scholarly journals Financial Risk Protection from Social Health Insurance

2016 ◽  
Author(s):  
Kayleigh Barnes ◽  
Arnab Mukherji ◽  
Patrick Mullen ◽  
Neeraj Sood
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Social Health Insurance ◽  
Social Health ◽  
Financial Risk Protection ◽  
Risk Protection

Healthcare System Challenges in Asia

2019 ◽  
Author(s):  
Winnie Yip
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Financial Risk ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
The Philippines ◽  
Social Health ◽  
Equitable Access ◽  
Financial Risk Protection ◽  
Risk Protection

Important health system challenges in the east and southeast Asian countries/territories of Japan, South Korea, Taiwan, Hong Kong, Malaysia, China, Thailand, Vietnam, Indonesia, the Philippines, Laos, Myanmar, and Cambodia exist. The most commonly adopted health system among these areas is social health insurance. The high-income, aging societies of Japan, South Korea, and Taiwan have adopted single-payer/single-pipe systems with a single uniform benefit package and a single fee schedule for paying providers for services included in the benefit package. All three have achieved universal coverage with relatively equitable access to affordable care. All grapple with overutilization, aging populations, and hospital-centric and curative-focused care that is ill-suited for addressing an increasing chronic disease burden. Rising patient expectations and demand for expensive technologies contribute to rising costs. Korea also faces comparatively poorer financial risk protection. China, Thailand, Vietnam, Indonesia, and the Philippines have also adopted social health insurance, though not single-payer systems. China and Thailand have established noncontributory schemes, whereby the government heavily subsidizes poor and non-poor populations. General tax revenue is used to extend coverage to those outside formal-sector employment. Both countries use multiple, unintegrated schemes to cover their populations. Thailand has improved access to care and financial risk protection. While China has improved insurance coverage, financial risk protection gains have been limited due to low levels of service coverage, fee-for-service payment systems, poor gatekeeping, and the fee schedule that incentivizes overprescription of tests and medicine. Indonesia, Vietnam, and the Philippines use contributory schemes. Government revenue provides insurance coverage for the poor, near-poor, and selected vulnerable populations; the rest of the population must contribute to enroll. Therefore, expanding insurance coverage to the informal sector has been a significant challenge. Instead of social health insurance, Hong Kong and Malaysia have two-tiered health systems where the public sector is financed by general tax revenue and the private sector is financed primarily by out-of-pocket payments and limited private insurance. There is universal access to care; free or subsidized, good-quality public-sector services provide financial risk protection. However, Hong Kong and Malaysia have fragmented delivery systems, weak primary care, budgetary strains, and inequitable access to private care (which may offer shorter wait times and better perceived quality). Laos, Cambodia, and Myanmar’s health systems feature high out-of-pocket spending, low government investment in health, and reliance on external aid. User fees, low insurance coverage, unequal distribution of health services, and fragmented financing pose pressing challenges to achieving equitable access and adequate financial risk protection. These countries/territories are diverse in terms of demographics, epidemiological profiles, and stages of economic development, and thus they face different health system challenges and opportunities. This diversity also suggests that these nations/territories will utilize different types of health systems to achieve universal health coverage, whereby all people have equitable access to affordable, good-quality care with adequate financial risk protection.

scholarly journals Financial risk protection from social health insurance

2017 ◽  
Vol 55 ◽  
pp. 14-29 ◽  
Author(s):  
Kayleigh Barnes ◽  
Arnab Mukherji ◽  
Patrick Mullen ◽  
Neeraj Sood
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Social Health Insurance ◽  
Social Health ◽  
Financial Risk Protection ◽  
Risk Protection

Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection

Health Policy ◽  
2011 ◽  
Vol 99 (3) ◽  
pp. 203-209 ◽  
Author(s):  
Priyanka Saksena ◽  
Adélio Fernandes Antunes ◽  
Ke Xu ◽  
Laurent Musango ◽  
Guy Carrin
Keyword(s):  
Health Insurance ◽  
Access To Care ◽  
Financial Risk ◽  
Financial Risk Protection ◽  
Risk Protection

scholarly journals Equity in Health Benefit Utilization and Financial Risk Protection in Outpatient and Inpatient Care: Baseline Survey of Two Socioeconomic Groups of a Pilot Primary Care Benefits Scheme in the Catchment Areas of a University-Based Health Facility

2020 ◽  
Vol 53 (1) ◽  
Author(s):  
Jose Rafael A. Marfori ◽  
Antonio Miguel L. Dans ◽  
Mica Olivine C. Bastillo ◽  
Ramon Pedro P. Paterno ◽  
Mia P. Rey ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Facility ◽  
Financial Risk ◽  
Health Benefit ◽  
Income Group ◽  
The Philippines ◽  
Financial Risk Protection ◽  
Risk Protection

Background. Health inequities in the Philippines are driven by health workforce maldistribution and health system fragmentation. These can be addressed by strengthening primary care through central social health insurance (PhilHealth) coverage. However, high reported PhilHealth population coverage and health provider accreditation have not necessarily increased health benefit utilization or financial risk protection. Objective. This study aims to examine the impact of an enhanced, comprehensive primary care benefits package at a university-based health facility. This paper reports baseline utilization of health services and health benefits, and out-of-pocket health spending in two socioeconomic strata of the catchment population, for outpatient and inpatient services. Methods. A questionnaire-guided survey was done among randomly selected faculty (higher income group) and non-faculty (lower income group) employees to determine the frequencies and costs of using outpatient and inpatient health services, and amounts paid out-of-pocket. Results. Annually, both groups had approximately 1 consultation/patient and about 15 hospitalizations per 100 families annually. For hospitalizations, non-faculty inpatients utilized health insurance more frequently than faculty inpatients (75.7% vs. 66.7%), but paid higher out-of-pocket proportions (73.3% or Php 92,479/hospitalization vs. 57.4% or Php 16,273/hospitalization). For outpatient care, health benefit utilization rates were higher among non-faculty (12.4% vs 2.1% of consultations) although low overall, with similar total (Php 2,319 vs Php 1,741) and out-of-pocket expenses (100%). Conclusion. These findings confirm inequities in accessing outpatient and inpatient health services and utilizing health insurance benefits in the target population.

scholarly journals Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0170996 ◽  
Author(s):  
Shankar Prinja ◽  
Akashdeep Singh Chauhan ◽  
Anup Karan ◽  
Gunjeet Kaur ◽  
Rajesh Kumar
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Healthcare Utilization ◽  
Financial Risk ◽  
Financial Risk Protection ◽  
Risk Protection
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