Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their depen...Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their dependents. In addition, other voluntary and community mechanisms have been developed. After several years of implementation, the level of catastrophic health expenditures among insured individuals shows that there is still a considerable level of financial risk associated with health care. This study aims to assess the impact of health insurance in Togo on insured populations. Methodology: The data used in this study come from the harmonized survey on household living conditions carried out in 2018 by the National Institute of Statistics, Economic and Demographic Studies. The propensity score matching method was used according to the following steps: estimation of propensity scores, verification of the conditional independence hypothesis (balancing property) and estimation of the average treatment effect on treated. Stata V14.2 software was used. Findings: The average effect of health insurance on household financial protection is −0.012 for the nearest neighbor method, −0.013 for the matching radius method, −0.015 for the Kernel and −0.016 for the stratification method. Results showed that health insurance contributes to reducing catastrophic health expenditures, but their effect remains very limited. This could be explained by the level of care package covered and the cost covered. Conclusion: Health insurance contributes to the reduction of catastrophic health expenses for households. However, it is important to widen the range of care covered and the cost covered. In addition, measures to extend this coverage to a larger proportion of the population will make it possible to have a greater impact.展开更多
Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim o...Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim of this study is to assess the impact of including dialysis in the health insurance package in Congo. Methodology: This is a descriptive cross-sectional study with an evaluative aim, analyzing the impact of dialysis on the financing capacity of health insurance and health facilities to provide this type of care. Results: The results show that including dialysis in the universal health insurance package will require an additional financial effort of 6.20% of the current total financing capacity of the care basket. Most dialysis sessions are provided by the private health sector (87.5%), whose health facilities are unevenly distributed across the country, and concentrated in the country’s two major cities. This problem is the dual consequence of the very high cost of a dialysis session (average cost 140,234,375 FCFA or 229 US Dollars) and the number of patients under care, which will increase in the absence of effective and ongoing prevention efforts against chronic diseases in general and end-stage renal failure in particular. Conclusion: Dialysis is a high-impact public health intervention. The impact of its inclusion in the universal health insurance care package is difficult to bear financially. For dialysis to be covered by universal health insurance, additional funding and improved technical facilities are needed.展开更多
Introduction: Several Nigerians are completely denied access to adequate health care because of cultural, temporal and financial factors with inequity. Objectives: To ascertain the household perceptions, willingness t...Introduction: Several Nigerians are completely denied access to adequate health care because of cultural, temporal and financial factors with inequity. Objectives: To ascertain the household perceptions, willingness to pay, benefit package preferences, and health systems readiness for Insurance Scheme. Methods: A cross-sectional study of 400 heads of households and 43 health workers in Enugu, Southern Nigeria. Results: Awareness of NHIS among the heads of household was 56.8%, while it was 86% among the health workers. Awareness of NHIS among heads of households was significantly associated to both educational level (X<sup>2</sup> = 16.083, P = 0.001), and occupation (X<sup>2</sup> = 5.694, P = 0.017). More males (61.6%) had correct perceptions of NHIS compared to females (58.6%), but not statistically significant (X<sup>2 </sup>= 0.336, P = 0.562). Majority of households respondents 89% are willing to pay for NHIS. Willingness to pay was significantly associated to occupation (X<sup>2</sup> = 5.169, df = 1, P = 0.023), but willingness to pay mandatory 5% premium was not significantly associated to occupation (X<sup>2</sup> = 0.884, P = 347). Only 11.6% of the health facilities are enlisted as providers in the scheme. Conclusion: Willingness to pay was high, but majority are not ready to pay 5% premium of their earnings. Awareness creation programmes should be improved for the public, and more health facilities enlisted for wider coverage.展开更多
<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: Inappro...<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: Inappropriate use of medicines is a global concern with serious con</span><span style="font-family:Verdana;">sequences related to prescribing, dispensing, and use. WHO estimate</span><span style="font-family:Verdana;">d that 50% of medicines are not used correctly on their journey from the facility to home. </span><b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: To assess medicines use using WHO drug core indicators rega</span><span><span style="font-family:Verdana;">rding prescribing, patient, and facilities. </span><b><span style="font-family:Verdana;">Setting</span></b><span style="font-family:Verdana;">: Outpatients, Hea</span></span><span style="font-family:Verdana;">lth centers in Wadmadani locality (Urban area) in Gezira State, Sudan. </span><b><span style="font-family:Verdana;">Method</span></b><span style="font-family:Verdana;">: A cross-sectional, prospective, analytical study was conducted in 30 health centers and 60 patients from each center were selected using a simple random sampling technique. WHO indicators form was used to collect data containing different variables. T-test at a level of confidence of 95% was used to test differences between indicators. Statistical Package for Social Science (SPSS) was used for data analysis. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The main prescribing indicators were 2.5 ± 0.6 for drugs per encounter, 44.1% ± 14.2%. Generic 54 ± 18.0 antibiotics, 12.0% ± 9.3% injectable, and 95.2% ± 11.5% of drugs were prescribed according to the NHIF-EML. The main patient’s indicators were, 2.9 ± 0.8 minutes for consultation time, 99.5 ± 36.8 seconds for dispensing time, and 72.5% ± 16.0% for medicines actually dispensed, 49.0% ± 18.0% for medicines adequately labeled, and 22.5% ± 7.3% of the patient’s knowledge about the correct dose. The Facility specific indicators were 66.7% for the availability of a copy of EML, while the percentage of key drugs in the stock was 75.3% ± 11.6%. No statistically significant differences were found between direct and indirect facilities except in generic prescribing. </span><b><span style="font-family:Verdana;">Main Outcome Measure</span></b><span style="font-family:Verdana;">: <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> Interventions to improve Generic and antibiotics prescribing indicators. <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> The patient-to-physician ratio should be revised to optimize consultation time. <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> The availability of key drugs should be improved to make sure effective treatment. <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> The pharmacy cadre should be oriented and trained to improve patients’ compliance. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The study concluded that there was irrational use of medicines when investigated by WHO drug core indicators. So, the study recommended interventions to improve the rationale prescribing, dispensing, and use of medicines.</span></span>展开更多
Objective To provide a reference for future budget of health insurance fund for the COVID-19 pandemic in other parts of China or other major public health events.Meanwhile,it also offers a reference for the government...Objective To provide a reference for future budget of health insurance fund for the COVID-19 pandemic in other parts of China or other major public health events.Meanwhile,it also offers a reference for the government to introduce and adjust the policy of health insurance funds after the pandemic.Methods Models of the income,expenditure and cumulative balance of health insurance fund in Hubei Province in 2020 were established and compared.The former was mainly established and tested using SPSS 26.0 and Excel,while the latter was obtained by inferential analysis.Results and Conclusion The COVID-19 pandemic reduced the income and increased expenditure of the health insurance fund in Hubei Province in 2020,resulting in a deficit.The COVID-19 outbreak has caused a deficit in health insurance fund of Hubei Province in the short term,but in the long term,the outbreak will not have a major impact on the health insurance fund.展开更多
The purpose of the current study was to model the health insurance coverage of Jamaicans;and to identify the determinants, strength and predictive power of the model in order to aid clinicians and other health practit...The purpose of the current study was to model the health insurance coverage of Jamaicans;and to identify the determinants, strength and predictive power of the model in order to aid clinicians and other health practitioners in understanding those who have health insurance coverage. This study utilized secondary data taken from the dataset of the Jamaica Survey of Living Conditions which was collected between July and October 2002. It was a nationally representative stratified random sample survey of 25,018 respondents, with 50.7% females and 49.3% males. The data was collected by way of a self-administered questionnaire. The non-response rate for the survey was 29.7% with 20.5% not responding to particular questions, 9.0% not participating in the survey and another 0.2% being rejected due to data cleaning. The current research extracted 16,118 people 15 years and older from the survey sample of 25,018 respondents in order to model the determinants of private health insurance coverage in Jamaica. Data were stored, retrieved and analyzed using SPSS for Windows 15.0. A p-value of less than 0.05 was used to establish statistical significance. Descriptive analysis was used to provide baseline information on the sample, and cross-tabulations were used to examine some non-metric variables. Logistic regression was used to identify, determine and establish those factors that influence private health insurance coverage in Jamaica. This study found that approximately 12% of Jamaicans had private health insurance coverage, of which the least health insurance was owned by rural residents (7.5%). Using logistic regression, the findings revealed that twelve variables emerged as statistically significant determinants of health insurance coverage in this sample. These variables are social standing (two weal- thiest quintile: OR = 1.68, 95% CI = 1.23 – 2.30), income (OR = 1.00, 95%CI = 1.00 – 1.00), durable goods (OR = 1.16, 95% CI = 1.12 – 1.19), marital status (married: OR = 1.97, 95% CI = 1.61 – 2.42), area of residence (Peri-urban: OR = 1.45, 95% CI = 1.199 – 1.75;urban: OR = 1.83, 95% CI = 1.40 – 2.40), education (secondary: OR = 1.57, 95% CI = 1.20 – 2.06;tertiary: OR = 9.03, 95% CI = 6.47 – 12.59), social support (OR = 0.64, 95% CI = 0.53 – 0.76), crowding (OR = 1.14, 95% CI = 1.02 – 1.28), psychological conditions (negative affective: OR = 0.97, 95% CI = 0.94 – 1.00;positive affective: OR = 1.11, 95% CI = 1.06 – 1.16), number of males in household (OR = 0.85, 95% CI = 0.77 – 0.93), living arrangements (OR = 0.62, 95% CI = 0.41 – 0.92) and retirement benefits (OR = 1.55, 95% CI = 1.03 – 2.35). This study highlighted the need to address preventative care for the wealthiest, rural residents and the fact that social support is crucial to health care, as well as the fact that medical care costs are borne by the extended family and other social groups in which the individual is (or was) a member, which explains the low demand for health insurance in Jamaica. Private health care in Jamaica is substantially determined by affordability and education rather than illness, and it is a poor measure of the health care- seeking behaviour of Jamaicans.展开更多
Previous main body of research on end-life-care in South Korea has focused on developing services quality in hospital settings or service payment system in National Health Insurance Program. The delivery system of hos...Previous main body of research on end-life-care in South Korea has focused on developing services quality in hospital settings or service payment system in National Health Insurance Program. The delivery system of hospice and palliative care services has evolved in diverse ways but there is little research on reviewing the past history of development and whole picture of them so far. So, the aim of this study is to review the old hospice and palliative care system and also to introduce the current one supported by the National Health Insurance Program in South Korea. The palliative care or hospice services in South Korea have been available in diverse settings and provided by different organizations (i.e. catholic hospitals or charity organizations). Finally, it was set up in 2004 that the hospice team or official Palliative Care Units (PCUs) was established in hospitals, in order to meet the end-of-life care for the patients with terminal cancer under the Cancer Control Act. The current hospice and palliative care services such as pain management, bereavement services, and counselling can be reimbursed by National Health Insurance program since 2008. Nevertheless hospice and palliative care services are available to dying patients, yet the utilization rate of hospice and palliative care services or the length of stay in the palliative care unit (PCU) is still relatively short compared to other country systems. South Korea is undergoing several efforts to expand the services in PCU along with the development of quality indicators for PCU. Hospice and palliative care services are still new in the health care system and unfamiliar to the public so it requires raising awareness for medical professionals and the public as well as further research.展开更多
Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresh...Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.展开更多
The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, ...The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.展开更多
Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insura...Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health insurance system aimed to create a more competitive market in which consumers would switch health plans, thereby stimulating insurers to price competition and quality improvement. This article evaluates the switching behavior of Dutch consumers and evaluates whether this behavior is advantageous to the goals of the reform. Methods: Three surveys were conducted: from 2005-2006 (n = 478), 2008-2009 (n = 389), and 2010-2011 (n = 191). Results: In 2005-2006, almost 20 percent of the Dutch consumers switched their insurance company. In between 2006 and 2012, however, the percentage of switchers decreased to less than four percent. The main cause of this decrease is that consumers no longer perceive sufficient differences between insurance companies in terms of premium and service. In addition, consumers have difficulties finding the proper information making the right decision and believe they may not be accepted for the supplementary insurance. Consequently, insurance companies only perceive limited incentives to create a more competitive market. Conclusion: Clear and unambiguous information, combined with an obligatory acceptance for the supplementary insurance might help to improve the potential mobility of Dutch consumers.展开更多
Health insurance is a mechanism by which a person protects himself from financial loss caused due to accident and/or disability.The chairman of Insurance Regulatory and Development Authority(IRDA)has mentioned that lo...Health insurance is a mechanism by which a person protects himself from financial loss caused due to accident and/or disability.The chairman of Insurance Regulatory and Development Authority(IRDA)has mentioned that low consumer awareness and insufficient healthcare infrastructure are the major hindrances to widen the reach of healthcare insurance in India.Healthcare costs have witnessed a phenomenal rise in the current times.This has led the customers to insure not only themselves but their family members for any future medical expenses and other related requirements.The need to insure assumes is more importance for older generations who are either retired or will be retired in near future.Given high health cost,it is important for us to get covered for health risks.With this,a good insurance policy is needed to cover doctor's visit,laboratory tests,hospital stays and diagnostic tests.There are quite a few companies covering health risks with good insurance policies.Health insurance(popularly known as Mediclaim)offers protection in case of unexpected medical emergencies.In case of a sudden illness or accident,the health insurance policy takes care of the hospitalization,medical and other costs incurred.Thus,health insurance to be introduced to all consumers in India to protect them from financial loss caused by unfortunate incidents.展开更多
Background:In 2011,Ghana piloted the integration of herbal medicine services into mainstream health care delivery in selected government hospitals across the country.To date,however,no single certified herbal drug is ...Background:In 2011,Ghana piloted the integration of herbal medicine services into mainstream health care delivery in selected government hospitals across the country.To date,however,no single certified herbal drug is generally covered by the national health insurance scheme.This study evaluated the implications of out-of-pocket payment for prescriptions on the patronage of herbal medicine units in 3 selected government hospitals within Kumasi Metropolis.Methods:A cross-sectional study on 413 participants was performed using a semi-structured questionnaire.Results:The majority of study respondents were female(54%),and the median age was 35 years.Most participants(83.1%)were aware that herbal medicine was integrated in the mainstream health care system of the country.Regarding the costs of certified herbal drugs,51.5%of respondents considered them very expensive;72.1%of the respondents believed that the costs of certified herbal drugs adversely affected the utilization of herbal units at government hospitals,which produced a positive correlation(r=0.5498).A total of 99.5%of the respondents recommended the inclusion of certified herbal drugs on the national health insurance drug list.Conclusion:This study revealed that the costs of certified herbal medicines negatively affect utilization of herbal units at government hospitals.To improve the utilization of herbal units,certified herbal drugs dispensed at these units must thus be included in the national health insurance drug list.展开更多
A critical problem plaguing regulators in promoting pharmaceutical innovation is to design and select efficient incentive policies. In this study, we develop a stylized model comprising a regulator and two representat...A critical problem plaguing regulators in promoting pharmaceutical innovation is to design and select efficient incentive policies. In this study, we develop a stylized model comprising a regulator and two representative drug producers to evaluate the effects of three incentive policies: Innovation subsides, inclusion new drugs in the health insurance plan, and the combination of the above two policies(also called hybrid policy). Our analysis shows that innovation subsidies and inclusion of new drugs in the health insurance plan can both promote pharmaceutical innovation, but their incentive effects vary in different policy objectives. Specifically, if the regulator aims to improve patient welfare, he should incorporate new drugs into the health insurance plan to expand the accessibility of new drug when the copayment level is low. However, if the regulator aims to improve social welfare, he should choose innovation subsidies when the copayment level is high, and the hybrid policy when the copayment level is low. In particular, with a sufficiently low copayment level, the hybrid policy allows the new drug producer, patients and the regulator to achieve Pareto improvement due to a lower regulator’s innovation subsidy expenditure, higher profits of the new drug producer and consumer surplus.展开更多
In recent years, the NCAA student athlete population in the United States has surpassed 500,000, and is continuing to rise each year [1]. These student athletes work their entire lives academically and athletically to...In recent years, the NCAA student athlete population in the United States has surpassed 500,000, and is continuing to rise each year [1]. These student athletes work their entire lives academically and athletically to reach the ultimate goal: competing in university athletics. However, when these athletes reach university, they are met with non-stop training, homework, exams, and evolving social lives. We have conducted a study at the University of Evansville evaluating how participation in university athletics may impact mental health status among these student athletes, as well as measuring players’ awareness of accessible mental health resources. Over fifty percent of participants reported experiencing at least one mental health condition while competing in their sport;eighty percent reported having knowledge of the mental health resources available to them on campus, however, nearly thirty percent of those knowledgeable reported not knowing how to access these resources. This has indicated a gap in awareness and utilization of mental health resources among student athletes at the University of Evansville.展开更多
文摘Context: To facilitate financial access to care for the population, health insurance mechanisms have been established, in particular the National Health Insurance Institute, which covers civil servants and their dependents. In addition, other voluntary and community mechanisms have been developed. After several years of implementation, the level of catastrophic health expenditures among insured individuals shows that there is still a considerable level of financial risk associated with health care. This study aims to assess the impact of health insurance in Togo on insured populations. Methodology: The data used in this study come from the harmonized survey on household living conditions carried out in 2018 by the National Institute of Statistics, Economic and Demographic Studies. The propensity score matching method was used according to the following steps: estimation of propensity scores, verification of the conditional independence hypothesis (balancing property) and estimation of the average treatment effect on treated. Stata V14.2 software was used. Findings: The average effect of health insurance on household financial protection is −0.012 for the nearest neighbor method, −0.013 for the matching radius method, −0.015 for the Kernel and −0.016 for the stratification method. Results showed that health insurance contributes to reducing catastrophic health expenditures, but their effect remains very limited. This could be explained by the level of care package covered and the cost covered. Conclusion: Health insurance contributes to the reduction of catastrophic health expenses for households. However, it is important to widen the range of care covered and the cost covered. In addition, measures to extend this coverage to a larger proportion of the population will make it possible to have a greater impact.
文摘Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim of this study is to assess the impact of including dialysis in the health insurance package in Congo. Methodology: This is a descriptive cross-sectional study with an evaluative aim, analyzing the impact of dialysis on the financing capacity of health insurance and health facilities to provide this type of care. Results: The results show that including dialysis in the universal health insurance package will require an additional financial effort of 6.20% of the current total financing capacity of the care basket. Most dialysis sessions are provided by the private health sector (87.5%), whose health facilities are unevenly distributed across the country, and concentrated in the country’s two major cities. This problem is the dual consequence of the very high cost of a dialysis session (average cost 140,234,375 FCFA or 229 US Dollars) and the number of patients under care, which will increase in the absence of effective and ongoing prevention efforts against chronic diseases in general and end-stage renal failure in particular. Conclusion: Dialysis is a high-impact public health intervention. The impact of its inclusion in the universal health insurance care package is difficult to bear financially. For dialysis to be covered by universal health insurance, additional funding and improved technical facilities are needed.
文摘Introduction: Several Nigerians are completely denied access to adequate health care because of cultural, temporal and financial factors with inequity. Objectives: To ascertain the household perceptions, willingness to pay, benefit package preferences, and health systems readiness for Insurance Scheme. Methods: A cross-sectional study of 400 heads of households and 43 health workers in Enugu, Southern Nigeria. Results: Awareness of NHIS among the heads of household was 56.8%, while it was 86% among the health workers. Awareness of NHIS among heads of households was significantly associated to both educational level (X<sup>2</sup> = 16.083, P = 0.001), and occupation (X<sup>2</sup> = 5.694, P = 0.017). More males (61.6%) had correct perceptions of NHIS compared to females (58.6%), but not statistically significant (X<sup>2 </sup>= 0.336, P = 0.562). Majority of households respondents 89% are willing to pay for NHIS. Willingness to pay was significantly associated to occupation (X<sup>2</sup> = 5.169, df = 1, P = 0.023), but willingness to pay mandatory 5% premium was not significantly associated to occupation (X<sup>2</sup> = 0.884, P = 347). Only 11.6% of the health facilities are enlisted as providers in the scheme. Conclusion: Willingness to pay was high, but majority are not ready to pay 5% premium of their earnings. Awareness creation programmes should be improved for the public, and more health facilities enlisted for wider coverage.
文摘<b><span style="font-family:Verdana;">Background</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: Inappropriate use of medicines is a global concern with serious con</span><span style="font-family:Verdana;">sequences related to prescribing, dispensing, and use. WHO estimate</span><span style="font-family:Verdana;">d that 50% of medicines are not used correctly on their journey from the facility to home. </span><b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: To assess medicines use using WHO drug core indicators rega</span><span><span style="font-family:Verdana;">rding prescribing, patient, and facilities. </span><b><span style="font-family:Verdana;">Setting</span></b><span style="font-family:Verdana;">: Outpatients, Hea</span></span><span style="font-family:Verdana;">lth centers in Wadmadani locality (Urban area) in Gezira State, Sudan. </span><b><span style="font-family:Verdana;">Method</span></b><span style="font-family:Verdana;">: A cross-sectional, prospective, analytical study was conducted in 30 health centers and 60 patients from each center were selected using a simple random sampling technique. WHO indicators form was used to collect data containing different variables. T-test at a level of confidence of 95% was used to test differences between indicators. Statistical Package for Social Science (SPSS) was used for data analysis. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The main prescribing indicators were 2.5 ± 0.6 for drugs per encounter, 44.1% ± 14.2%. Generic 54 ± 18.0 antibiotics, 12.0% ± 9.3% injectable, and 95.2% ± 11.5% of drugs were prescribed according to the NHIF-EML. The main patient’s indicators were, 2.9 ± 0.8 minutes for consultation time, 99.5 ± 36.8 seconds for dispensing time, and 72.5% ± 16.0% for medicines actually dispensed, 49.0% ± 18.0% for medicines adequately labeled, and 22.5% ± 7.3% of the patient’s knowledge about the correct dose. The Facility specific indicators were 66.7% for the availability of a copy of EML, while the percentage of key drugs in the stock was 75.3% ± 11.6%. No statistically significant differences were found between direct and indirect facilities except in generic prescribing. </span><b><span style="font-family:Verdana;">Main Outcome Measure</span></b><span style="font-family:Verdana;">: <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> Interventions to improve Generic and antibiotics prescribing indicators. <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> The patient-to-physician ratio should be revised to optimize consultation time. <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> The availability of key drugs should be improved to make sure effective treatment. <span style="white-space:nowrap;"><span style="white-space:nowrap;">•</span></span> The pharmacy cadre should be oriented and trained to improve patients’ compliance. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The study concluded that there was irrational use of medicines when investigated by WHO drug core indicators. So, the study recommended interventions to improve the rationale prescribing, dispensing, and use of medicines.</span></span>
文摘Objective To provide a reference for future budget of health insurance fund for the COVID-19 pandemic in other parts of China or other major public health events.Meanwhile,it also offers a reference for the government to introduce and adjust the policy of health insurance funds after the pandemic.Methods Models of the income,expenditure and cumulative balance of health insurance fund in Hubei Province in 2020 were established and compared.The former was mainly established and tested using SPSS 26.0 and Excel,while the latter was obtained by inferential analysis.Results and Conclusion The COVID-19 pandemic reduced the income and increased expenditure of the health insurance fund in Hubei Province in 2020,resulting in a deficit.The COVID-19 outbreak has caused a deficit in health insurance fund of Hubei Province in the short term,but in the long term,the outbreak will not have a major impact on the health insurance fund.
文摘The purpose of the current study was to model the health insurance coverage of Jamaicans;and to identify the determinants, strength and predictive power of the model in order to aid clinicians and other health practitioners in understanding those who have health insurance coverage. This study utilized secondary data taken from the dataset of the Jamaica Survey of Living Conditions which was collected between July and October 2002. It was a nationally representative stratified random sample survey of 25,018 respondents, with 50.7% females and 49.3% males. The data was collected by way of a self-administered questionnaire. The non-response rate for the survey was 29.7% with 20.5% not responding to particular questions, 9.0% not participating in the survey and another 0.2% being rejected due to data cleaning. The current research extracted 16,118 people 15 years and older from the survey sample of 25,018 respondents in order to model the determinants of private health insurance coverage in Jamaica. Data were stored, retrieved and analyzed using SPSS for Windows 15.0. A p-value of less than 0.05 was used to establish statistical significance. Descriptive analysis was used to provide baseline information on the sample, and cross-tabulations were used to examine some non-metric variables. Logistic regression was used to identify, determine and establish those factors that influence private health insurance coverage in Jamaica. This study found that approximately 12% of Jamaicans had private health insurance coverage, of which the least health insurance was owned by rural residents (7.5%). Using logistic regression, the findings revealed that twelve variables emerged as statistically significant determinants of health insurance coverage in this sample. These variables are social standing (two weal- thiest quintile: OR = 1.68, 95% CI = 1.23 – 2.30), income (OR = 1.00, 95%CI = 1.00 – 1.00), durable goods (OR = 1.16, 95% CI = 1.12 – 1.19), marital status (married: OR = 1.97, 95% CI = 1.61 – 2.42), area of residence (Peri-urban: OR = 1.45, 95% CI = 1.199 – 1.75;urban: OR = 1.83, 95% CI = 1.40 – 2.40), education (secondary: OR = 1.57, 95% CI = 1.20 – 2.06;tertiary: OR = 9.03, 95% CI = 6.47 – 12.59), social support (OR = 0.64, 95% CI = 0.53 – 0.76), crowding (OR = 1.14, 95% CI = 1.02 – 1.28), psychological conditions (negative affective: OR = 0.97, 95% CI = 0.94 – 1.00;positive affective: OR = 1.11, 95% CI = 1.06 – 1.16), number of males in household (OR = 0.85, 95% CI = 0.77 – 0.93), living arrangements (OR = 0.62, 95% CI = 0.41 – 0.92) and retirement benefits (OR = 1.55, 95% CI = 1.03 – 2.35). This study highlighted the need to address preventative care for the wealthiest, rural residents and the fact that social support is crucial to health care, as well as the fact that medical care costs are borne by the extended family and other social groups in which the individual is (or was) a member, which explains the low demand for health insurance in Jamaica. Private health care in Jamaica is substantially determined by affordability and education rather than illness, and it is a poor measure of the health care- seeking behaviour of Jamaicans.
文摘Previous main body of research on end-life-care in South Korea has focused on developing services quality in hospital settings or service payment system in National Health Insurance Program. The delivery system of hospice and palliative care services has evolved in diverse ways but there is little research on reviewing the past history of development and whole picture of them so far. So, the aim of this study is to review the old hospice and palliative care system and also to introduce the current one supported by the National Health Insurance Program in South Korea. The palliative care or hospice services in South Korea have been available in diverse settings and provided by different organizations (i.e. catholic hospitals or charity organizations). Finally, it was set up in 2004 that the hospice team or official Palliative Care Units (PCUs) was established in hospitals, in order to meet the end-of-life care for the patients with terminal cancer under the Cancer Control Act. The current hospice and palliative care services such as pain management, bereavement services, and counselling can be reimbursed by National Health Insurance program since 2008. Nevertheless hospice and palliative care services are available to dying patients, yet the utilization rate of hospice and palliative care services or the length of stay in the palliative care unit (PCU) is still relatively short compared to other country systems. South Korea is undergoing several efforts to expand the services in PCU along with the development of quality indicators for PCU. Hospice and palliative care services are still new in the health care system and unfamiliar to the public so it requires raising awareness for medical professionals and the public as well as further research.
文摘Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.
文摘The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.
文摘Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health insurance system aimed to create a more competitive market in which consumers would switch health plans, thereby stimulating insurers to price competition and quality improvement. This article evaluates the switching behavior of Dutch consumers and evaluates whether this behavior is advantageous to the goals of the reform. Methods: Three surveys were conducted: from 2005-2006 (n = 478), 2008-2009 (n = 389), and 2010-2011 (n = 191). Results: In 2005-2006, almost 20 percent of the Dutch consumers switched their insurance company. In between 2006 and 2012, however, the percentage of switchers decreased to less than four percent. The main cause of this decrease is that consumers no longer perceive sufficient differences between insurance companies in terms of premium and service. In addition, consumers have difficulties finding the proper information making the right decision and believe they may not be accepted for the supplementary insurance. Consequently, insurance companies only perceive limited incentives to create a more competitive market. Conclusion: Clear and unambiguous information, combined with an obligatory acceptance for the supplementary insurance might help to improve the potential mobility of Dutch consumers.
文摘Health insurance is a mechanism by which a person protects himself from financial loss caused due to accident and/or disability.The chairman of Insurance Regulatory and Development Authority(IRDA)has mentioned that low consumer awareness and insufficient healthcare infrastructure are the major hindrances to widen the reach of healthcare insurance in India.Healthcare costs have witnessed a phenomenal rise in the current times.This has led the customers to insure not only themselves but their family members for any future medical expenses and other related requirements.The need to insure assumes is more importance for older generations who are either retired or will be retired in near future.Given high health cost,it is important for us to get covered for health risks.With this,a good insurance policy is needed to cover doctor's visit,laboratory tests,hospital stays and diagnostic tests.There are quite a few companies covering health risks with good insurance policies.Health insurance(popularly known as Mediclaim)offers protection in case of unexpected medical emergencies.In case of a sudden illness or accident,the health insurance policy takes care of the hospitalization,medical and other costs incurred.Thus,health insurance to be introduced to all consumers in India to protect them from financial loss caused by unfortunate incidents.
文摘Background:In 2011,Ghana piloted the integration of herbal medicine services into mainstream health care delivery in selected government hospitals across the country.To date,however,no single certified herbal drug is generally covered by the national health insurance scheme.This study evaluated the implications of out-of-pocket payment for prescriptions on the patronage of herbal medicine units in 3 selected government hospitals within Kumasi Metropolis.Methods:A cross-sectional study on 413 participants was performed using a semi-structured questionnaire.Results:The majority of study respondents were female(54%),and the median age was 35 years.Most participants(83.1%)were aware that herbal medicine was integrated in the mainstream health care system of the country.Regarding the costs of certified herbal drugs,51.5%of respondents considered them very expensive;72.1%of the respondents believed that the costs of certified herbal drugs adversely affected the utilization of herbal units at government hospitals,which produced a positive correlation(r=0.5498).A total of 99.5%of the respondents recommended the inclusion of certified herbal drugs on the national health insurance drug list.Conclusion:This study revealed that the costs of certified herbal medicines negatively affect utilization of herbal units at government hospitals.To improve the utilization of herbal units,certified herbal drugs dispensed at these units must thus be included in the national health insurance drug list.
基金Supported by the National Social Science Fund of China(18BGL045)。
文摘A critical problem plaguing regulators in promoting pharmaceutical innovation is to design and select efficient incentive policies. In this study, we develop a stylized model comprising a regulator and two representative drug producers to evaluate the effects of three incentive policies: Innovation subsides, inclusion new drugs in the health insurance plan, and the combination of the above two policies(also called hybrid policy). Our analysis shows that innovation subsidies and inclusion of new drugs in the health insurance plan can both promote pharmaceutical innovation, but their incentive effects vary in different policy objectives. Specifically, if the regulator aims to improve patient welfare, he should incorporate new drugs into the health insurance plan to expand the accessibility of new drug when the copayment level is low. However, if the regulator aims to improve social welfare, he should choose innovation subsidies when the copayment level is high, and the hybrid policy when the copayment level is low. In particular, with a sufficiently low copayment level, the hybrid policy allows the new drug producer, patients and the regulator to achieve Pareto improvement due to a lower regulator’s innovation subsidy expenditure, higher profits of the new drug producer and consumer surplus.
基金国家自然科学基金面上项目“基于高压人群身心健康的工作环境绿色空间体系研究”(编号51978364)丰田跨学科专项2022“未来城市跨学科研究关键技术集成与示范”(Action Plan for Integrated Demonstration of Key Technologies for Interdisciplinary Research on Future Cities)共同资助。
文摘In recent years, the NCAA student athlete population in the United States has surpassed 500,000, and is continuing to rise each year [1]. These student athletes work their entire lives academically and athletically to reach the ultimate goal: competing in university athletics. However, when these athletes reach university, they are met with non-stop training, homework, exams, and evolving social lives. We have conducted a study at the University of Evansville evaluating how participation in university athletics may impact mental health status among these student athletes, as well as measuring players’ awareness of accessible mental health resources. Over fifty percent of participants reported experiencing at least one mental health condition while competing in their sport;eighty percent reported having knowledge of the mental health resources available to them on campus, however, nearly thirty percent of those knowledgeable reported not knowing how to access these resources. This has indicated a gap in awareness and utilization of mental health resources among student athletes at the University of Evansville.
