-
International Journal For Equity in... Feb 2021Fragmentation in health insurance system may lead to inequity in financial access to and utilization of health care services. One possible option to overcome this... (Review)
Review
BACKGROUND
Fragmentation in health insurance system may lead to inequity in financial access to and utilization of health care services. One possible option to overcome this challenge is merging the existing health insurance funds together. This article aims to review and compare the experience of South Korea, Turkey, Thailand and Indonesia regarding merging their health insurance funds.
METHODS
This was a cross-country comparative study. The countries of the study were selected purposefully based on the availability of data to review their experience regarding merging health insurance funds. To find the most relevant documents about the subject, different sources of information including books, scientific papers, dissertations, reports, and policy documents were studied. Research databases including PubMed, Scopus, Google Scholar, Science Direct and ProQuest were used to find relevant articles. Documents released by international organizations such as WHO and World Bank were analyzed as well. The content of documents was analyzed using a data-driven conventional content analysis approach and all details regarding the subject were extracted. The extracted information was reviewed by all authors several times and nine themes emerged.
RESULTS
The findings show that improving equity in health financing and access to health care services among different groups of population was one of the main triggers to merge health insurance funds. Resistance by groups enjoying better benefit package and concerns of workers and employers about increasing the contribution rates were among challenges ahead of merging health insurance funds. Improving equity in the health care financing; reducing inequity in access to and utilization of health care services; boosting risk pooling; reducing administrative costs; higher chance to control total health care expenditures; and enhancing strategic purchasing were the main advantages of merging health insurance funds. The experience of these countries also emphasizes that political commitment and experiencing a reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging are required to facilitate implementation of merging health insurance funds.
CONCLUSIONS
Other contributing health reforms should be implemented simultaneously or sequentially in both supply side and demand side of the health system if merging is going to pave the way reaching universal health coverage.
Topics: Financial Management; Healthcare Financing; Humans; Indonesia; Insurance, Health; Thailand; Turkey
PubMed: 33637090
DOI: 10.1186/s12939-021-01382-w -
Croatian Medical Journal Feb 2001A period of changes in what had previously been public health insurance began in Slovenia in 1992. A new legislation introduced a mixed public-private insurance, the... (Review)
Review
A period of changes in what had previously been public health insurance began in Slovenia in 1992. A new legislation introduced a mixed public-private insurance, the share of GDP allocated for health care insurance in Slovenia equaled the EU average, and the financing of the public health insurance has been balanced up - until now. For the first time since Slovenia gained independence, the compulsory health insurance is planning a 6% reduction in its income. The way to the solution of the problem lies in a political consensus on the public health issues in Slovenia, but it is still unclear whether it can be reached. A successful political agreement on the adequate amount of health care, granted to the Slovenian citizens by the public health insurance, should secure its balanced financing, which is about to be disturbed.
Topics: Croatia; Delivery of Health Care; Health Care Reform; Health Expenditures; Humans; Insurance, Health; Insurance, Health, Reimbursement; Policy Making
PubMed: 11172651
DOI: No ID Found -
JAMA Aug 2018
Topics: Financing, Government; Health Insurance Exchanges; Humans; Insurance; Insurance Coverage; Insurance, Health; Patient Protection and Affordable Care Act; State Government; United States
PubMed: 29987334
DOI: 10.1001/jama.2018.8117 -
Postgraduate Medicine Feb 1989
Topics: Costs and Cost Analysis; Insurance, Health; United States
PubMed: 2915967
DOI: 10.1080/00325481.1989.11700590 -
JAMA Feb 2015
Topics: Data Collection; Health Insurance Exchanges; Health Literacy; Insurance, Health; Patient Protection and Affordable Care Act; United States
PubMed: 25668248
DOI: 10.1001/jama.2014.17419 -
Journal of Global Health Dec 2020
Review
Topics: COVID-19; Humans; Insurance, Health; Pandemics; Senegal
PubMed: 33214897
DOI: 10.7189/jogh.10.020394 -
The Lancet. Oncology Nov 2020
Topics: Cancer Survivors; Humans; Insurance, Health; Medically Uninsured; Patient Protection and Affordable Care Act; Policy Making; Politics; Time Factors; United States
PubMed: 33069279
DOI: 10.1016/S1470-2045(20)30623-9 -
Journal of Health Economics Jan 2018In exchange for tax exemptions, Blue Cross and Blue Shield (BCBS) health insurers were expected to provide health insurance to the "bad risks," those for whom coverage...
In exchange for tax exemptions, Blue Cross and Blue Shield (BCBS) health insurers were expected to provide health insurance to the "bad risks," those for whom coverage was unavailable from other insurers. I present evidence that five years after a BCBS plan converted to for-profit status, the probability of having insurance was 1.4 percentage points higher, a 9% reduction in the uninsured. The increase in coverage does not mask reductions among populations often targeted by public policies. However, there is evidence of increased risk selection which suggests that the bad risks might have been worse off after a conversion.
Topics: Adult; Blue Cross Blue Shield Insurance Plans; Female; For-Profit Insurance Plans; Humans; Insurance Coverage; Insurance, Health; Male; Medically Uninsured; United States
PubMed: 29182936
DOI: 10.1016/j.jhealeco.2017.09.001 -
Issue Brief (Health Policy Tracking... Dec 2018
Topics: Antitrust Laws; Drug Costs; Emergency Medical Services; Health Facility Merger; Health Insurance Exchanges; Humans; Insurance Benefits; Insurance Carriers; Insurance Coverage; Insurance, Health; Insurance, Pharmaceutical Services; Medicare; Patient Navigation; Patient Protection and Affordable Care Act; Preexisting Condition Coverage; Privacy; Small Business; State Government; Taxes; United States
PubMed: 30681303
DOI: No ID Found -
Croatian Medical Journal Jun 1999This paper advances a new concept in health insurance. Health status insurance is a health insurance whose primary aim is to improve health status and decrease...
This paper advances a new concept in health insurance. Health status insurance is a health insurance whose primary aim is to improve health status and decrease inequality in health within the covered population. Redistribution and control of cost is a secondary aim, closely integrated with the health status aim. Health status insurance differs from conventional health insurance in four respects: 1) the health status and health risks of enrollees are assessed and individual plans are developed jointly by the providers and enrollees to raise their health status to a given level; 2) interventions are not limited to the patients, but they extend to the patients' physical and social environments; 3) supplementary income or help in organizing are provided to enrollees who do not have an income sufficient to maintain their health or who need help to overcome local environmental situations adverse to their health, respectively; and, 4) the health status insurance organization actively champions national policies to change the social environment for the improvement of health. The concept of health status insurance is applicable to national health insurance systems, large private health insurance systems, or, national health service (when the responsible governmental agency becomes the health status insurer). Three modalities of implementation are presented. The readiness of society and governments to adopt health status insurance is discussed from a historical perspective.
Topics: Health Behavior; Health Care Costs; Health Policy; Health Status; Humans; Insurance, Health; Preventive Medicine
PubMed: 10234054
DOI: No ID Found