Winners and Losers of Universal Health Insurance: A Macroeconomic Analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Wung Lik Ng ◽  
Yin-Chi Wang
Keyword(s):  
Health Insurance ◽  
Service Sector ◽  
Medical Service ◽  
Specialty Choice ◽  
Universal Health Insurance ◽  
Overlapping Generations Model ◽  
Macroeconomic Analysis ◽  
The Cost ◽  
Universal Health

AbstractThis paper studies the supply-side distortions and the consequences resulted from provider-side cost containing universal health insurance (UHI) scheme. A two-sector overlapping generations model of endogenous physicians’ specialty choice is presented. We find that the general public is possible to be benefited from the cost containing UHI if the quality of medical services does not deteriorate too much. However, physicians in the medical service sector suffer from such scheme and end up earning lower incomes, regardless of one’s specialty and talent. Inequality among physicians also increases.

scholarly journals Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042084
Author(s):  
I-Anne Huang ◽  
Yiing-Jenq Chou ◽  
I-Jun Chou ◽  
Yu-Tung Huang ◽  
Jhen-Ling Huang ◽  
...  
Keyword(s):  
Health Insurance ◽  
Paediatric Population ◽  
Population Based ◽  
Universal Health Insurance ◽  
Cross Sectional ◽  
Single Payer ◽  
Insurance Programme ◽  
Ed Visits ◽  
Cross Sectional Design ◽  
Universal Health

ObjectivesEmergency services utilisation is a critical policy concern. The paediatric population is the main user of emergency department (ED) services, and the main contributor to low acuity (LA) ED visits. We aimed to describe the trends of ED and LA ED visits under a comprehensive, universal health insurance programme in Taiwan, and to explore factors associating with potentially unnecessary ED utilisation.Design and settingWe used a population-based, repeated cross-sectional design to analyse the full year of 2000, 2005, 2010 and 2015 National Health Insurance claims data individually for individuals aged 18 years and under.ParticipantsWe identified 5 538 197, 4 818 213, 4 401 677 and 3 841 174 children in 2000, 2005, 2010 and 2015, respectively.Primary and secondary outcome measuresWe adopted a diagnosis grouping system and severity classification system to define LA paediatric ED (PED) visits. Generalised estimating equation was applied to identify factors associated with LA PED visits.ResultsThe annual LA PED visits per 100 paediatric population decreased from 10.32 in 2000 to 9.04 in 2015 (12.40%). Infectious ears, nose and throat, dental and mouth diseases persistently ranked as the top reasons for LA visits (55.31% in 2000 vs 33.94% in 2015). Physical trauma-related LA PED visits increased most rapidly between 2000 and 2015 (0.91–2.56 visits per 100 population). The dose–response patterns were observed between the likelihood of incurring LA PED visit and either child’s age (OR 1.06–1.35 as age groups increase, p<0.0001) or family socioeconomic status (OR 1.02–1.21 as family income levels decrease, p<0.05).ConclusionDespite a comprehensive coverage of emergency care and low cost-sharing obligations under a single-payer universal health insurance programme in Taiwan, no significant increase in PED utilisation for LA conditions was observed between 2000 and 2015. Taiwan’s experience may serve as an important reference for countries considering healthcare system reforms.

scholarly journals A qualitative inquiry of access to and quality of primary healthcare in seven communities in East and West Africa (SevenCEWA): perspectives of stakeholders, healthcare providers and users

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Soter Ameh ◽  
Bolarinwa Oladimeji Akeem ◽  
Caleb Ochimana ◽  
Abayomi Olabayo Oluwasanu ◽  
Shukri F. Mohamed ◽  
...  
Keyword(s):  
Health Insurance ◽  
West Africa ◽  
Primary Healthcare ◽  
A Priori ◽  
Healthcare Providers ◽  
Health Coverage ◽  
Health Seeking ◽  
East And West ◽  
Universal Health

Abstract Background Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in East and West Africa. The aim of this study was to describe the viewpoints of healthcare users, healthcare providers and other stakeholders on health-seeking behaviour, access to and quality of healthcare in seven communities in East and West Africa. Methods A qualitative study was conducted in four communities in Nigeria and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit: 155 respondents (mostly healthcare users) for 24 focus group discussions, 25 healthcare users, healthcare providers and stakeholders for in-depth interviews and 11 healthcare providers and stakeholders for key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four ‘As’ of access to care, and pathway model to better understand the a priori themes on access to and quality of primary healthcare as well as health-seeking behaviours of the study respondents. A content analysis of the data was done using MAXQDA 2018 qualitative software to identify these a priori themes and emerging themes. Results Access to primary healthcare in the seven communities was limited, especially use of health insurance. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Health providers and users as well as stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in the Nigerian sites. Conclusions There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery that address social and health inequities, through affordable health insurance, can be used to fill this gap and facilitate achieving universal health coverage.

BPJS Kesehatan Memberikan Jaminan Kesehatan Terhadap Pasien Atau Masyarakat

2021 ◽  
Vol 7 (2) ◽  
pp. 146-154
Author(s):  
Aidha Puteri Mustikasari
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Social Security ◽  
The State ◽  
Universal Health Care ◽  
Universal Health Insurance ◽  
Universal Health ◽  
Provide Health Insurance

Abstrak. Kepesertaan BPJS Kesehatan pada tahun 2020 tidak akan mencakup 90% penduduk Indonesia, namun rencana Universal Health Care Implementation (UHC) telah direncanakan sejak tahun sebelumnya. Di masa pandemi Covid, sejumlah besar status kepesertaan BPJS Kesehatan  dicabut karena terlambat, padahal masyarakat membutuhkan layanan kesehatan dan asuransi dengan kondisi yang ada. Kajian ini bersifat norma deskriptif , dibahas dalam konteks kepesertaan BPJS kesehatan, dan cukup  menggunakan prinsip asuransi dengan hanya memberikan jaminan kepada peserta, tetapi negara mengikuti kewajiban UUD 1945 yaitu memberikan jaminan kesehatan dan pelayanan kepada warga negara. Untuk mendukung keberadaan jaminan kesehatan universal, Indonesia perlu menerapkan formulir kepesertaan dan  sanksi untuk ketentuan wajib  peserta jaminan sosial yang efektif dan efisien. Abstract. BPJS Health membership in 2020 will not cover 90% of Indonesia's population, but the Universal Health Care Implementation (UHC) plan has been planned since the previous year. During the Covid pandemic, a large number of BPJS Health membership statuses were revoked because they were late, even though people needed health services and insurance with the existing conditions. This study is descriptive in nature, discussed in the context of BPJS health participation, and it is sufficient to use the insurance principle by only providing guarantees to participants, but the state follows the obligations of the 1945 Constitution, namely to provide health insurance and services to citizens. To support the existence of universal health insurance, Indonesia needs to implement an effective and efficient membership form and sanctions for mandatory provisions for social security participants.

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