How do Chinese people perceive their healthcare system? Trends and determinants of public satisfaction and perceived fairness, 2006–2019

Background The public’s perception of the health system provides valuable insights on health system performance and future directions of improvement. While China’s health care reform was a response to people’s discontent in the health care system due to the lack of accessibility and affordability, little is known on changes in public perception of China’s health system. This paper examines trends in public perception of the health system between 2006 and 2019 and assesses determinants of public perception in China’s health system. Methods Seven waves of the China Social Survey, a nationally representative survey, were used to examine trends in public satisfaction with health care and perceived fairness in health care. Chi-square tests were used to examine differences across waves. Logistic regression models were used to explore determinants of public perception, including variables on sociodemographic characteristics, health system characteristics, and patient experience. Results Satisfaction with health care increased from 57.76% to 77.26% between 2006 and 2019. Perceived fairness in health care increased from 49.79% to 72.03% during the same period. Both indicators showed that the major improvement occurred before 2013. Sociodemographic characteristics are weakly associated with public perception. Financial protection and perceived medical safety are strongly associated with public perception, while accessibility is weakly associated with public perception. Patient experience such as perceived affordability and quality in the last medical visit are strongly associated with public perception of the health care system, while the accessibility of the last medical visit shows no impacts. Conclusion Public satisfaction on health care and perceived fairness in health care in China improved over 2006–2019. The main improvement occurred in accordance with huge financial investments in public health insurance before 2013. Financial protection and perceived quality play significant roles in determining public perception, whereas accessibility and sociodemographic characteristics have limited influence on people’s perception of China’s health system. To achieve higher satisfaction and a higher sense of fairness in health care, China’s health system needs to continue its reforms on hospital incentives and integrated delivery system to control health expenditure and improve health care quality.

Rules and regulations review on micro-takaful scheme development in Malaysia

Purpose This study aims to review Although the features of the first micro-takaful are slightly different from the customary long-established takaful settings, the rules and regulations remain unchanged following the original guidelines of operating insurance and takaful. Until Perlindungan Tenang makes its first premiere, the rules and regulations on micro-takaful are gaining ground. The dissimilarity of micro-takaful from the original takaful calls for updated guidelines, so that any micro-takaful scheme launched in the market meets the demand and needs of the targeted population. the current rules and regulations on micro-takaful in Malaysia to determine whether it addresses the basic principles of micro-takaful. Design/methodology/approach This study uses content analysis as the best method to review each guideline in the related rules and regulations across several documents such as microinsurance and micro-takaful discussion paper and guidelines on family takaful products. Findings Overall, the findings reveal that guidelines on micro-takaful operating in Malaysia support the micro-takaful requirement to be affordable, valuable, accessible, understandable and simplified. Matching the rules and regulations with this population feedback, the extended distribution channel may need further scrutiny due to deficit trust among public members toward insurance and takaful. Originality/value The insights presented are of important illumination to achieve long-term sustainability financial protection while preserving human well-being among those underserved.

IN SEARCH OF A FINANCIAL PROTECTION MODEL FOR OLD AGE

Discussions about the shortcomings of the pension system and its design raise the question of how to ensure a dignified life after working life. According to the currently adopted model of old age security, the responsibility is generally placed on the state and its structures. A number of questions arise in this context, in particular whether this is a rational approach from the point of view of its optimality, or whether the responsibility should not be distributed among various actors: public authorities, employers, employees or someone else.

From Personal Responsibility to Political Mobilization: Using Attribution Frames to Overcome Policy Feedback Effects

Public policies that promote personal responsibility while minimizing government responsibility are a key feature of modern American political economy. They can decrease Americans’ political participation on a given issue, with detrimental consequences for the wellbeing of economically insecure families. Can this pattern be overcome? I argue that attribution frames highlighting government’s role in and responsibility for policies may increase people’s propensity for political action on an issue, but only if the frame can increase the salience of their preexisting beliefs about government intervention. Drawing on the case of consumer financial protection, I administer an experiment to determine the effect of attribution framing on people’s willingness to act in support of a popular banking reform. I find that helping people draw parallels between an issue they feel responsibility for and one they accept government responsibility for can boost political engagement on behalf of the original policy.

Costs incurred by patients with oral potentially malignant disorders: is there a public health need for financial protection in India?

Objectives Financial protection mechanisms are in place to overcome the costs of a few diseases in India. Our objective was to estimate the costs incurred due to Oral Potentially Malignant Disorders (OPMD) and to determine predictors of such costs. Results We found that the median (Interquartile range IQR) total costs of OPMD was Indian Rupees (INR) 500 (350–750), direct medical costs was INR 0 (0–50), direct non-medical costs was INR 150 (40–200) and indirect costs was INR 350 (250–500). The travel cost to attend the health facilities [INR 100 (40–150)] and the patient’s loss of wages [INR 200 (150–400)] mainly accounted for the direct non-medical and indirect costs respectively. The median expenditure on smokeless and smoking forms of tobacco was INR 6000 (5400–7200) and INR 2400 (1800–3600) respectively. On multiple linear regression analysis, rural residence, belonging to below poverty line family, being a sole earner in the family, number of months since diagnosis and first visit at a private provider were found to be the significant predictors of total costs of OPMD. Financial protection mechanisms are needed for covering the direct non-medical and indirect costs. Early management of OPMD might mitigate the costs of OPMD.

Recognition and Analysis of the Drivers and Key Factors Affecting Exposure Households with Catastrophic and Impoverishing Health Expenditure in Iran with the Futures Study Approach Protocol (Preprint)

BACKGROUND Health expenditure is a vital issue for policymakers not as it were due to the health outcome significance, but moreover since of the gradual total health expenditure rises that has ended up a major concern. To survey the financial related burden due to out-of-pocket payments, two commonly elite approaches have been utilized: catastrophic and impoverishing health expenditures. Catastrophic healthcare expenditures and impoverishment both can prevent individuals from accessing effective healthcare services. In Iran, the high out-of-pocket and increase in the share of the population experiencing catastrophic healthcare expenditures and poor financial protection of households against catastrophic healthcare expenditures are among the major public health concerns. To identify the drivers, key factors, and the trends of catastrophic and impoverishing healthcare expenditures among Iranian households, this study will be conducted by futures studies approach. OBJECTIVE - To identify the key drivers affecting the future of catastrophic and impoverishing healthcare expenditure in Iran. - To assess the trend in the incidence and intensity of CHE in Iran. - To categorize the key drivers - To prioritize main promoter factors in terms of importance, effectiveness and lack of uncertainty. METHODS This study will conduct in four steps. The drivers of the future of Exposure Households with Catastrophic and Impoverishing Health Expenditure will be listed by analyzing the results of a scoping review and then semi-structured interviews with health financial experts. Afterward, key drivers will be categorized using Porter's five forces (social, technical, economic, environmental, and political) for the macro environment and prioritized using the Fuzzy Analytical Hierarchy Process (FAHP) formulated in excel software. Further, cross-impact analysis of promoter factors and analytic hierarchy process will be used to determine main promoter factors in terms of importance, effectiveness, and lack of uncertainty. RESULTS We anticipate that the results of this protocol study will provide a comprehensive overview of the evidence on the determinants of unfairness and payments that expose the Iranian households to catastrophic and impoverishing health care expenditures and identify research gaps. CONCLUSIONS In our study, we will examine the rates of catastrophic health expenditure and impoverishment from medical expenses and its drivers in Iran. This will provide insight into the level of financial protection that a healthcare financing system provides for its citizens. It reflects the financial burden shouldered by families and the financial barriers that reduce their access to health care.