Actuarial cost and fiscal impact of expanding the Jordan Civil Insurance Programme for health coverage to vulnerable citizens

Yara Halasa-Rappel; Taisser Fardous; Manal Jrasat

doi:10.26719/2020.26.2.206

Occurrence of Medical Cases and Utilisation among Enrollees of Private Health Insurance Programme in Kaduna, Nigeria

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2020/v18i630215 ◽

2020 ◽

pp. 30-37

Author(s):

Oni, Oluwatobi Dapo ◽

Zakari, Mustapha Mohammed ◽

Okemmiri, Innocentia Chidinma

Keyword(s):

Health Insurance ◽

Private Health Insurance ◽

Healthcare Providers ◽

Healthcare Services ◽

Health Coverage ◽

Primary Case ◽

Health Maintenance ◽

Insurance Programme ◽

Chi Square Analysis ◽

Health Insurance Programme

Aims: This study examines the occurrence of various medical cases presented by enrollees that have subscribed to access healthcare from a network of healthcare providers (HCPs) managed by a Health Maintenance Organisation (HMO) under its Private Health Insurance Programme (PHIP). Study Design: A descriptive cross-sectional design was employed. Methodology: Secondary data from collected or submitted medical encounters in form of bills of registered enrollees (principals and their dependants) who have visited and received treatment from their chosen healthcare providers in Kaduna State between the month of January and December 2019 were purposively compiled and analysed. Cases were classified using the National Health Insurance Scheme (NHIS) Operational Guideline. Frequency tables, charts, percentages and Chi-Square analysis were used with the aid of Statistical Package for Social Sciences (SPSS) 22 at P=.05 level of significance. Results: A total of 11,156 medical cases were recorded after attrition, 9,525 (85.38%) primary cases and 1,632 (14.62%) secondary cases. Malaria (41.23%) and Respiratory Tract Infection (11.98%) led the primary case table while Hypertension (3.83%) Urology related cases (2.49%) and Diabetes (0.79%) were among the leading secondary cases. Female enrollees had slightly more cases and therefore higher tendencies to seek medical treatment than their male counterpart even though there was no significant relation between gender and type of case. Conclusion: The study concludes that the awareness and utilization of healthcare services are gradually growing among enrollees under the Private Health Insurance Programme (PHIP). In ensuring that there is an improvement in the health sector of Nigeria and achieving universal health coverage, focus should be on the primary healthcare services with high consideration for research, proper data management and periodic sharing of trends, observations and outcome of researches with the growing health community.

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Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2019.49 ◽

2019 ◽

Vol 8 (10) ◽

pp. 593-606 ◽

Cited By ~ 1

Author(s):

Emmanuel Nshakira-Rukundo ◽

Essa Chanie Mussa ◽

Nathan Nshakira ◽

Nicolas Gerber ◽

Joachim von Braun

Keyword(s):

Developing Countries ◽

Health Insurance ◽

Negative Binomial ◽

Health Coverage ◽

Network Information ◽

Health Insurance Premiums ◽

Insurance Programme ◽

National Health Insurance Programme ◽

The Government ◽

Western Uganda

Background: The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households’ decisions to enrol and renew membership in these schemes. Methods: We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. Results: Results revealed that household’s socioeconomic status, husband’s employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. Conclusion: While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.

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The actuarial cost and fiscal impact of expanding the Jordan Civil Insurance Program for health coverage to vulnerable citizens

Eastern Mediterranean Health Journal ◽

10.26719/emhj.19.044 ◽

2019 ◽

Author(s):

Yara A. Halasa-Rappel ◽

Taisser Fardous ◽

Manal Jrasat ◽

Ihab Al-Halaseh ◽

Muien Abu-Shaer ◽

...

Keyword(s):

Health Coverage ◽

Fiscal Impact ◽

Insurance Program

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The prominent role of informal medicine vendors despite health insurance: a weekly diaries study in rural Nigeria

Health Policy and Planning ◽

10.1093/heapol/czz172 ◽

2020 ◽

Vol 35 (3) ◽

pp. 354-363

Author(s):

Heleen E Nelissen ◽

Daniëlla Brals ◽

Hafsat A Ameen ◽

Marijn van der List ◽

Berber Kramer ◽

...

Keyword(s):

Health Insurance ◽

Universal Health Coverage ◽

Insurance Coverage ◽

Health Expenditures ◽

Insurance Status ◽

Health Coverage ◽

Rural Nigeria ◽

Informal Providers ◽

Insurance Programme ◽

Universal Health

Abstract In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.

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