Features of health insurance: an analysis of the German experience

The article examines the models of health insurance in Western countries. A comparative analysis of forms of social insurance and sources of financing payments for four models of medical insurance is carried out. The practical aspects of the functioning of compulsory health insurance in Germany are investigated, its positive features are revealed. Attention is paid to medical insurance, which provides insurance in case of loss of health for any reason. It provides greater accessibility, quality and completeness to meet the diverse needs of the population in the provision of medical services, and is more effective than government funding of the health care system. In addition, the social and economic efficiency of health insurance related to reimbursement of citizens' expenses related to receiving medical care, as well as other expenses aimed at maintaining health, depends on how comprehensively the concept of developing insurance medicine in the country has been worked out. The positive and negative aspects of health insurance are analyzed. The forms of health insurance are considered: compulsory health insurance and voluntary health insurance. It was found that one of the first countries where health insurance was introduced was Germany. There are two types of health insurance in Germany: public and private. Germany's state health insurance is compulsory. That is, every employee, as well as persons trained in production (Auszubildende), are subject to compulsory state health insurance and must be members of one of their freely chosen state health insurance funds. At the same time, if a person wishes to receive medical services that are not included in the list of compulsory health insurance, he can conclude a supplementary health insurance contract with the insurance company. Voluntary health insurance allows you to choose an inpatient medical institution and the conditions of stay in it, special services of a personal physician.

Predictors of Health Insurance Literacy Among University Employees

Background: Health insurance literacy (HIL) is “the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about plans, select the best plan for their own or their families’ financial and health circumstances and use the plan once enrolled”. Many Americans have low health insurance literacy, but this concept has not been studied to the same extent as general health literacy. Objective: The purpose of this study was to explore predictors of health insurance literacy among employees of a large public institution of higher education in the South-Atlantic. Design: This single-setting cross-sectional study employed an online, anonymous survey administered to approximately 3,000 employees at a large university in the USA after open enrollment in state health insurance. The survey measured demographics and included a validated measure of health insurance literacy. Results: Using several multivariate regression models, results (N=480) indicated high overall HIL. Subscale means were highest for likelihood of using insurance plans proactively and confidence comparing insurance plans but were lower for confidence choosing and using insurance plans, indicating lack of understanding that may lead to poor insurance coverage choice and use. Employment category, income, race, and age also predicted HIL. Discussion: Based on the results, there is an opportunity for employers to provide information about health insurance policies. Health promotion programs should also seek to increase HIL through educational programs and policies to ensure both adequate coverage and ability to use health insurance in such a way that it promotes and protects one’s health.

Home Mechanical Ventilation: Results of A National Program In Adults (2008 to 2017), Ministry of Health, Chile

Background: Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF) of different causes. The Chilean Ministry of Health started in 2006 a program for HMV in Children and in 2008 it began a program for HMV in adults. All belonged to the state health insurance.Methods: Prospective cohort of adult patients with CRF in 10 regions of Chile admitted to the national HMV program, their demographic, clinical and functional characteristics, mode of admission, time in the program and survival.Results: A total of 1,105 patients were included. Median age was 59 years (44-58, IQR1-IQR3). Women were 58.1%. The body mass index was 34.9 (26-46) kg/m2, and 942 (85.4%) belonged to low-income socioeconomic groups. The baseline score on the Severe Respiratory Insufficiency questionnaire (SRI) was 47 (35-62.1) points, 98.5% lived in urban areas, 76.2% initiated HMV in the stable chronic mode, 23.8% in the acute mode and 99 patients were transferred from the children's program. There were 1047 patients on noninvasive ventilation and 58 on invasive ventilation through tracheostomy. Baseline PaCO2 was 58.2 (52-65) mmHg. Device usage time was 7.3 h/d (5.8-8.8), the time in HMV was 21.6 (12.2-49.5) months. The diagnostic groups were COPD, 35%; obesity hypoventilation syndrome (OHS), 23.9%; neuromuscular disease (NMD) 16.3%; non-cystic fibrosis bronchiectasis or tuberculosis (non-CF BC or TBC) 8.3%; Scoliosis, 5.9%; and Amyotrophic Lateral Sclerosis (ALS) 5.24%. The lowest 1- and 3-year survival rates were observed in the ALS group, i.e., 67% and 26%, respectively, and the lowest 9-year survival was observed in the non-CF BC or TB and COPD, 27% and 30.9%, respectively. The best survival rates at 9 years were 57.7%, 57.2% and 50.9% for patients with OHS, Scoliosis and NMD, respectively.Conclusion: The most common diagnoses were COPD and OHS. Patients were hypercapnic and had poor quality of life at program admission. The best survival was observed in patients with OHS, Scoliosis and NMD.

Matrix for direct-to-consumer telemedicine quality assessing

Introduction. The growing demand for online medical services, the active inclusion of telemedicine consultations in state health insurance programs, and the general intensive development of telemedicine require a methodology for quality assurance and control. Objective is to develop a methodological basis for a comprehensive assessment of the quality and effectiveness of direct-to-consumer telemedicine consultations. Material and methods. There are sources of primary data: systematizing scientific publications (descriptions of models and methodologies for telemedicine quality assessing); own theoretical researches, accumulated practical experience with of directto-consumer telemedicine. Methods of analysis and synthesis have been use. Results and discussion. The matrix for for direct-to-consumer telemedicine quality assessing has formed. It includes four domains «Accessibility», «Efficiency», «Safety» and «Responsibility» from the standpoint of all participants of the distant interaction processes: patient and/or legal representative; medical consultant; operator of a telemedicine information system; medical organization; health care system (society). The matrix takes into account the aspects of goal-setting and the interests of each participant. There are structured metrics in frame of each domain. Conclusions. The matrix can be used as a basis for scientific research and as a methodology for internal and departmental quality control of medical care provided via telemedicine technologies.

ETHICAL ASPECTS OF COMMERCIAL SURROGACY

Surrogacy is an initiated process, whereby intended parents wish to have a child by having an embryo carried in another woman’s womb and, after the birth, the baby is given to the intended parents. In Israel, giving birth and motherhood are perceived to great extent as a significant, essential and natural component of female identity and the existence of children is perceived as a vital and central element of couple-hood and family. The Israeli society encourages fertility and family expansion. This is illustrated by the support of surrogacy and fertility treatments pursuant to the Israeli Embryo Carrying Agreement Law (Agreement Authorization and Status of the Newborn Child) legislated in 1996. On the other hand, the government limits the supply of contraceptives that are included in the authorized list of medicines, pursuant to the State Health Insurance Law (Ministry of Health, 1994). Surrogacy constitutes a solution for people who wish to give birth to a child but they are unable to do so. The issue raises ethical dilemmas in the global village in which we are living. This dilemma has become more prominent in the present age, due to the corona virus crisis that entailed cancelling all flights and forcing each country to close its borders to foreign travelers. In this study, the aim is to explore and comprehend the process of surrogacy according to the economic sociological theory, called the agency theory; the relationships between the parties to the agreement; and the ethical issues stemming from this issue.

Moral Hazard on Public Health Insurance: Evidence from BPJS in Indonesia

In early 2014 State Health Insurance program was launched by Indonesian Government. The program is called Badan Penyelenggara Jaminan Sosial (BPJS). The mission of the BPJS is that in the end of 2019 all Indonesian People are already covered by the State Health Insurance. This research is aimed to investigate that moral hazard is inevitable from the public health insurance. Using convenience method, 1011 data were collected. There are 893 member of BPJS, and there are 117 were not member of BPJS yet. One is datum missing. Cross-Tabulation and Chi-Square are employed to test the availability of moral hazard. It is found out that moral hazard is inevitable in the health insurance of BPJS. They are who are already member of BPJS tend to visit doctor frequently than that they are who are not member yet. They are whose premium are paid out of pocket tend to visit doctor more frequently than that they are whose premium is partly or totally paid by other parties

General-Compulsory Medical Insurance: World Experience

Given the insufficient level of regulation of the health insurance institute in Ukrainian legislation, the article attempts to investigate global experience in the context of this issue. In particular, a number of international documents were investigated, their content was characterized and the main provisions were highlighted. Based on collected and analyzed data, the authors outlined the areas of adaptation of Ukrainian legislation to the highest standards of the EU, made a proposal for the ratification of the conventions of the International Labor Organization. Supported a proposal for the development and adoption of a separate special law on general-compulsory state health insurance, which would regulate issues related to health insurance.