have no regular source of care. Mediation analysis suggests that returnees' high rate of uninsurance contributes to their inadequate access to care. This study reveals limited access to medical care among the growing population of Mexican return migrants, highlighting the need for targeted policies to facilitate successful reintegration and ensure access to vital resources such as health care.

  2. Functional coverages

    NARCIS (Netherlands)

    Donchyts, G.; Baart, F.; Jagers, H.R.A.; Van Dam, A.

    2011-01-01

    A new Application Programming Interface (API) is presented which simplifies working with geospatial coverages as well as many other data structures of a multi-dimensional nature. The main idea extends the Common Data Model (CDM) developed at the University Corporation for Atmospheric Research

  3. Regional disparities in child mortality within China 1996-2004: epidemiological profile and health care coverage.

    Science.gov (United States)

    Feng, Xing Lin; Guo, Sufang; Yang, Qing; Xu, Ling; Zhu, Jun; Guo, Yan

    2011-07-01

    China was one of the 68 "countdown" countries prioritized to attain Millennium Development Goals (MDG 4). The aim of this study was to analyze data on child survival and health care coverage of proven cost-effective interventions in China, with a focus on national disparities. National maternal and child mortality surveillance data were used to estimate child mortality. Coverage for proven interventions was analyzed based on data from the National Health Services Survey, National Nutrition and Health Survey, and National Immunization Survey. Consultations and qualitative field observations by experts were used to complement the Survey data. Analysis of the data revealed a significant reduction in the overall under-5 (U5) child mortality rate in China from 1996 to 2007, but also great regional disparities, with the risk of child mortality in rural areas II-IV being two- to sixfold higher than that in urban areas. Rural areas II-IV also accounted for approximately 80% of the mortality burden. More than 60% of child mortality occurred during the neonatal period, with 70% of this occurring during the first week of life. The leading causes of neonatal mortality were asphyxia at birth and premature birth; during the post-neonatal period, these were diarrhea and pneumonia, especially in less developed rural areas. Utilization of health care services in terms of both quantity and quality was positively correlated with the region's development level. A large proportion of children were affected by inadequate feeding, and the lack of safe water and essential sanitary facilities are vital indirect factors contributing to the increase in child mortality. The simulation analysis revealed that increasing access to and the quality of the most effective interventions combined with relatively low costs in the context of a comprehensive approach has the potential to reduce U5 deaths by 34%. China is on track to meet MDG 4; however, great disparities in health care do exist within

  4. Prevalence of HBV and HBV vaccination coverage in health care workers of tertiary hospitals of Peshawar, Pakistan

    Directory of Open Access Journals (Sweden)

    Ali Ijaz

    2011-06-01

    Full Text Available Abstract Background Hepatitis B Virus (HBV may progress to serious consequences and increase dramatically beyond endemic dimensions that transmits to or from health care workers (HCWs during routine investigation in their work places. Basic aim of this study was to canvass the safety of HCWs and determine the prevalence of HBV and its possible association with occupational and non-occupational risk factors. Hepatitis B vaccination coverage level and main barriers to vaccination were also taken in account. Results A total of 824 health care workers were randomly selected from three major hospitals of Peshawar, Khyber Pakhtunkhwa. Blood samples were analyzed in Department of Zoology, Kohat University of Science and Technology Kohat, and relevant information was obtained by means of preset questionnaire. HCWs in the studied hospitals showed 2.18% prevalence of positive HBV. Nurses and technicians were more prone to occupational exposure and to HBV infection. There was significant difference between vaccinated and non-vaccinated HCWs as well as between the doctors and all other categories. Barriers to complete vaccination, in spite of good knowledge of subjects in this regard were work pressure (39.8%, negligence (38.8% un-affordability (20.9%, and unavailability (0.5%. Conclusions Special preventive measures (universal precaution and vaccination, which are fundamental way to protect HCW against HBV infection should be adopted.

  5. A federal tax credit to encourage employers to offer health coverage.

    Science.gov (United States)

    Meyer, J A; Wicks, E K

    2001-01-01

    Many firms that employ low-wage workers cannot afford to offer an employee health plan, and many of the uninsured work for such firms. This article makes the case for an employer tax credit, administered by the Internal Revenue Service, as a way to extend health coverage to uninsured workers and their families. The permanent, fixed-dollar, refundable credit would be available to all low-wage employers (those with average wages of $10 per hour and less), including those already offering coverage. The credit would be graduated depending on average wage: the maximum credit would equal 50% of the cost of a standard benefit package; the minimum would equal 30% of the package. It also would vary by family size and could be used to cover part-time and temporary workers. Participating employers would be required to pay at least 50% of the health insurance premium, proof of which would be shown on firms' tax returns. The paper provides justification for this approach. It closes with a discussion of strengths and weaknesses of this approach and alternative design features.

  6. The utilization of dental care services according to health insurance coverage in Catalonia (Spain).

    Science.gov (United States)

    Pizarro, Vladimir; Ferrer, Montse; Domingo-Salvany, Antonia; Benach, Joan; Borrell, Carme; Pont, Angels; Schiaffino, Anna; Almansa, Josue; Tresserras, Ricard; Alonso, Jordi

    2009-02-01

    The aim of this study was to assess the relationship of dental care service use with health insurance and its evolution. The Catalan Health Interview Survey is a cross-sectional study conducted in 1994 (n = 15 000) and 2001-2 (n = 8400) by interviews at home to a representative sample of Catalonia (Spain). All the estimates were obtained by applying weights to restore the representativeness of the Catalonia general population. In the bivariate analysis, age, gender, social class and health insurance coverage were statistically associated with a dental visit in the previous year (P use in the previous year, from 26.7% in 1994 to 34.3% in 2002. Future studies will be needed to monitor this tendency.

  7. Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009.

    Science.gov (United States)

    Liu, Jinan; Shi, Lizheng; Meng, Qingyue; Khan, M Mahmud

    2012-08-14

    China introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China. The China Health and Nutrition Survey (CHNS) data of 2006 and 2009 were used to create the concentration curve and the concentration index. GEE logistic regression was used to model the health insurance coverage as dependent variable and household income per capita as independent variable, controlling for individuals' age, gender, marital status, educational attainment, employment status, year 2009 (Y2009), household size, retirement status, and geographic variations. The change in the income-related inequality in 2009 was estimated using the interaction term of income*Y2009. In 2006, 49.7% (4,712/9,476) respondents had health insurance: 13.4% with BHIS and 28.4% with NCMS. In 2009, 90.8% (8,964/9,863) had health insurance: 10.1% with URBMI, 18.3% with BHIS, and 57.6% with NCMS. The BHIS, URBMI, and NCMS programs had different patterns of population coverage over 10 income deciles. The concentration index was 0.15 in 2006 and 0.04 in 2009. The dominance test showed that the concentration curves were significantly different between 2006 and 2009 (p China through rapid expansion of CHNS in rural areas and initiation of URBMI in urban areas.

  8. Strategies to improve treatment coverage in community-based public health programs: A systematic review of the literature.

    Directory of Open Access Journals (Sweden)

    Katrina V Deardorff

    2018-02-01

    Full Text Available Community-based public health campaigns, such as those used in mass deworming, vitamin A supplementation and child immunization programs, provide key healthcare interventions to targeted populations at scale. However, these programs often fall short of established coverage targets. The purpose of this systematic review was to evaluate the impact of strategies used to increase treatment coverage in community-based public health campaigns.We systematically searched CAB Direct, Embase, and PubMed archives for studies utilizing specific interventions to increase coverage of community-based distribution of drugs, vaccines, or other public health services. We identified 5,637 articles, from which 79 full texts were evaluated according to pre-defined inclusion and exclusion criteria. Twenty-eight articles met inclusion criteria and data were abstracted regarding strategy-specific changes in coverage from these sources. Strategies used to increase coverage included community-directed treatment (n = 6, pooled percent change in coverage: +26.2%, distributor incentives (n = 2, +25.3%, distribution along kinship networks (n = 1, +24.5%, intensified information, education, and communication activities (n = 8, +21.6%, fixed-point delivery (n = 1, +21.4%, door-to-door delivery (n = 1, +14.0%, integrated service distribution (n = 9, +12.7%, conversion from school- to community-based delivery (n = 3, +11.9%, and management by a non-governmental organization (n = 1, +5.8%.Strategies that target improving community member ownership of distribution appear to have a large impact on increasing treatment coverage. However, all strategies used to increase coverage successfully did so. These results may be useful to National Ministries, programs, and implementing partners in optimizing treatment coverage in community-based public health programs.

  9. Trends in Disparities in Low-Income Children's Health Insurance Coverage and Access to Care by Family Immigration Status.

    Science.gov (United States)

    Jarlenski, Marian; Baller, Julia; Borrero, Sonya; Bennett, Wendy L

    2016-03-01

    To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status. We used data from the National Survey of Children's Health in 2003 to 2011-2012, including 83,612 children aged 0 to 17 years with family incomes immigration status categories: citizen children with nonimmigrant parents; citizen children with immigrant parents; and immigrant children. We used multivariable regression analyses to obtain adjusted trends in health insurance coverage and access to care. All low-income children experienced gains in health insurance coverage and access to care from 2003 to 2011-2012, regardless of family immigration status. Relative to citizen children with nonimmigrant parents, citizen children with immigrant parents had a 5 percentage point greater increase in health insurance coverage (P = .06), a 9 percentage point greater increase in having a personal doctor or nurse (P Immigrant children had significantly lower health insurance coverage than other groups. However, the group had a 14 percentage point greater increase in having a personal doctor or nurse (P immigration status have lessened over time among children in low-income families, although large disparities still exist. Policy efforts are needed to ensure that children of immigrant parents and immigrant children are able to access health insurance and health care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  10. Journalism as health education: media coverage of a nonbranded pharma web site.

    Science.gov (United States)

    Mackert, Michael; Love, Brad; Holton, Avery E

    2011-03-01

    As healthcare consumers increasingly use the Internet as a source for health information, direct-to-consumer (DTC) prescription drug advertising online merits additional attention. The purpose of this research was to investigate media coverage of the joint marketing program linking the movie Happy Feet and the nonbranded disease education Web site FluFacts-a resource from Tamiflu flu treatment manufacturer Roche Laboratories Inc. Twenty-nine articles (n = 29) were found covering the Happy Feet-FluFacts marketing campaign. A coding guide was developed to assess elements of the articles, including those common in the sample and information that ideally would be included in these articles. Two coders independently coded the articles, achieving intercoder agreement of κ = 0.98 before resolving disagreements to arrive at a final dataset. The majority of articles reported that Roche operated FluFacts (51.7%) and mentioned the product Tamiflu (58.6%). Almost half (48.3%) reported FluFacts was an educational resource; yet, no articles mentioned other antiviral medications or nonmedical options for preventing the flu. Almost a quarter of the articles (24.1%) provided a call to action-telling readers to visit FluFacts or providing a link for them to do so. Findings suggest that journalists' coverage of this novel campaign-likely one of the goals of the campaign-helped spread the message of the Happy Feet-FluFacts relationship, often omitting other useful health information. Additional research is needed to better understand online DTC campaigns and how consumers react to these campaigns and resulting media coverage and to inform the policymakers' decisions regarding DTC advertising online.

  11. Toward Better Access to Health Insurance Coverage for U.S. Retirees in Mexico

    Directory of Open Access Journals (Sweden)

    Warner David C.

    2001-01-01

    Full Text Available Many retirees from the United States of America have limited health insurance coverage while living in Mexico. Medicare and Medicaid benefits are not portable to other countries and Medigap (private insurance that supplements Medicare is very limited. This causes economic and medical hardships and serves as a barrier to retirement to Mexico. Increasing numbers of U.S. retirees will be interested in moving to Mexico in the future because of the climate, the culture, and the lower cost of living. The numbers are increasing as a result of several factors such as aging "baby boomers" and the rapidly growing Mexican-origin population in the U.S.A. who are citizens or permanent residents but would like to return to their communities of origin after working in the U.S.A. There are several policy initiatives that could provide opportunities for improving health insurance coverage for these retirees that could be cost-effective. The full version of this paper is available too at: http://www.insp.mx/salud/index.html

  12. Health Insurance Instability Among Older Immigrants: Region of Origin Disparities in Coverage

    Science.gov (United States)

    Hardy, Melissa

    2015-01-01

    Objectives. We provide a detailed analysis of how the dynamics of health insurance coverage (HIC) at older ages differs among Latino, Asian, and European immigrants in the United States. Method. Using Survey of Income and Program Participation data from the 2004 and 2008 panels, we estimate discrete-time event history models to examine first and second transitions into and out of HIC, highlighting substantial differences in hazard rates among immigrants aged 50–64 from Asia, Latin America, and Europe. Results. We find that the likelihood of having HIC at first observation and the rates of gaining and losing coverage within a relatively short time frame are least favorable for older Latino immigrants, although immigrants from all three regions are at a disadvantage relative to native-born non-Hispanic Whites. This disparity among immigrant groups persists even when lower rates of citizenship, greater difficulty with English, and low-skill job placements are taken into account. Discussion. Factors that have contributed to the lower rates and shorter durations of HIC among older immigrants, particularly those from Latin America, may not be easily resolved by the Affordable Care Act. The importance of region of origin and assimilation characteristics for the risk of being uninsured in later life argues that immigration and health care policy should be jointly addressed. PMID:25637934

  13. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues

    Directory of Open Access Journals (Sweden)

    Byungmook Lim

    2013-09-01

    Full Text Available National Health Insurance (NHI in Korea has covered Korean medicine (KM services including acupuncture, moxibustion, cupping, and herbal preparations since 1987, which represents the first time that an entire traditional medicine system was insured by an NHI scheme anywhere in the world. This nationwide insurance coverage led to a rapid increase in the use of KM, and the KM community became one of the main interest groups in the Korean healthcare system. However, due to the public's safety concern of and the stagnancy in demand for KM services, KM has been facing new challenges. This paper presents a brief history and the current structure of KM health insurance, and describes the critical issues related to KM insurance for in-depth understanding of the present situation.

  14. National health expenditure projections, 2013-23: faster growth expected with expanded coverage and improving economy.

    Science.gov (United States)

    Sisko, Andrea M; Keehan, Sean P; Cuckler, Gigi A; Madison, Andrew J; Smith, Sheila D; Wolfe, Christian J; Stone, Devin A; Lizonitz, Joseph M; Poisal, John A

    2014-10-01

    In 2013 health spending growth is expected to have remained slow, at 3.6 percent, as a result of the sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements. The combined effects of the Affordable Care Act's coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth this year and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015-23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990-2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013-23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023. Project HOPE—The People-to-People Health Foundation, Inc.

  15. Immunization Coverage

    Science.gov (United States)

    ... room/fact-sheets/detail/immunization-coverage","@context":"http://schema.org","@type":"Article"}; العربية 中文 français русский español ... Plan Global Health Observatory (GHO) data - Immunization More information on vaccines and immunization News 1 in 10 ...

  16. The impact of race, income, drug abuse and dependence on health insurance coverage among US adults.

    Science.gov (United States)

    Wang, Nianyang; Xie, Xin

    2017-06-01

    Little is known about the impact of drug abuse/dependence on health insurance coverage, especially by race groups and income levels. In this study, we examine the disparities in health insurance predictors and investigate the impact of drug use (alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence) on lack of insurance across different race and income groups. To perform the analysis, we used insurance data (8057 uninsured and 28,590 insured individual adults) from the National Surveys on Drug Use and Health (NSDUH 2011). To analyze the likelihood of being uninsured we performed weighted binomial logistic regression analyses. The results show that the overall prevalence of lacking insurance was 19.6 %. However, race differences in lack of insurance exist, especially for Hispanics who observe the highest probability of being uninsured (38.5 %). Furthermore, we observe that the lowest income level bracket (annual income <$20,000) is associated with the highest likelihood of being uninsured (37.3 %). As the result of this investigation, we observed the following relationship between drug use and lack of insurance: alcohol abuse/dependence and nicotine dependence tend to increase the risk of lack of insurance for African Americans and whites, respectively; illicit drug use increases such risk for whites; alcohol abuse/dependence increases the likelihood of lack of insurance for the group with incomes $20,000-$49,999, whereas nicotine dependence is associated with higher probability of lack of insurance for most income groups. These findings provide some useful insights for policy makers in making decisions regarding unmet health insurance coverage.

  17. The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Glenn Flores

    2017-05-01

    Full Text Available Abstract Background Of the 4.8 million uninsured children in America, 62–72% are eligible for but not enrolled in Medicaid or CHIP. Not enough is known, however, about the impact of health insurance on outcomes and costs for previously uninsured children, which has never been examined prospectively. Methods This prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 community sites, and 11 outcomes monitored monthly for 1 year. Results In this sample of 237 children, those obtaining coverage were significantly (P 6 months at baseline were associated with remaining uninsured for the entire year. In multivariable analysis, children who had been uninsured for >6 months at baseline (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4–10.3 and African-American children (OR, 2.8; 95% CI, 1.1–7.3 had significantly higher odds of remaining uninsured for the entire year. Insurance saved $2886/insured child/year, with mean healthcare costs = $5155/uninsured vs. $2269/insured child (P = .04. Conclusions Providing health insurance to Medicaid/CHIP-eligible uninsured children improves health, healthcare access and quality, and parental satisfaction; reduces unmet needs and out-of-pocket costs; and saves $2886/insured child/year. African-American children and those who have been uninsured for >6 months are at greatest risk for remaining uninsured. Extrapolation of the savings realized by insuring uninsured, Medicaid/CHIP-eligible children suggests that America potentially could save $8.7–$10.1 billion annually by providing health insurance to all Medicaid/CHIP-eligible uninsured children.

  18. U.S. physicians' views on financing options to expand health insurance coverage: a national survey.

    Science.gov (United States)

    McCormick, Danny; Woolhandler, Steffie; Bose-Kolanu, Anjali; Germann, Antonio; Bor, David H; Himmelstein, David U

    2009-04-01

    Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States. To assess physician views on financing options for expanding health care coverage and on access to health care. Nationally representative mail survey conducted between March 2007 and October 2007 of U.S. physicians engaged in direct patient care. Rated support for reform options including financial incentives to induce individuals to purchase health insurance and single-payer national health insurance; rated views of several dimensions of access to care. 1,675 of 3,300 physicians responded (50.8%). Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance. The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.

  19. Local television news coverage of President Clinton's introduction of the Health Security Act.

    Science.gov (United States)

    Dorfman, L; Schauffler, H H; Wilkerson, J; Feinson, J

    1996-04-17

    To investigate how local television news reported on health system reform during the week President Clinton presented his health system reform bill. Retrospective content analysis of the 1342-page Health Security Act of 1993, the printed text of President Clinton's speech before Congress on September 22, 1993, and a sample of local television news stories on health system reform broadcast during the week of September 19 through 25, 1993. The state of California. During the week, 316 television news stories on health system reform were aired during the 166 local news broadcasts sampled. Health system reform was the second most frequently reported topic, second to stories on violent crime. News stories on health system reform averaged 1 minute 38 seconds in length, compared with 57 seconds for violent crime. Fifty-seven percent of the local news stories focused on interest group politics. Compared with the content of the Health Security Act, local news broadcasts devoted a significantly greater portion of their stories to financing, eligibility, and preventive services. Local news stories gave significantly less attention to cost-saving mechanisms, long-term care benefits, and changes in Medicare and Medicaid, and less than 2% of stories mentioned quality assurance mechanisms, malpractice reform, or new public health initiatives. Of the 316 televised news stories, 53 reported on the president's speech, covering many of the same topics emphasized in the speech (financing, organization and administration, and eligibility) and de-emphasizing many of the same topics (Medicare and Medicaid, quality assurance, and malpractice reform). Two percent of the president's speech covered partisan politics; 45% of the local news stories on the speech featured challenges from partisan politicians. Although health system reform was the focus of a large number of local television news stories during the week, in-depth explanation was scarce. In general, the news stories provided

  20. Behavioral consequences of conflict-oriented health news coverage: the 2009 mammography guideline controversy and online information seeking.

    Science.gov (United States)

    Weeks, Brian E; Friedenberg, Laura M; Southwell, Brian G; Slater, Jonathan S

    2012-01-01

    Building on channel complementarity theory and media-system dependency theory, this study explores the impact of conflict-oriented news coverage of health issues on information seeking online. Using Google search data as a measure of behavior, we demonstrate that controversial news coverage of the U.S. Preventive Services Task Force's November 2009 recommendations for changes in breast cancer screening guidelines strongly predicted the volume of same-day online searches for information about mammograms. We also found that this relationship did not exist 1 year prior to the coverage, during which mammography news coverage did not focus on the guideline controversy, suggesting that the controversy frame may have driven search behavior. We discuss the implications of these results for health communication scholars and practitioners.

  1. Medicines coverage and community-based health insurance in low-income countries

    Directory of Open Access Journals (Sweden)

    Wagner Anita K

    2008-10-01

    Full Text Available Abstract Objectives The 2004 International Conference on Improving Use of Medicines recommended that emerging and expanding health insurances in low-income countries focus on improving access to and use of medicines. In recent years, Community-based Health Insurance (CHI schemes have multiplied, with mounting evidence of their positive effects on financial protection and resource mobilization for healthcare in poor settings. Using literature review and qualitative interviews, this paper investigates whether and how CHI expands access to medicines in low-income countries. Methods We used three complementary data collection approaches: (1 analysis of WHO National Health Accounts (NHA and available results from the World Health Survey (WHS; (2 review of peer-reviewed articles published since 2002 and documents posted online by national insurance programs and international organizations; (3 structured interviews of CHI managers about key issues related to medicines benefit packages in Lao PDR and Rwanda. Results In low-income countries, only two percent of WHS respondents with voluntary insurance belong to the lowest income quintile, suggesting very low CHI penetration among the poor. Yet according to the WHS, medicines are the largest reported component of out-of-pocket payments for healthcare in these countries (median 41.7% and this proportion is inversely associated with income quintile. Publications have mentioned over a thousand CHI schemes in 19 low-income countries, usually without in-depth description of the type, extent, or adequacy of medicines coverage. Evidence from the literature is scarce about how coverage affects medicines utilization or how schemes use cost-containment tools like co-payments and formularies. On the other hand, interviews found that medicines may represent up to 80% of CHI expenditures. Conclusion This paper highlights the paucity of evidence about medicines coverage in CHI. Given the policy commitment to expand CHI

  2. mHealth Series: Measuring maternal newborn and child health coverage by text messaging – a county–level model for China

    Directory of Open Access Journals (Sweden)

    Yanfeng Zhang

    2013-12-01

    Full Text Available Effective interventions in maternal, newborn and child health (MNCH, if achieving high level of population coverage, could prevent most of deaths in children under five years of age. High–quality measurements of MNCH coverage are essential for tracking progress and making evidence–based decisions.

  3. National Health Care Spending In 2016: Spending And Enrollment Growth Slow After Initial Coverage Expansions.

    Science.gov (United States)

    Hartman, Micah; Martin, Anne B; Espinosa, Nathan; Catlin, Aaron; The National Health Expenditure Accounts Team

    2018-01-01

    Total nominal US health care spending increased 4.3 percent and reached $3.3 trillion in 2016. Per capita spending on health care increased by $354, reaching $10,348. The share of gross domestic product devoted to health care spending was 17.9 percent in 2016, up from 17.7 percent in 2015. Health spending growth decelerated in 2016 following faster growth in 2014 and 2015 associated with coverage expansions under the Affordable Care Act (ACA) and strong retail prescription drug spending growth. In 2016 the slowdown was broadly based, as spending for the largest categories by payer and by service decelerated. Enrollment trends drove the slowdown in Medicaid and private health insurance spending growth in 2016, while slower per enrollee spending growth influenced Medicare spending. Furthermore, spending for retail prescription drugs slowed, partly as a result of lower spending for drugs used to treat hepatitis C, while slower use and intensity of services drove the slowdown in hospital care and physician and clinical services.

  4. Coverage and accessibility levels of health services in the metropolitan periphery of Mexico City

    Directory of Open Access Journals (Sweden)

    Flor López

    2012-02-01

    Full Text Available The aim of this study is two fold: first, to analyze the spatial distribution of health services that different public institutions offer in the metropolitan peripheral municipalities of Mexico City; and second, give some reasons that explain that distribution. The analysis tries to demonstrate a lack of territorial approach in the construction of the social policy in the particular case of the health sector. The spatial range of health service, coverage and accessibility in the eastern part of the State of Mexico was calculate through variables much as number of doctors, nurses, beds and medical center, that the different public institution particularly IMSS, ISSSTE and ISSEMYM, offer. Results tend to show an unequal distribution of health resources either human or material, as well as a territorial disorden in their distribution with a high concentration in urban areas. Thus, analysis shows that space plays a fundamental role as a structuring factor in the application of health policies and in the planning of such services.

  5. Are doctors and nurses associated with coverage of essential health services in developing countries? A cross-sectional study

    Directory of Open Access Journals (Sweden)

    de Pinho Helen

    2009-03-01

    Full Text Available Abstract Background There is broad policy consensus that a shortage of doctors and nurses is a key constraint to increasing utilization of essential health services important for achieving the health Millennium Development Goals. However there is limited research on the quantitative links between health workers and service coverage rates. We examined the relationship between doctor and nurse concentrations and utilization rates of five essential health services in developing countries. Methods We performed cross-national analyses of low- and middle-income countries by means of ordinary least squares regression with coverage rates of antenatal care, attended delivery, caesarean section, measles immunization, tuberculosis case diagnosis and care for acute respiratory infection as outcomes. Doctor, nurse and aggregate health worker (sum of doctors and nurses concentrations were the main explanatory variables. Results Nurses were associated with utilization of skilled birth attendants (P = 0.02 and doctors were associated with measles immunization rates (P = 0.01 in separate adjusted analyses. Aggregate health workers were associated with the utilization of skilled birth attendants (P Conclusion A range of health system and population-level factors aside from health workers influences coverage of health services in developing countries. However, it is also plausible that health workers who are neither doctors nor nurses, such as clinical officers and community health workers, may be providing a substantial proportion of health services. The human resources for health research agenda should be expanded beyond doctors and nurses.

  6. Innovations that reach the patient : Early health technology assessment and improving the chances of coverage and implementation

    NARCIS (Netherlands)

    Van Harten, W. H.; Retèl, V. P.

    2016-01-01

    With growing concerns for the sustainability of the financial burden that health care-and especially cancer services-poses on the national budgets, the role of health economic analyses in coverage decisions is likely to grow. One of the strategies for the biomedical research field-also in oncology

  7. “Aging Out” of Dependent Coverage and the Effects on US Labor Market and Health Insurance Choices

    Science.gov (United States)

    2015-01-01

    Objectives. I examined how labor market and health insurance outcomes were affected by the loss of dependent coverage eligibility under the Patient Protection and Affordable Care Act (ACA). Methods. I used National Health Interview Survey (NHIS) data and regression discontinuity models to measure the percentage-point change in labor market and health insurance outcomes at age 26 years. My sample was restricted to unmarried individuals aged 24 to 28 years and to a period of time before the ACA’s individual mandate (2011–2013). I ran models separately for men and women to determine if there were differences based on gender. Results. Aging out of this provision increased employment among men, employer-sponsored health insurance offers for women, and reports that health insurance coverage was worse than it was 1 year previously (overall and for young women). Uninsured rates did not increase at age 26 years, but there was an increase in the purchase of non–group health coverage, indicating interest in remaining insured after age 26 years. Conclusions. Many young adults will turn to state and federal health insurance marketplaces for information about health coverage. Because young adults (aged 18–29 years) regularly use social media sites, these sites could be used to advertise insurance to individuals reaching their 26th birthdays. PMID:26447916

  8. Income, Poverty, and Health Insurance Coverage in the United States: 2012. Current Population Reports P60-245

    Science.gov (United States)

    DeNavas-Walt, Carmen; Proctor, Bernadette D.; Smith, Jessica C.

    2013-01-01

    This report presents data on income, poverty, and health insurance coverage in the United States based on information collected in the 2013 and earlier Current Population Survey Annual Social and Economic Supplements (CPS ASEC) conducted by the U.S. Census Bureau. For most groups, the 2012 income, poverty, and health insurance estimates were not…

  9. Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

    Science.gov (United States)

    Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

    2015-01-01

    Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

  10. Determinants of employment-based private health insurance coverage in Denmark

    Directory of Open Access Journals (Sweden)

    Astrid Kiil

    2011-10-01

    Full Text Available This study estimates the determinants of having employment-based private health insurance (EPHI based on data from a survey of the Danish workforce conducted in 2009. The study contributes to the literature by exploring the role of satisfaction with the tax-financed health care system as a potential determinant of EPHI ownership and by taking into account that some employees receive EPHI free of charge, while others pay the premium out of their pre-tax income and thus make an actual choice. The results indicate that the probability of having EPHI is positively affected by private sector employment, size of the workplace, whether the workplace has a health scheme, income, being employed as a white-collar worker, and age until the age of 49, while the presence of subordinates, gender, education level, membership of 'denmark' and living in the capital region are not significantly associated with EPHI coverage. As expected, the characteristics related to the workplace are by far the quantitatively most important determinants. The association between EPHI and self-assessed health is found to be quadratic such that individuals in good self-assessed health are more likely to be covered by EPHI than those in excellent and fair, poor or very poor self-assessed health, respectively. Finally, the probability of having EPHI is found to be negatively related to the level of satisfaction with the tax-financed health care system. The findings of the study are not affected notably by distinguishing empirically between employees who receive EPHI free of charge and those who pay the premium out of their pre-tax income. Link to Appendix

  11. National trends in the cost of employer health insurance coverage, 2003-2013.

    Science.gov (United States)

    Collins, Sara R; Radley, David C; Schoen, Cathy; Beutel, Sophie

    2014-12-01

    Looking at trends in private employer-based health insurance from 2003 to 2013, this issue brief finds that premiums for family coverage increased 73 percent over the past decade--faster than median family income. Employees' contributions to their premiums climbed by 93 percent over that time frame. At the same time, deductibles more than doubled in both large and small firms. Workers are thus paying more but getting less protective benefits. However, the study also finds that while premiums continued to rise through 2013, the rate of growth slowed between 2010 and 2013, following implementation of the Affordable Care Act. While families experienced slower growth in premium contributions and deductibles over this period, sluggish growth in median family income means families are paying more in premiums and deductibles as a share of their income than ever before.

  12. Application of HIPAA group market rules to individuals who were denied coverage due to a health status-related factor--HCFA. Clarification of regulations.

    Science.gov (United States)

    1997-12-29

    This document addresses certain issues arising under the group market portability provisions added by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with respect to employees (or their dependents) who, until the effective date of the HIPAA nondiscrimination provisions, were denied coverage under a group health plan, including group health insurance coverage, because of a health status-related factor.

  13. The impact of universal National Health Insurance on population health: the experience of Taiwan

    Directory of Open Access Journals (Sweden)

    Kuo Ken N

    2010-08-01

    Full Text Available Abstract Background Taiwan established a system of universal National Health Insurance (NHI in March, 1995. Today, the NHI covers more than 98% of Taiwan's population and enrollees enjoy almost free access to healthcare with small co-payment by most clinics and hospitals. Yet while this expansion of coverage will almost inevitably have improved access to health care, however, it cannot be assumed that it will necessarily have improved the health of the population. The aim of this study was to determine whether the introduction of National Health Insurance (NHI in Taiwan in 1995 was associated with a change in deaths from causes amenable to health care. Methods Identification of discontinuities in trends in mortality considered amenable to health care and all other conditions (non-amenable mortality using joinpoint regression analysis from 1981 to 2005. Results Deaths from amenable causes declined between 1981 and 1993 but slowed between 1993 and 1996. Once NHI was implemented, the decline accelerated significantly, falling at 5.83% per year between 1996 and 1999. In contrast, there was little change in non-amenable causes (0.64% per year between 1981 and 1999. The effect of NHI was highest among the young and old, and lowest among those of working age, consistent with changes in the pattern of coverage. NHI was associated with substantial reductions in deaths from circulatory disorders and, for men, infections, whilst an earlier upward trend in female cancer deaths was reversed. Conclusions NHI was associated in a reduction in deaths considered amenable to health care; particularly among those age groups least likely to have been insured previously.

  14. Measuring coverage in MNCH: tracking progress in health for women and children using DHS and MICS household surveys.

    Directory of Open Access Journals (Sweden)

    Attila Hancioglu

    Full Text Available Household surveys are the primary data source of coverage indicators for children and women for most developing countries. Most of this information is generated by two global household survey programmes-the USAID-supported Demographic and Health Surveys (DHS and the UNICEF-supported Multiple Indicator Cluster Surveys (MICS. In this review, we provide an overview of these two programmes, which cover a wide range of child and maternal health topics and provide estimates of many Millennium Development Goal indicators, as well as estimates of the indicators for the Countdown to 2015 initiative and the Commission on Information and Accountability for Women's and Children's Health. MICS and DHS collaborate closely and work through interagency processes to ensure that survey tools are harmonized and comparable as far as possible, but we highlight differences between DHS and MICS in the population covered and the reference periods used to measure coverage. These differences need to be considered when comparing estimates of reproductive, maternal, newborn, and child health indicators across countries and over time and we discuss the implications of these differences for coverage measurement. Finally, we discuss the need for survey planners and consumers of survey results to understand the strengths, limitations, and constraints of coverage measurements generated through household surveys, and address some technical issues surrounding sampling and quality control. We conclude that, although much effort has been made to improve coverage measurement in household surveys, continuing efforts are needed, including further research to improve and refine survey methods and analytical techniques.

  15. [Coverage of nutritional and health programs in the low income strata].

    Science.gov (United States)

    Cruzat, M A; González, N; Mardones, F; Moenne, A M; Sánchez, H

    1982-06-01

    The extent and consequences of exclusion of low income strata from maternal and child health programs in Chile are analyzed using available data. Infant mortality has been shown by several studies to be closely associated with socioeconomic status in Chile. Babies of illiterate mothers showed the highest rate of mortality and the least improvement in rate between 1972-78. The effect of socioeconomic status on the mortality rate of infants in greatly influenced by birth weight; low birth weight infants of low income groups suffer significantly higher mortality than among higher income groups. Several national studies in Chile demonstrated a relationship between infant malnutrition and health program coverage. Infant malnutrition is greatest in groups benefiting least from health care. Based on the fact that 90.5% of births in 1980 were professionally attended, it is estimated that 9.5% of the low income population lacks access to health care. A recent survey showed that 9.9% of the population under 6 years, some 105,848 children, was not covered by the National Complementary Feeding Program. Another study showed that 12.3% of mothers had no prenatal medical attention prior to their most recent birth; mothers with little or no education, living in rural areas, and of high parity were most likely not to have received medical attention. Factors responsible for lack of access to health and nutrition programs appeared to include unsatisfactory relationships with the health workers, poor acceptability of foods offered, excessive distance and waiting times, and lack of interest or motivation on the part of the mothers.

  16. Child health insurance coverage: a survey among temporary and permanent residents in Shanghai.

    Science.gov (United States)

    Lu, Mingshan; Zhang, Jing; Ma, Jin; Li, Bing; Quan, Hude

    2008-11-17

    Under the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shanghai to describe children's health insurance coverage according to their migration status. Between 2005 and 2006, we conducted an in-person health survey of the adult care-givers of children aged 7 and under, residing in five districts of Shanghai. We compared uninsurance rates between temporary and permanent child residents, and investigated factors associated with child health uninsurance. Even though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6%) than permanent child residents (21.1%, adjusted odds ratio (OR): 5.85, 95% confidence interval (95% CI): 4.62-7.41). For both groups, family income was associated with having child health insurance; children in lower income families were more likely to be uninsured (OR: 1.96, 95% CI: 1.40-2.96). Children must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program. Children from migrant families are at even higher risk for uninsurance due to their lower socioeconomic status. Government initiatives specifically targeting temporary residents and providing health insurance benefits for their children are urgently needed.

  17. Supplementary contribution payable to the health insurance scheme for the spouse's coverage

    CERN Multimedia

    HR Department

    2007-01-01

    Staff Members, Fellows and Pensioners are reminded that any change in their marital status, as well as any change in the spouse or registered partner's income or health insurance cover, shall be notified in writing to CERN, within 30 calendar days of the change, in accordance with Articles III 6.01 to 6.03 of the Rules of the CERN Health Insurance Scheme. Such changes may have consequences on the conditions of the spouse or registered partner's affiliation to the CERN Health Insurance Scheme (CHIS) or on the payment of the supplementary contribution to the CHIS for the coverage of the spouse or registered partner. From 1.1.2007, for the following monthly income brackets, the indexed amounts in Swiss francs of the monthly supplementary contribution are: more than 2'500 CHF and up to 4'250 CHF: 134.- more than 4'250 CHF and up to 7'500 CHF: 234.- more than 7'500 CHF and up to 10'000 CHF: 369.- more than 10'000 CHF: 461.- It is in the member of the personnel's interest to declare a change in the annual ...

  18. Determinants for employer-paid health insurance coverage: a population-based study of the Danish labour force.

    Science.gov (United States)

    Christensen, Ann; Søgaard, Rikke

    2013-08-01

    In 2002, the Danish tax law was changed, giving employees a tax exemption on supplemental, employer-paid health insurance. This might have conflicted with one of the key foundations of the healthcare system, namely equal access for equal needs. The aim of this study was to investigate determinants for employer-paid health insurance coverage. Because the policy change affected only people who were part of the labour force and because the public sector at that time had no tradition of providing fringe benefits, the analysis was restricted to the private labour force. The analysis was based on data from a range of Danish person-level and company-level registers (explanatory variables). These data were combined with information on insurance status obtained from the trade organisation for insurance (dependent variable). A logistic regression was performed to estimate the odds of having employer-paid health insurance coverage. The individuals who were most likely to be insured were those employed in foreign companies as mid-level managers within the field of building and construction. Other important variables were the number of persons employed in a company, gender, ethnicity, region of residence, years of education, and annual income. Both company and individual characteristics were found to be important and significant predictors for employer-paid health insurance coverage. The Danish tax exemption on private health insurance in the years 2002-12 thus seems to have led to inequality in employer-paid health insurance coverage.

  19. REMINDER: SUPPLEMENTARY CONTRIBUTION PAYABLE TO THE HEALTH INSURANCE SCHEME FOR THE SPOUSE'S COVERAGE

    CERN Document Server

    2003-01-01

    Staff Members, Fellows and Pensioners are reminded that any change in the marital status of members of the personnel, as well as any change in the spouse's income or health insurance cover, shall be notified in writing to CERN, within 30 calendar days of the change, in accordance with Article R IV 1.17 of the Staff Regulations. Such changes may have consequences on the conditions of the spouse's affiliation to the CERN Health Insurance Scheme (CHIS) or on the payment of the supplementary contribution to the CHIS for the coverage of the spouse. In 2003, for the following income brackets, the indexed amounts in Swiss francs of the supplementary contribution are : - more than 30'000 CHF and up to 50'000 CHF: 134.- - more than 50'000 CHF and up to 90'000 CHF: 234.- - more than 90'000 CHF and up to 130'000 CHF: 369.- - more than 130'000 CHF: 468.- It is in the member of the personnel's interest to declare as soon as possible a change in the annual income of his spouse in order that the contribution is adjusted w...

  20. Supplementary contribution payable to the health insurance scheme for the spouse's coverage

    CERN Multimedia

    Human Resources Department

    2005-01-01

    Staff Members, Fellows and Pensioners are reminded that any change in the marital status of members of the personnel, as well as any change in the spouse's income or health insurance cover, shall be notified in writing to CERN, within 30 calendar days of the change, in accordance with Article R IV 1.17 of the Staff Regulations. Such changes may have consequences on the conditions of the spouse's affiliation to the CERN Health Insurance Scheme (CHIS) or on the payment of the supplementary contribution to the CHIS for the coverage of the spouse. Changes to the rules and simplification to the system are currently being prepared and should be operational by mid-2005. Meanwhile from 1.1.2005, for the following income brackets, the indexed amounts in Swiss francs of the monthly supplementary contribution are: more than 30'000 CHF and up to 50'000 CHF: 134.- more than 50'000 CHF and up to 90'000 CHF: 234.- more than 90'000 CHF and up to 130'000 CHF: 369.- more than 130'000 CHF: 459.- It is in the member o...

  1. Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS

    Directory of Open Access Journals (Sweden)

    Gilmara Silveira da Silva

    Full Text Available Abstract Introduction: Cost management has been identified as an essential tool for the general control and evaluation of health organizations. Objectives: To identify the coverage percentage of transferred funds from the Unified Health System for coronary artery bypass grafts in a philanthropic hospital having a consolidated costing system in the municipality of São Paulo. Methods: A quantitative, descriptive and cross-sectional research with information provided from a database composed of 1913 patients undergoing coronary artery bypass graft from March 13 to September 30, 2012, including isolated elective coronary artery bypass graft with the use of extracorporeal circulation. It excluded 551 (28.8% patients, among them 76 (4.0% deaths and 8 hospitalized patients, since the cost was compared according to the length of hospital stay. Therefore, the sample consisted of 1362 patients. Results: The average total cost per patient was $7,992.55. The average fund transfer by the Unified Health System was $3,450.73 (48.66%, resulting in a deficit of $4,541.82 (51.34%. Conclusion: The Unified Health System transfers covered 48.66% of the average total cost of hospitalization. Although the amount transferred increased with increasing costs, it was not proportional to the total cost, resulting in a percentage difference in revenue that was increasingly negative for each increase in cost and hospital stay. Those hospitalized for longer than seven days presented higher costs, older age, higher percentage of diabetics and chronic kidney disease patients and more postoperative complications.

  2. Second-generation immigrant children: health prevention for a new population in terms of vaccination coverage and health assessment.

    Science.gov (United States)

    Ferrara, Pietro; Zenzeri, Letizia; Fabrizio, Giovanna C; Gatto, Antonio; Pio, Liberatore; Gargiullo, Luisa; Ianniello, Francesca; Valentini, Piero; Ranno, Orazio

    2016-04-01

    In recent years the total number of foreigners taking up residence in Italy is increasing: the number of children born in Italy to foreign parents currently account for 15% of all babies born in the country. This population is generally referred to as "second-generation immigrants". We evaluated the health conditions of this particular population by investigating the vaccination coverage and auxological data in a group of foreign children living in a foster care setting and by comparing them to those regarding a group of foreign children living with their own parents. This study was conducted in a foster care association in Rome. The Pediatric Unit of "A. Gemelli" Hospital, Rome, provided all data for comparison. Two groups of children (group 1: 60 children from a foster care association; group 2: 91 children living with their parents; group 3: 112 healthy controls) with similar characteristics were taken into consideration. There were statistical differences between groups: the administration rate of hexavalent vaccine was significantly higher in group 2 than in group 1 (84.6% vs. 65.0%) (P0.05), although the administration rate of serogroup C meningococcal vaccine was lower in group 1 (10/60; 16.7%) compared to group 2 (17/91; 18.7%) (P>0.05). As for auxological parameters, there were no statistical differences between groups. The data presented in this study seem to suggest the need for a special health programme to be promoted by the Italian National Health System in order to address the needs of the particular risk group of second-generation immigrant children. Vaccination coverage should be especially boosted, and pediatricians should have a key role in terms of awareness raising and education of immigrant families.

  3. The Effectiveness of Education Based on BASNEF Model Program in Promotion of Preventive Behavior of Leishmaniasis among Health Workers and Families under Health Centers Coverage

    Directory of Open Access Journals (Sweden)

    Ali Khani Jeihooni

    2012-06-01

    Full Text Available Background & Objective: Intervention of educational training in order to prevent the leishmaniasis in endemic areas seems necessary. This study was implemented with the aim of assessing the effectiveness of education based on BASNEF Model program in promotion of preventive behavior of leishmaniasis among Health workers and families under the coverage of Health centers. Materials & Methods: An intervention study was carried out in rural health centers during 2009. Questionnaires were completed by 20 health- workers of two rural health centers. Also 20 families under the coverage of this health centers were randomly selected to complete the questionnaire. Then four training sessions for health workers and 2 training sessions for the influential individuals were conducted to increase the enabling factors and solving their problems, weekly meetings was held with health workers representatives. After three months of health workers training the data were collected again and analyzed via Chi- Square, T Independent, T pair, Regression and Mann- Whitney statistics. Results: The mean score for to knowledge, attitude, behavior intension, enabling factors and health workers behaviors significantly increased after educational intervention in experimental group and influential individuals. The mean scores for knowledge, attitude, behavior intension, enabling factors and the behavior of attendant families under coverage also increased significantly. Conclusion: Educational program of BASNEF Model, leads to behavior change of health workers and eventually their training behavior leads to preventive actions in families under coverage.

  4. 26 CFR 1.420-1 - Significant reduction in retiree health coverage during the cost maintenance period.

    Science.gov (United States)

    2010-04-01

    ... sale or other transfer in connection with which the employees of a trade or business of the employer... of the trade or business. (d) Examples. The following examples illustrate the application of this... individuals died in Year 2. During Year 3, Employer W amends its health plan to eliminate coverage for 5...

  5. Public health news frames in North Carolina newspaper coverage of the 100% Tobacco-Free Schools campaign? Sometimes.

    Science.gov (United States)

    Morrison, Suzanne DePalma; Sutton, Sonya F; Mebane, Felicia E

    2006-01-01

    News organizations are an important and influential part of the social environment. They identify certain issues by the extent and nature of their coverage. To help explain what public health policy messages may have influenced school policy decisions, this content analysis provides an examination of newspaper coverage of North Carolinas 100% tobacco-free schools campaign. Researchers searched LexisNexis for articles published in North Carolina newspapers between January 1, 2001 and December 31, 2004 that included variations of "North Carolina tobacco-free schools." Researchers then conducted a descriptive analysis of 138 stories from nine North Carolina newspapers (approximately 4% of all the states newspapers) and used page placement and story type to examine the level of importance placed on the issue. Finally, frames for and against tobacco-free school policies were tracked, along with the presence of key messages presented by 100% TFS advocates. The volume of news coverage changed throughout the study period, with peaks and valleys closely associated with external "trigger" events. In addition, a majority of the newspaper articles did not include key public health messages. The results suggest an opportunity for public health experts and officials to work more effectively with local journalists to increase the use (and impact) of public health messages in news coverage of tobacco policies affecting youth.

  6. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

    Directory of Open Access Journals (Sweden)

    Muhammad Ashraf Majrooh

    Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. RESULTS: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. CONCLUSION: The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and

  7. Dynamics of social health insurance development: examining the determinants of Chinese basic health insurance coverage with panel data.

    Science.gov (United States)

    Liu, Jun-Qiang

    2011-08-01

    Social health insurance (SHI) is gaining popularity in many developing countries, but there are few systematic empirical studies on the dynamics of SHI development. This study investigates the determinants of coverage of the Basic Healthcare Insurance for Urban Employees (BHI) in China. Using a panel database ranging from 1999 to 2007, the study finds that: (1) economic development plays a valuable role in BHI development; (2) strong financial capacity and administrative capacity in the government contributes to BHI progress; (3) higher trade union density is closely related to more rapid BHI expansion; and (4) taxation agencies are better at collecting SHI premiums. These findings provide evidence-based lessons for new and ongoing SHI programs. In addition, this article aims to make a more general contribution to the study of social policy development by expanding the scope of current theories on social policy development. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Providing Coverage for the Unique Lifelong Health Care Needs of Living Kidney Donors Within the Framework of Financial Neutrality.

    Science.gov (United States)

    Gill, J S; Delmonico, F; Klarenbach, S; Capron, A M

    2017-05-01

    Organ donation should neither enrich donors nor impose financial burdens on them. We described the scope of health care required for all living kidney donors, reflecting contemporary understanding of long-term donor health outcomes; proposed an approach to identify donor health conditions that should be covered within the framework of financial neutrality; and proposed strategies to pay for this care. Despite the Affordable Care Act in the United States, donors continue to have inadequate coverage for important health conditions that are donation related or that may compromise postdonation kidney function. Amendment of Medicare regulations is needed to clarify that surveillance and treatment of conditions that may compromise postdonation kidney function following donor nephrectomy will be covered without expense to the donor. In other countries lacking health insurance for all residents, sufficient data exist to allow the creation of a compensation fund or donor insurance policies to ensure appropriate care. Providing coverage for donation-related sequelae as well as care to preserve postdonation kidney function ensures protection against the financial burdens of health care encountered by donors throughout their lives. Providing coverage for this care should thus be cost-effective, even without considering the health care cost savings that occur for living donor transplant recipients. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  9. Authentic leadership in a health sciences university.

    Science.gov (United States)

    Al-Moamary, Mohamed S; Al-Kadri, Hanan M; Tamim, Hani M

    2016-01-01

    To study authentic leadership characteristics between academic leaders in a health sciences university. Cross-sectional study at a health sciences university in Saudi Arabia. The Authentic Leadership Questionnaire (ALQ) was utilized to assess authentic leadership. Out of 84 ALQs that were distributed, 75 (89.3%) were eligible. The ALQ scores showed consistency in the dimensions of self-awareness (3.45 ± 0.43), internalized moral prospective (3.46 ± 0.33) and balanced processing (3.42 ± 0.36). The relational transparency dimension had a mean of 3.24 ± 0.31 which was significantly lower than other domains. Academic leaders with medical background represented 57.3%, compared to 42.7% from other professions. Academic leaders from other professions had better ALQ scores that reached statistical significance in the internalized moral perspective and relational transparency dimensions with p values of 0.006 and 0.049, respectively. In reference to the impact of hierarchy, there were no significant differences in relation to ALQ scores. Almost one-third of academic leaders (34.7%) had Qualifications in medical education that did not show significant impact on ALQ scores. There was less-relational transparency among academic leaders that was not consistent with other ALQ domains. Being of medical background may enhance leaders' opportunity to be at a higher hierarchy status but it did not enhance their ALQ scores when compared to those from other professions. Moreover, holding a master in medical education did not impact leadership authenticity.

  10. Why do managers allocate resources to workplace health promotion programmes in countries with national health coverage?

    Science.gov (United States)

    Downey, Angela M; Sharp, David J

    2007-06-01

    There is extensive evidence that worksite health promotion (WHP) programmes reduce healthcare costs and improve employee productivity. In many countries, a large proportion of healthcare costs are borne by the state. While the full benefits of WHP are still created, they are shared between employers and the state, even though the employer bears the full (after-tax) cost. Employers therefore have a lower incentive to implement WHP activity. We know little about the beliefs of managers with decision responsibility for the approval and implementation of WHP programmes in this context. This article reports the results of a study of the attitudes of Canadian senior general managers (GMs) and human resource managers (HRMs) in the auto parts industry in Ontario, Canada towards the consequences of increasing discretionary spending on WHP, using Structural Equation Modelling and the Theory of Planned Behaviour. We identified factors that explain managers' intentions to increase discretionary spending on wellness programmes. While both senior GMs and HRMs are motivated primarily by their beliefs that WHP reduces indirect costs of health failure, GMs were also motivated by their moral responsibility towards employees (but surprisingly HRMs were not). Importantly, HRMs, who usually have responsibility for WHP, felt constrained by a lack of power to commit resources. Most importantly, we found no social expectation that organizations should provide WHP programmes. This has important implications in an environment where the adoption of WHP is very limited and cost containment within the healthcare system is paramount.

  11. TEL4Health research at University College Cork (UCC)

    NARCIS (Netherlands)

    Drachsler, Hendrik

    2013-01-01

    Drachsler, H. (2013, 12 May). TEL4Health research at University College Cork (UCC). Invited talk given at Application of Science to Simulation, Education and Research on Training for Health Professionals Centre (ASSERT for Health Care), Cork, Ireland.

  12. Racial gaps in child health insurance coverage in four South American countries: the role of wealth, human capital, and other household characteristics.

    Science.gov (United States)

    Wehby, George L; Murray, Jeffrey C; McCarthy, Ann Marie; Castilla, Eduardo E

    2011-12-01

    OBJECTIVE. To evaluate the extent of racial gaps in child health insurance coverage in South America and study the contribution of wealth, human capital, and other household characteristics to accounting for racial disparities in insurance coverage. DATA SOURCES/STUDY SETTING. Primary data collected between 2005 and 2006 in 30 pediatric practices in Argentina, Brazil, Ecuador, and Chile. DESIGN. Country-specific regression models are used to assess differences in insurance coverage by race. A decomposition model is used to quantify the extent to which wealth, human capital, and other household characteristics account for racial disparities in insurance coverage. DATA COLLECTION/EXTRACTION METHODS. In-person interviews were conducted with the mothers of 2,365 children. PRINCIPAL FINDINGS. The majority of children have no insurance coverage except in Chile. Large racial disparities in insurance coverage are observed. Household wealth is the single most important household-level factor accounting for racial disparities in coverage and is significantly and positively associated with coverage, followed by maternal education and employment/occupational status. Geographic differences account for the largest part of racial disparities in insurance coverage in Argentina and Ecuador. CONCLUSIONS. Increasing the coverage of children in less affluent families is important for reducing racial gaps in health insurance coverage in the study countries. © Health Research and Educational Trust.

  13. Can Plan Recommendations Improve the Coverage Decisions of Vulnerable Populations in Health Insurance Marketplaces?

    Science.gov (United States)

    Barnes, Andrew J; Hanoch, Yaniv; Rice, Thomas

    2016-01-01

    The Affordable Care Act's marketplaces present an important opportunity for expanding coverage but consumers face enormous challenges in navigating through enrollment and re-enrollment. We tested the effectiveness of a behaviorally informed policy tool--plan recommendations--in improving marketplace decisions. Data were gathered from a community sample of 656 lower-income, minority, rural residents of Virginia. We conducted an incentive-compatible, computer-based experiment using a hypothetical marketplace like the one consumers face in the federally-facilitated marketplaces, and examined their decision quality. Participants were randomly assigned to a control condition or three types of plan recommendations: social normative, physician, and government. For participants randomized to a plan recommendation condition, the plan that maximized expected earnings, and minimized total expected annual health care costs, was recommended. Primary data were gathered using an online choice experiment and questionnaire. Plan recommendations resulted in a 21 percentage point increase in the probability of choosing the earnings maximizing plan, after controlling for participant characteristics. Two conditions, government or providers recommending the lowest cost plan, resulted in plan choices that lowered annual costs compared to marketplaces where no recommendations were made. As millions of adults grapple with choosing plans in marketplaces and whether to switch plans during open enrollment, it is time to consider marketplace redesigns and leverage insights from the behavioral sciences to facilitate consumers' decisions.

  14. Can Plan Recommendations Improve the Coverage Decisions of Vulnerable Populations in Health Insurance Marketplaces?

    Directory of Open Access Journals (Sweden)

    Andrew J Barnes

    Full Text Available The Affordable Care Act's marketplaces present an important opportunity for expanding coverage but consumers face enormous challenges in navigating through enrollment and re-enrollment. We tested the effectiveness of a behaviorally informed policy tool--plan recommendations--in improving marketplace decisions.Data were gathered from a community sample of 656 lower-income, minority, rural residents of Virginia.We conducted an incentive-compatible, computer-based experiment using a hypothetical marketplace like the one consumers face in the federally-facilitated marketplaces, and examined their decision quality. Participants were randomly assigned to a control condition or three types of plan recommendations: social normative, physician, and government. For participants randomized to a plan recommendation condition, the plan that maximized expected earnings, and minimized total expected annual health care costs, was recommended.Primary data were gathered using an online choice experiment and questionnaire.Plan recommendations resulted in a 21 percentage point increase in the probability of choosing the earnings maximizing plan, after controlling for participant characteristics. Two conditions, government or providers recommending the lowest cost plan, resulted in plan choices that lowered annual costs compared to marketplaces where no recommendations were made.As millions of adults grapple with choosing plans in marketplaces and whether to switch plans during open enrollment, it is time to consider marketplace redesigns and leverage insights from the behavioral sciences to facilitate consumers' decisions.

  15. Promoting universal financial protection: health insurance for the poor in Georgia--a case study.

    Science.gov (United States)

    Zoidze, Akaki; Rukhazde, Natia; Chkhatarashvili, Ketevan; Gotsadze, George

    2013-11-15

    The present study focuses on the program "Medical Insurance for the Poor (MIP)" in Georgia. Under this program, the government purchased coverage from private insurance companies for vulnerable households identified through a means testing system, targeting up to 23% of the total population. The benefit package included outpatient and inpatient services with no co-payments, but had only limited outpatient drug benefits. This paper presents the results of the study on the impact of MIP on access to health services and financial protection of the MIP-targeted and general population. With a holistic case study design, the study employed a range of quantitative and qualitative methods. The methods included document review and secondary analysis of the data obtained through the nationwide household health expenditure and utilisation surveys 2007-2010 using the difference-in-differences method. The study findings showed that MIP had a positive impact in terms of reduced expenditure for inpatient services and total household health care costs, and there was a higher probability of receiving free outpatient benefits among the MIP-insured. However, MIP insurance had almost no effect on health services utilisation and the households' expenditure on outpatient drugs, including for those with MIP insurance, due to limited drug benefits in the package and a low claims ratio. In summary, the extended MIP coverage and increased financial access provided by the program, most likely due to the exclusion of outpatient drug coverage from the benefit package and possibly due to improper utilisation management by private insurance companies, were not able to reverse adverse effects of economic slow-down and escalating health expenditure. MIP has only cushioned the negative impact for the poorest by decreasing the poor/rich gradient in the rates of catastrophic health expenditure. The recent governmental decision on major expansion of MIP coverage and inclusion of additional drug

  16. Evaluation of the impact of the 2012 Rhode Island health care worker influenza vaccination regulations: implementation process and vaccination coverage.

    Science.gov (United States)

    Kim, Hanna; Lindley, Megan C; Dube, Donna; Kalayil, Elizabeth J; Paiva, Kristi A; Raymond, Patricia

    2015-01-01

    In October 2012, the Rhode Island Department of Health (HEALTH) amended its health care worker (HCW) vaccination regulations to require all HCWs to receive annual influenza vaccination or wear a surgical mask during direct patient contact when influenza is widespread. Unvaccinated HCWs failing to wear a mask are subject to a fine and disciplinary action. To describe the implementation of the 2012 Rhode Island HCW influenza vaccination regulations and examine their impact on vaccination coverage. Two data sources were used: (1) a survey of all health care facilities subject to the HCW regulations and (2) HCW influenza vaccination coverage data reported to HEALTH by health care facilities. Descriptive statistics and paired t tests were performed using SAS Release 9.2. For the 2012-2013 influenza season, 271 inpatient and outpatient health care facilities in Rhode Island were subject to the HCW regulations. Increase in HCW influenza vaccination coverage. Of the 271 facilities, 117 facilities completed the survey (43.2%) and 160 facilities reported vaccination data to HEALTH (59.0%). Between the 2011-2012 and 2012-2013 influenza seasons, the proportion of facilities having a masking policy, as required by the revised regulations, increased from 9.4% to 94.0% (P employee HCWs in Rhode Island increased from 69.7% in the 2011-2012 influenza season to 87.2% in the 2012-2013 season. Rhode Island's experience demonstrates that statewide HCW influenza vaccination requirements incorporating mask wearing and moderate penalties for noncompliance can be effective in improving influenza vaccination coverage among HCWs.

  17. The impact of stakeholder values and power relations on community-based health insurance coverage: qualitative evidence from three Senegalese case studies.

    Science.gov (United States)

    Mladovsky, Philipa; Ndiaye, Pascal; Ndiaye, Alfred; Criel, Bart

    2015-07-01

    Continued low rates of enrolment in community-based health insurance (CBHI) suggest that strategies proposed for scaling up are unsuccessfully implemented or inadequately address underlying limitations of CBHI. One reason may be a lack of incorporation of social and political context into CBHI policy. In this study, the hypothesis is proposed that values and power relations inherent in social networks of CBHI stakeholders can explain levels of CBHI coverage. To test this, three case studies constituting Senegalese CBHI schemes were studied. Transcripts of interviews with 64 CBHI stakeholders were analysed using inductive coding. The five most important themes pertaining to social values and power relations were: voluntarism, trust, solidarity, political engagement and social movements. Analysis of these themes raises a number of policy and implementation challenges for expanding CBHI coverage. First is the need to subsidize salaries for CBHI scheme staff. Second is the need to develop more sustainable internal and external governance structures through CBHI federations. Third is ensuring that CBHI resonates with local values concerning four dimensions of solidarity (health risk, vertical equity, scale and source). Government subsidies is one of the several potential strategies to achieve this. Fourth is the need for increased transparency in national policy. Fifth is the need for CBHI scheme leaders to increase their negotiating power vis-à-vis health service providers who control the resources needed for expanding CBHI coverage, through federations and a social movement dynamic. Systematically addressing all these challenges would represent a fundamental reform of the current CBHI model promoted in Senegal and in Africa more widely; this raises issues of feasibility in practice. From a theoretical perspective, the results suggest that studying values and power relations among stakeholders in multiple case studies is a useful complement to traditional health

  18. mHealth Series: Measuring maternal newborn and child health coverage by text messaging – a county–level model for China

    Science.gov (United States)

    Zhang, Yanfeng; Chen, Li; van Velthoven, Michelle H. M. M. T.; Wang, Wei; Liu, Li; Du, Xiaozhen; Wu, Qiong; Li, Ye; Car, Josip

    2013-01-01

    Background Effective interventions in maternal, newborn and child health (MNCH), if achieving high level of population coverage, could prevent most of deaths in children under five years of age. High–quality measurements of MNCH coverage are essential for tracking progress and making evidence–based decisions. Methods MNCH coverage data are mainly collected through fieldworkers’ interview with preselected households in standard programs of Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS) in most low– and middle–income countries. Household surveys will continue to be the major data source for MNCH coverage in the foreseeable future. However, face–to–face data collection broadly used in household surveys is labor–intensive, time–consuming and expensive. Mobile phones are drawing more and more interest in medical research with the rapid increase in usage and text messaging could be an innovative way of data collection, that is, we could collect DHS data through mHealth method. We refer to it as “mDHS”. Finding We propose in this paper a conceptual model for measuring MNCH coverage by text messaging in China. In developing this model, we considered resource constraints, sample representativeness, sample size and survey bias. The components of the model are text messaging platform, routine health information system, health facilities, communities and households. Conclusions Measuring MNCH interventions coverage by text messaging could be advantageous in many ways and establish a much larger evidence–base for MNCH health policies in China. Before mDHS could indeed be launched, research priorities would include a systematic assessment of routine health information systems and exploring feasibility to collect name lists, mobile phone numbers and general demographic and socio–economic data; qualitative interviews with health workers and caregivers; assessment of data validity of all indicators to be collected by text

  19. Changes in health insurance coverage during the economic downturn: 2000-2002.

    Science.gov (United States)

    Holahan, John; Wang, Marie

    2004-01-01

    Using Current Population Survey data from 2000-2002, this paper documents the changes that led the uninsured population to grow by 3.8 million during that time period. All of the increase in the uninsured occurred among adults, and two-thirds was among low-income adults. The extent to which the loss of employer coverage resulted in people becoming uninsured depended on their access to public programs: Children were more likely than adults to gain public coverage; women more likely than men; and parents more likely than nonparents. Middle- and higher-income Americans were also affected because many lost income and because rates of employer coverage were lower.

  20. Effects of public premiums on children's health insurance coverage: evidence from 1999 to 2003.

    Science.gov (United States)

    Kenney, Genevieve; Hadley, Jack; Blavin, Fredric

    This study uses 2000 to 2004 Current Population Survey data to examine the effects of public premiums on the insurance coverage of children whose family incomes are between 100% and 300% of the federal poverty level. The analysis employs multinomial logistic models that control for factors other than premium costs. While the magnitude of the estimated effects varies across models, the results consistently indicate that raising public premiums reduces enrollment in public programs, with some children who forgo public coverage having private coverage instead and others being uninsured. The results indicate that public premiums have larger effects when applied to lower-income families.

  1. [The role of the Fund against Catastrophic Expenditures in Health on the coverage of patients with cataract].

    Science.gov (United States)

    Navarrete-López, Mariana; Puentes-Rosas, Esteban; Pineda-Pérez, Dayana; Martínez-Ojeda, Haydeé

    2013-08-01

    To describe the effect of the Fund against Catastrophic Expenditures in Health on the provision of services for patients with cataract. We used administrative dataset on hospital discharges and official figures on population to estimate the rate of care and the coverage for cataract. To estimate the variation on resources, we used data from the National System of Health Information. Coverage for this disease had a significant increase between 2000 and 2010, passing from 24 per thousand cataract patients receiving attention to 58.8 per thousand. This growth is mainly due to the incorporation of cataract to the catalog of diseases covered by the Fund against Catastrophic Expenditures in Health, although this variation is not based on additional resources but in a higher productivity. The growth of services is noticeable in Aguascalientes, Coahuila, Distrito Federal and Nayarit. Our results suggest that policy-making based on evidence have actually brought benefits for Mexican population.

  2. Determinants for employer-paid health insurance coverage: a population-based study of the Danish labour force

    DEFF Research Database (Denmark)

    Christensen, Ann Demant; Søgaard, Rikke

    2013-01-01

    AIM: In 2002, the Danish tax law was changed, giving employees a tax exemption on supplemental, employer-paid health insurance. This might have conflicted with one of the key foundations of the healthcare system, namely equal access for equal needs. The aim of this study was to investigate...... determinants for employer-paid health insurance coverage. Because the policy change affected only people who were part of the labour force and because the public sector at that time had no tradition of providing fringe benefits, the analysis was restricted to the private labour force. METHOD: The analysis...... employer-paid health insurance coverage. RESULTS: The individuals who were most likely to be insured were those employed in foreign companies as mid-level managers within the field of building and construction. Other important variables were the number of persons employed in a company, gender, ethnicity...

  3. University of Global Health Equity’s Contribution to the Reduction of Education and Health Services Rationing

    Directory of Open Access Journals (Sweden)

    Agnes Binagwaho

    2017-08-01

    Full Text Available The inadequate supply of health workers and demand-side barriers due to clinical practice that heeds too little attention to cultural context are serious obstacles to achieving universal health coverage and the fulfillment of the human rights to health, especially for the poor and vulnerable living in remote rural areas. A number of strategies have been deployed to increase both the supply of healthcare workers and the demand for healthcare services. However, more can be done to improve service delivery as well as mitigate the geographic inequalities that exist in this field. To contribute to overcoming these barriers and increasing access to health services, especially for the most vulnerable, Partners In Health (PIH, a US non-governmental organization specializing in equitable health service delivery, has created the University of Global Health Equity (UGHE in a remote rural district of Rwanda. The act of building this university in such a rural setting signals a commitment to create opportunities where there have traditionally been few. Furthermore, through its state-of-the-art educational approach in a rural setting and its focus on cultural competency, UGHE is contributing to progress in the quest for equitable access to quality health services.

  4. Health workers' ICT literacy in a Nigerian University Teaching Hospital

    African Journals Online (AJOL)

    This study investigated the ICT literacy among the health workers of Igbinedion University Teaching Hospital. The emergence of Internet for Telemedicine and health information revolution necessitates that issue of computer and other communication technology literacy among the health workers of Igbinedion University ...

  5. Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of Bangalore city using cluster sampling and lot quality assurance sampling techniques

    Directory of Open Access Journals (Sweden)

    Punith K

    2008-01-01

    Full Text Available Research Question: Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? Objective: To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Study Design: Population-based cross-sectional study. Study Setting: Areas under Mathikere Urban Health Center. Study Subjects: Children aged 12 months to 23 months. Sample Size: 220 in cluster sampling, 76 in lot quality assurance sampling. Statistical Analysis: Percentages and Proportions, Chi square Test. Results: (1 Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2 Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

  6. Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of bangalore city using cluster sampling and lot quality assurance sampling techniques.

    Science.gov (United States)

    K, Punith; K, Lalitha; G, Suman; Bs, Pradeep; Kumar K, Jayanth

    2008-07-01

    Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Population-based cross-sectional study. Areas under Mathikere Urban Health Center. Children aged 12 months to 23 months. 220 in cluster sampling, 76 in lot quality assurance sampling. Percentages and Proportions, Chi square Test. (1) Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2) Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

  7. HPV vaccination coverage of teen girls: the influence of health care providers.

    Science.gov (United States)

    Smith, Philip J; Stokley, Shannon; Bednarczyk, Robert A; Orenstein, Walter A; Omer, Saad B

    2016-03-18

    Between 2010 and 2014, the percentage of 13-17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine ("fully vaccinated") increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine ("not immunized") decreased by 11.3 percentage points to 40.0%. To evaluate the complex interactions between parents' vaccine-related beliefs, demographic factors, and HPV immunization status. Vaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n=8490) were analyzed. HPV vaccination status was determined from teens' health care provider (HCP) records. Among teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (pteen girls administered 1-2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration. Results suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses. Published by Elsevier Ltd.

  8. Geographical accessibility and spatial coverage modeling of the primary health care network in the Western Province of Rwanda

    Directory of Open Access Journals (Sweden)

    Huerta Munoz Ulises

    2012-09-01

    Full Text Available Abstract Background Primary health care is essential in improving and maintaining the health of populations. It has the potential to accelerate achievement of the Millennium Development Goals and fulfill the “Health for All” doctrine of the Alma-Ata Declaration. Understanding the performance of the health system from a geographic perspective is important for improved health planning and evidence-based policy development. The aims of this study were to measure geographical accessibility, model spatial coverage of the existing primary health facility network, estimate the number of primary health facilities working under capacity and the population underserved in the Western Province of Rwanda. Methods This study uses health facility, population and ancillary data for the Western Province of Rwanda. Three different travel scenarios utilized by the population to attend the nearest primary health facility were defined with a maximum travelling time of 60 minutes: Scenario 1 – walking; Scenario 2 – walking and cycling; and Scenario 3 – walking and public transportation. Considering these scenarios, a raster surface of travel time between primary health facilities and population was developed. To model spatial coverage and estimate the number of primary health facilities working under capacity, the catchment area of each facility was calculated by taking into account population coverage capacity, the population distribution, the terrain topography and the travelling modes through the different land categories. Results Scenario 2 (walking and cycling has the highest degree of geographical accessibility followed by Scenario 3 (walking and public transportation. The lowest level of accessibility can be observed in Scenario 1 (walking. The total population covered differs depending on the type of travel scenario. The existing primary health facility network covers only 26.6% of the population in Scenario 1. In Scenario 2, the use of a bicycle

  9. Health facility characteristics and their relationship to coverage of PMTCT of HIV services across four African countries: the PEARL study.

    Directory of Open Access Journals (Sweden)

    Didier K Ekouevi

    Full Text Available Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT coverage in sub-Saharan are poorly understood.We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Côte d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33-68 was correlated with PMTCT quality score (rho = 0.51; p = 0.003; infrastructure quality score (rho = 0.43; p = 0.017; time spent at clinic (rho = 0.47; p = 0.013; patient understanding of medications score (rho = 0.51; p = 0.006; and patient satisfaction quality score (rho = 0.38; p = 0.031. PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091. Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p<0.001 and the PMTCT quality score and patient understanding of medications remained marginally significant.We observed a positive relationship between an antenatal quality score and PMTCT coverage but did not identify

  10. University of Washington Center for Child Environmental Health Risks Research

    Data.gov (United States)

    Federal Laboratory Consortium — The theme of the University of Washington based Center for Child Environmental Health Risks Research (CHC) is understanding the biochemical, molecular and exposure...

  11. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries

    Science.gov (United States)

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-01-01

    Summary Background How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. Methods We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011. Findings Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (tax revenue per year substantially increased the proportion of births with a skilled attendant presen