Does Autonomization of Public Hospitals and Exposure to Market Pressure Complement or Debilitate Social Health Insurance Systems? Evidence from a Low-Income Country

2014 ◽  
Vol 44 (1) ◽  
pp. 73-92 ◽  
Author(s):  
Ardeshir Sepehri
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Social Health Insurance ◽  
Public Hospitals ◽  
Income Country ◽  
Social Health ◽  
Low Income Country ◽  
Market Pressure

Health insurance and treatment seeking behaviour: evidence from a low-income country

2004 ◽  
Vol 13 (9) ◽  
pp. 845-857 ◽  
Author(s):  
Matthew Jowett ◽  
Anil Deolalikar ◽  
Peter Martinsson
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Income Country ◽  
Treatment Seeking ◽  
Low Income Country

scholarly journals Healthcare Systems and Variation in Healthcare Utilization at the End of Life Across Countries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 560-560
Author(s):  
Jennifer Ailshire ◽  
Cristian Herrar ◽  
Margarita Maria Osuna
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Service ◽  
End Of Life ◽  
Low Income ◽  
Health Care Systems ◽  
Social Health Insurance ◽  
Social Health ◽  
Care Utilization ◽  
Care Systems

Abstract With rapid population ageing, providing better end-of-life care (EOLC) is becoming a source of social demand and financial pressure for public and private budgets in many countries. This paper uses data from harmonized end-of-life interviews in the HRS family of studies to assesses variation in health care utilization across different income groups and how they differ across different health care systems. Hospital stay did not vary across health care systems, but nursing home stays were lower in countries with either national or statist social health insurance systems. Hospice use was low in all countries, but particularly in national and social health insurance systems. Lower income was associated with greater use of nursing homes in both the private and social health care systems. Low income was also associated with greater use of hospice in national health service, but lower use in social health service.

scholarly journals DOES MORAL HAZARD OCCOUR IN THE IMPLEMENTATION OF SOCIAL HEALTH INSURANCE? EVIDENCE FROM PUBLIC HOSPITALS IN A RURAL PROVINCE OF INDONESIA

2020 ◽  
Vol 5 (1) ◽  
pp. 24
Author(s):  
Rizanda Machmud ◽  
Syafrawati Syafrawati ◽  
Prof. Syed Mohamed Aljunid ◽  
Rima Semiarty
Keyword(s):  
Health Insurance ◽  
Moral Hazard ◽  
National Health Insurance ◽  
National Health ◽  
Medical Records ◽  
Social Health Insurance ◽  
Public Hospitals ◽  
Social Health ◽  
Severity Level ◽  
Discharge Status

Indonesia is now encountering moral hazard problems in the implementation of social health insurance. BPJS, as the administrator of Indonesia’s National Health Insurance, reported that there was an increase in deficit in the 4 years of the implementation of National Health Insurance from US$ 228 million in 2014 to US$ 470 million in 2016. Despite efforts conducted to overcome the problem, no evidence-based predictor that might be significantly associated with moral hazard in a rural province hospital in Indonesia. The purpose of this research is to identify the incidence of moral hazard in the implementation of National Health Insurance in Indonesia. Data consisting of 180 medical records obtained from three public hospitals in rural province of Indonesia were selected as samples in this study. These medical records were reviewed by Independent Senior Coder (ISC) who had more than 5 years experiences as a coder. The indicators of moral hazard in this study were upcoding, readmission, and possible unnecessary admission. Logistic regression was used to explore determinant of moral hazard from patient, coder, and physician side. The results show that rate of moral hazard cases for upcoding is 10%, readmission is 2.8%, and possible unnecessary admission is 18.9%. It can be seen from multivariate analysis that discharge status, severity level and LOS have a significant relationship with moral hazard. Illness severity level, Discharge against Medical Advice, and higher Length of Stay are risk factors for moral hazard incidence.

Social Health Insurance Difference in Inpatient Expenditure and Service Category in China

2018 ◽  
Vol 30 (1) ◽  
pp. 56-66 ◽  
Author(s):  
Qing Wang ◽  
Jay Shen ◽  
Jennifer Rice ◽  
Kaitlyn Frakes
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Public Hospitals ◽  
Social Health ◽  
Institutional Characteristics ◽  
Inpatient Service ◽  
Care Seeking ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Service Category

China successfully achieved universal health insurance coverage in 2011. Previous work on the effects of social health insurance in China has overlooked the association between health insurance and inpatient service category as well as the mechanisms of institutional characteristics. This study seeks to estimate the social health insurance difference in inpatient expenditure and service category. The role of institutional characteristics was also studied. The logistic model was applied to estimate the association of social health insurance and service category. In addition, Heckman Selected Model and generalized linear model were used to examine the association of health insurance and inpatient expenditure. Estimations were done for 4076 individuals older than 45 years using pooled cross-sectional survey data from the China Health and Retirement Longitudinal Study conducted in 2011 and 2013. Patients with health insurance were more likely to spend more and receive more types of inpatient service. This relationship was partially explained by the institutional characteristics. Therefore, this study highlights the importance of enforcing the regulation of referral mechanisms, the tiered copayment requirement to guide people’s care-seeking behavior, and reforming the allocation of limited health resources between different levels of facilities and also between private and public hospitals.

Poland

2021 ◽  
pp. 745-766
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Public Hospitals ◽  
Social Health ◽  
Health Politics ◽  
Insurance System ◽  
Out Of Pocket Payments ◽  
Healthcare Politics ◽  
Veto Points ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Poland, financed through social health insurance. It traces the development of the Polish healthcare system under communism, characterized by a complete shift from an insurance system to a state-run Soviet Semashko model of healthcare with some elements of private provision. Since 1989, Polish health policy went through systemic changes which included a shift to a decentralized social health insurance system in the late 1990s and re-centralization in 2001. Polish healthcare politics has been turbulent, marked by political instability matched by a dense network of veto points, including the President and the judiciary, that had an impact on the direction of health reforms. As the chapter highlights, some of the main issues have been high out-of-pocket payments, corruption, and privatization and commercialization of public hospitals.

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