RESUMO
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.
RESUMO
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.
RESUMO
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.
RESUMO
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.