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Background: As access to vital health services expands and universal health coverage is attained, health insurance is projected to serve as a critical risk protection for families and small enterprises. Aim: To assess the informal sector’s awareness, willingness, and problems in enrolling in the state national health insurance program. Materials and Methods: This cross-sectional descriptive study was done in Benin City, Nigeria, in the unorganized sector. A self-structured questionnaire was created, distributed, and retrieved for this study, which was conducted among 155 artisans chosen through a stratified random sample procedure. To evaluate the data, Statistical Package for the Social Sciences, SPSS version 22 was used. Results: In total, 138 people (89.0%) are aware of the National Health Insurance Scheme (NHIS), while only 93 people (60.0%) know that Edo state has a state-owned Health Insurance Scheme (SHIS). Only 17 people, or 11.0%, are engaged in the NHIS/SHIS program, whereas 107 people, or 77.5%, have expressed interest. Lack of accessibility to authorized healthcare facilities near house 22 (71.0%) is a significant deterrent to enrollment in the program. Long lines at service points (3.88, 1.093), the time it takes to enroll new members in the program (3.78, 1.101), the time it takes for health maintenance organizations to issue authorization codes (3.62, 1.316), the accessibility of NHIS services outside of registration institutions (3.29, 1.289), and the standard of drugs provided by the SHIS (3.12, 1.358) are all factors that hinder utilization. Sex and place of residence each strongly correlated with readiness to sign up for the program (AOR = 4.234, P = 0.017, 95% CI: 1.293–13.873 and AOR = 5.224, P = 0.007, 95% CI: 1.557–17.530, respectively). Conclusion: The artisans have a low rate of health insurance coverage but are eager to sign up for the program. State policymakers should increase their reach and make enrollment required to attain a higher range.
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Background: Enrollees’ knowledge, behavior, and perception of health insurance substantially influence a decision about the uptake of sustainability of the program. This study assessed enrollees’ knowledge, satisfaction, and barriers to the National Health Insurance Scheme (NHIS) uptake in Benue State, Nigeria. Materials and Methods: The study was a descriptive survey conducted among hospital clients enrolled in the formal sector program of the health insurance scheme in Makurdi, Benue State, Nigeria. A structured questionnaire was used to collect respondents’ demographic information and data related to the knowledge, satisfaction, and barriers to the uptake of NHIS in Nigeria. IBM-SPSS version 25.0 was used to analyze the data. Results: The study comprised 53.2% males, and 46.8% were females. The majority (82.9%) of the enrollees were aware of the objectives of the NHIS, but only 33.4% were aware of their benefits as enrollees and only 56.0% were satisfied with NHIS services. Factors that significantly influenced enrollees’ satisfaction include sex, age, education level, income, and knowledge of enrollees’ entitlements (P < 0.05), but the family size and knowledge of the objectives of the NHIS were not significantly associated with the level of satisfaction (P > 0.05). The most common barriers to the uptake of the NHIS include cultural and religious norms (67.4%) and poor social infrastructures (60.6%). Conclusion: This study revealed that the enrollees had poor knowledge of their entitlements for enrolling in the NHIS and a low level of satisfaction. There is a need for more awareness interventions across Nigeria to sensitize citizens of the scheme’s importance, objectives, and benefits.
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Background:Sickle cell disease is a genetic condition that affects millions of people globally. In view of this, the study aims at determining the financial burden of sickle cell disease among caregivers of children with sickle cell disease in Nigeria.Methods:It was a descriptive cross sectionalstudy and systematic sampling method was used in selecting 162 caregivers amongst the patients in the Lagos State University Teaching Hospital. Semi-structured questionnaires were used to collect data and analysed using SPSS version 22 software and Microsoft Excel 2007. Results were presented in frequency tables, chi-square to test association between categorical variables and the statistical significance level was set at p<0.05.Results:The mean age of the caregivers was 34.3 years with an increase in frequency of hospitalization 39% amongst respondents and a cost of hospital bill was over thirty thousand naira (US$76.82).The reason given mostly by 77% of the respondents for non-usage of health insurance was that the enrolment’s premium was high and 53% of the caregivers took loan to treat their wards. Catastrophic healthcare expenditure was found among a quarter 21% of the respondents due to non-usage of health insurance. There was a statistical significance association between level of education and Catastrophic healthcare expenditure at p value <0.05.Conclusions:Due to high level of financial burden on caregivers and family members, it will be an important step for the government to strengthen the health insurance scheme, intensify campaigns and subsidize costs of healthcare for these patients.
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Agriculture production and farm income in India are frequently affected by natural disasters such as droughts, floods, cyclones, storms, landslides and earthquakes. In recent times, mechanisms like contract farming and future trading have been established which are expected to provide some insurance against price fluctuations directly or indirectly. But, agricultural insurance is considered as an important mechanism to address the risk of output and income effectively which is resulting from various natural and manmade events. The study was conducted in Karnataka State during the year 2017-18 by using “Ex-post- facto” research design. Belgavi, Dharwad, Haveri and Vijayapura districts were selected purposely based on more number of insured farmers. Further, two taluks from each district and from each taluk three villages (i.e. total 24 villages) were randomly selected. Sample size for the study was 240. Purposive sampling procedure was used. Descriptive statistics and multiple linear regression model were applied to analyze the data. The findings of the study revealed that, 44.17 per cent of the insured farmers belonged to low knowledge level followed by medium (37.92%) and high (17.91%) level with respect to Crop Insurance Schemes. The variable ‘credit availed’ had positive and significant relationship at one per cent level of probability. The co-efficient of determination (R2) was 0.427 which indicated that 42.70 per cent of the variation in the knowledge level of insured farmers was together explained by all the independent variables. Thus, concerned officers should conduct awareness programmes from time to time by using different extension teaching methods like trainings, workshops, distribution of pamphlets, road shows, advertisement through television, newspaper, radio, mobile SMS etc to enhance the knowledge level of farmers.
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Background: The Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) is cashless medical insurance scheme launched in 2nd July 2012 by Maharashtra government is for poor families like below poverty line, above poverty line categories, Antyodaya and Annapurna cards holders with annual income less than Rs. 1 lakh. It’s implemented throughout the state of Maharashtra in phased manner for a period of 3 years. The aim is to provide quality care and free medical facilities worth Rs. 1.5 lakh. Aim of this study is to see awareness of the scheme and satisfaction level among beneficiaries about RGJAY scheme.Methods: It’s a cross sectional hospital based study. 500 Patient enrolled under RGJAY scheme selected daily during study period January 2013 to June 2014 in Raigad district. Statistical analysis was done by using SPSS 21.0.Results: Most of the beneficiaries were male (63.4%), age group 40-70 (51.2%). 67.2% participants were aware about RGJAY and 35% were came to know through media. Only 20% participants utilized services under RGJAY scheme more than one time. 31% participant’s family members had taken benefits of the scheme. 45.4% participants were highly satisfied, 28.8% satisfied with services provided under RGJAY scheme.Conclusions: The participants were aware about the scheme, but utilization of the scheme was low in the population. Most of the participants were satisfied with services provided under scheme. It shows that scheme was successful in Raigad district.
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Background: Nigerian Government established National Health Insurance Scheme (NHIS) including Community Based Health Insurance Scheme (CBHIS) to reduce out-of-pocket health expenses of enrollees,strengthen and ensure access to quality healthcare services. The functionality of the schemes however, revolves round health facilities being able to meet the expectation of the enrollees.Study Objectives: The study assessed the adequacy of the designated health facilities in offering quality healthcare services to the enrollees or potential enrollees under the CBHIS, and to identify likely challenges Study Design: This is part of a larger prospective cross-sectional study that assessed the implementation of the Community-Based Health Insurance Scheme (CBHIS) in selected local government areas of Kwara in the north central and Ogun in the South Western part of Nigeria.Place and Duration of the Study: Health facilities of selected wards from two Local Government Areas in Kwara and Ogun States were assessed between February and May 2015.Methods: Semi-structured questionnaires and health facility assessment checklist were used to assess services rendered, storage of drugs and the vaccines, manpower, training opportunities, available infrastructures and perceived challenges to smooth operation of health facilities designated for CBHIS.Results:A total of twenty designated health facilities were visited and assessed (Seventeen public and three private). Services claimed to be available at the facilities included clinical, nursing, pharmaceutical and laboratory services. The assessment showed inadequacy of some critical human resources for health. Seventeen of the 20 health facilities (85%) had evidence of recent renovation while 3 (15%) had no evidence of renovation. Twelve (60%) had backup supply of electricity from generator or solar panel. Other challenges that could impede quality healthcare service delivery under the CBHIS were identified. Conclusion: Thestudy showed that inadequate personnel, paucity of training opportunities for health workers, poor infrastructures (lack of ambulance services, poor electricity supply and lack of portable water supply) were the main challenges impeding delivery of quality healthcare services to the CBHIS enrollees patronizing the studied facilities
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The consumption and sales of Kampo products, as well as the crude drugs that make up the products, have been increasing recently. However, the Kampo industry has been exhibiting a long-term decline due to the rise in price of imported crude drugs and reduction in standard prices of crude drugs by the Japanese National Health Insurance scheme. As the production of crude drug in Japan has been decreasing for the past thirty years, efforts have been made to improve the situation. Although the production of Aizu Ginseng decreased from 153 metric tons to 8 metric tons in Fukushima, university research institutes have initiated research on expansion of the farm field for Ginseng and reduction in a cultivation term. In Nara, farmers, pharmaceutical and food manufacturers, and university research institutes, aiming to develop new products using Yamato Angelica root, organized a joint council and have been working together to establish integrated systems from cultivation to sales. The Ministry of Agriculture, Forestry and Fisheries, the Ministry of Health, Labour and Welfare, and Japan Kampo Medicines Manufacturers Association have held local meetings with farmers and pharmaceutical companies in different areas throughout Japan over the past three years from fiscal year 2013. In order to reduce national healthcare costs by Kampo medicine, it is necessary to upgrade the health care system where not only Kampo extract products but also medicinal plants as raw materials including decoctions can be used. Discussions on measures to cover the costs of domestic production of crude drugs should be required.
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Objective:Based on the perspective of Universal Health Coverage(UHC),a mathematical model was developed to conduct quantitative study on the development status of Basic Medical Insurance Schemes(BMIS) in China.Methods:A mixed model was developed to conduct quantitative study on the development of BMIS in the period of 2003-2015 from five dimensions:coverage of population,benefit package,reimbursement rate,risk pooling level and unity of the schemes.Sensitivity analysis was also performed.Results:The UHC scores for BMIS in China from 2003 to 2015 fluctuated obviously.Given the range of 0-100 percent,the UHC score in 2003 was 52.2％,28.5％ in 2006,23.9％ in 2010 and 26.5％ in 2015.The integration and equalization of BMIS and scaling up the risk pooling levels were shown to contribute significantly to UHC.Conclusion:The construction of mixed models was developed to provide a new calculation assessment tool for measuring the UHC,which consisted of completed evaluation tool package with addition model and multiplication model.Considering the future development of UHC,there is a still long way to go for BMIS in China.Emphases should be given to integration and equalization of BMIS as well as scaling up the risk polling to provincial and national level.
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Background: An insurance scheme called Jaminan Kesehatan Aceh (JKA) was established by the local government to achieve universal coverage for Aceh's population who were not registered under the national insurance scheme for the poor (Jamkesmas). Objective: This study was conducted to compare women's satisfaction before and after the implementation of JKA and across different insurance schemes. Methods: The study was conducted from July 2011 to July 2012 on satisfaction of maternal health services among 1197, 15-49 years aged old women living in eight districts of Aceh Province, Indonesia, and a cluster sampling technique was applied. Analysis of variance was used to assess the effects of different insurance schemes, period, and type of services on satisfaction with maternal health services. Results: Women were mostly satisfied with birth delivery services (mean score: 2.69) followed by postnatal care (mean score: 2.62) and antenatal care services (mean score: 2.37). Conclusion: Over the changing period, the average level of satisfaction in the JKA group increased significantly.
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Aims: National Health Insurance Scheme became operational in Nigeria over eight years ago; yet, population coverage is below 20% and healthcare services are provided ineffectively and inefficiently. Satisfaction surveys might be part of useful interventions required to increase universal healthcare coverage and improve optimal access and success of the scheme. Study Design: A cross-sectional, exploratory study. Place and Duration of Study: Federal Secretariat, Ibadan, Nigeria. 4 weeks of the month of July, 2011. Methodology: 380 eligible federal staff completed a self-administered modified SERVQUAL questionnaire, which assessed satisfaction domains of healthcare provider services (competence), staff attitude and waiting time. Clients’ experiences were related to a health facility visit in the last three months preceding the survey and assessed on a 5-point Likert scale of “very poor = 1”, “poor = 2”, “good = 3”, “very good = 4” and “excellent = 5”. Associations between dependent and independent variables were subjected to Chi-square test and logistic regression at P-value of 0.05. Results: 201 (52.8%) male and 179 (47.2%) female participated in the study. Their mean age was 42.5±8.0 years. Most frequently health conditions for which services were sought were malaria (52.9%), medical check-up (5.8%) and dental problem (2.9%). 55.6% of participants were satisfied with drug services, 56.2% with healthcare provider services, 77.8% with waiting time and 51.7% with staff attitude. Education and type of health facility were predictors of satisfaction with healthcare provider services. Length of years of enrolment was a predictor of satisfaction with waiting time while length of years and grade level attained in service were predictors of satisfaction with staff attitude. Conclusion: Periodic documentation of experiences of enrollees in relation to satisfaction domains of social insurance is useful as it could help identify and prioritise appropriate interventions required to improve its effectiveness and efficiency.
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Background: Information on economic burden of hypertension is needed for relevant decisions and policies due to escalating cost of disease management. Aims: The study assessed economic burden of pharmacotherapy in hypertension management on the National Health Insurance Scheme (NHIS) of Nigeria and the economies of antihypertensives selection. Study Design: Cross-sectional study. Place and Duration of Study: Out-patient-department of a private teaching hospital located in Lagos, Nigeria over four-month duration in 2011. Methodology: Two hundred and fifty case notes of hypertensive patients were randomly selected. These were assessed for costs of pharmacotherapeutic management of hypertension. Patients’ details such as demographic data, drug regimens and funding status were extracted from the case notes. Drugs’ prices were obtained from the hospital billing guide. Data presentation was by using descriptive statistics. Results: Two hundred and eight (83.2%) of the selected case notes met the study criteria. Diuretics were the most economical at an average monthly cost per prescription of NGN858.6 ($5.51) followed by the beta-blockers at NGN1,101.1 ($7.07) while fixed dose combinations were the costliest at NGN10,425.0 ($66.93). Health Maintenance Organizations (HMOs) having 104 (50.0%) of the cohort as enrollees incurred most of the cost at NGN446, 325.0 ($2,865.47) followed by NHIS 75 (36.0%) at NGN321, 354.0 ($2,063.14). An average monthly cost of antihypertensives per patient was highest for private patients NGN4, 314.47 ($27.69) and least for NHIS NGN4, 284.72 ($27.50). The national cost implication using the least average monthly antihypertensive cost per patient of NGN4,284 .72 ($27.50) for NHIS implies an average of NGN51,416.64 ($330.10) per annum for each patient and a whooping sum in excess of NGN1.054 trillion (over $6.76billion) for over 20 million affected hypertensive patients in Nigeria. Conclusion: Cost burden of hypertension management is high, incurred mostly by HMOs and NHIS. Diuretics were the most economical of all prescribed regimens.
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The Rajiv Aarogyasri Community Health Insurance (RACHI) in Andhra Pradesh (AP) has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households. A brief analysis of the RACHI scheme based on offi cially available data and media reports has been undertaken from a public health perspective to understand the nature and fi nancing of partnership and the lessons it provides. The analysis of the annual budget spent on the surgeries in private hospitals compared to tertiary public hospitals shows that the current scheme is not sustainable and pose huge burden on the state exchequers. The private hospital association’s in AP, further acts as pressure groups to increase the budget or threaten to withdraw services. Thus, profi ts are privatized and losses are socialized.
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Introducción. El cáncer es la segunda causa de mortalidad infantil. La leucemia linfoblástica aguda es el tipo de cáncer más frecuente en niños. En México, las familias afiliadas al Seguro Popular tienen acceso a los servicios médico-quirúrgicos, farmacéuticos y hospitalarios que satisfacen sus necesidades de salud. El objetivo de este trabajo fue conocer el impacto del apoyo de las organizaciones no gubernamentales en la mortalidad de pacientes con leucemia linfoblástica aguda afiliados al Seguro Popular. Métodos. Se aplicaron 182 entrevistas a familiares de pacientes con leucemia linfoblástica aguda, vivos y fallecidos, en nueve instituciones afiliadas al Seguro Popular. Las preguntas se enfocaron en conocer los gastos durante el tratamiento, si recibían apoyo de alguna organización no gubernamental y en qué consistía este apoyo. Se realizó un análisis bivariado para conocer el peso estadístico del apoyo de las organizaciones no gubernamentales sobre la mortalidad cruda. Resultados. Los familiares de pacientes con leucemia linfoblástica aguda afiliados al Seguro Popular realizaron gastos complementarios durante el tratamiento. El apoyo de las organizaciones no gubernamentales fue estadísticamente significativo como protector de la mortalidad (OR = 0.25; IC 95% 0.11-0.54), y se efectuó en rubros como alimentos, medicamentos, antibióticos y catéteres. Conclusiones. Las organizaciones no gubernamentales son de gran apoyo para los pacientes con leucemia linfoblástica aguda y, aunque no suplen el apoyo del Seguro Popular, facilitan el tratamiento integral y parecen tener un efecto positivo en la reducción de la mortalidad.
Background. Cancer is the second leading cause of pediatric mortality. Acute lymphoblastic leukemia (ALL) is the most common type of cancer. In Mexico, families affiliated with the Seguro Popular insurance program have access to medical, pharmaceutical and hospital services that meet their health needs. The objective of the study was to determine the impact of nongovernmental organization (NGO) support on mortality in ALL patients affiliated with the Seguro Popular program. Methods. We conducted 182 interviews with families with living and deceased patients with ALL in nine institutions affiliated with the Seguro Popular program. We inquired about the expenses necessary during ALL treatment and whether they received support from NGO and the type of support received. We performed bivariate analysis to determine the statistical weight of the support of NGO on crude mortality. Results. Families of patients with ALL affiliated with the Seguro Popular insurance program incurred additional expenses during treatment. NGO support was statistically significant in protection from mortality (OR = 0.25; 95% CI 0.11-0.54). Significant items were support with food, medicines, antibiotics and catheters. Conclusions. NGO offer a high level of support for ALL patients and although they are not a substitute for the support of the Popular Insurance Scheme, they provide a holistic type of support and demonstrate a positive effect in reducing mortality.
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This article aims to extract some lessons from the last five years' experience of Japan in its implementation of Long-term Care Insurance scheme(LTCI). Although both Korea and Japan are facing the most rapid ageing of the population among the OECD countries, the Japan precedes Korea in many aspects by about thirty years. Long-term care(LTC) services had been provided through two schemes in Japan before the introduction of LTCI in April 2000: Welfare Service Programs and the Health Service System for the Elderly(HSSE). LTCI incorporated both the previous social or welfare services and the long-term care services under the HSSE. Japanese LTCI started with the aims of introducing improved insurance coverage for home care, extending such coverage for the first time to nursing homes and further reducing the dependency of the elderly on beds in hospitals. In Korea, due to the lack of infrastructure to support the LTC services in Korea as well as the yet immature ageing of population, it would be quite risky to make haste in introducing LTCI in Korea. Rather the main focus of the Korean LTC policy should be put on establishing and enlarging both facilities and human resources to support the LTC services.
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Aged , Humans , Asian People , Health Services , Home Care Services , Insurance Coverage , Insurance, Long-Term Care , Japan , Korea , Long-Term Care , Nursing HomesABSTRACT
This study was performed in a rural community, Kanghwa county which was introduced to a regional medical insurance pilot program in 1982. The purposes of this study were, firstly, to observe the changes in ambulatory care utilization in the three years 1982, 1983 and 1987 ; secondly, to analyse factors which convert perceived medical care needs to effective medical care demand. During the three periods, a serial interview survey was performed to determine the changes in medical utilization before and after the regional medical insurance program implementation. The number of subjects was 3,356 persons in the year 1982, 3,705 in 1983 and 2,745 in 1987. The results of the study were as follows : 1. Total ambulatory care utilization rates per 100 persons during a 2-week period were 23.6 in the year 1982, 21.8 in 1983, and 29.3 in 1987 ; and physician visit rates were 6.1 in 1982, 11.7 in 1983, and 14.9 in 1987. Thus, compared to the total utilization rate there was a definite increase in physician visit, and during the study periods there was a decrease in drug stores visits whereas an increase in hospital or clinic visits was noticed. 2. The rates of effective demand for medical care need were 70.7% in 1982, 70.5% in 1983 and 75.9% in 1987 ; and the rates of patients who visited physicians were 20.2% in 1982, 42.8% in 1983 and 35.6% in 1987. Thus, physician visits increased sharply by introducing the medical insurance program, but after the latent medical care demands were fulfilled, there was a slight decrease in the physician visits. 3. The number of acute symptoms and the number of chronic symptoms were common determinants of total ambulatory care utilization and physician visits. Besides the medical care need factors, age in 1982, sex and accessibility in 1983, and accessibility in 1987 were statistically significant determinants of the total utilization ; sex and accessibility in 1983, and education in 1987 were also statistically significant determinants of the physician visit. 4. For persons with perceived acute symptoms during the 2-week periods, accessibility in total utilization and age in physician visits were common discriminating factors of ambulatory care utilization in the three years, and education and income were also statistically significant variables For persons with perceived chronic symptoms, occupation and income were statistically significant discriminating variables commonly observed in total utilization and physician visits.