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Lim MY, Kamaruzaman HF, Wu O, Geue C. Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review. Arch Public Health 2023; 81:148. [PMID: 37592326 PMCID: PMC10433621 DOI: 10.1186/s13690-023-01159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) has received much attention and many countries are striving to achieve it. The Southeast Asian region, in particular, comprises many developing countries with limited resources, exacerbating challenges around attaining UHC. This paper aims to specifically explore the health financing challenges these countries face in achieving UHC via a systematic review approach and formulate recommendations that will be useful for policymakers. METHODS The systematic review followed the guidelines as recommended by PRISMA. The narrative synthesis approach was used for data synthesis, followed by identifying common themes. RESULTS The initial search returned 160 articles, and 32 articles were included after the screening process. The identified challenges in health financing towards achieving UHC in the Southeast Asian region are categorised into six main themes, namely (1) Unsustainability of revenue-raising methods, (2) Fragmented health insurance schemes, (3) Incongruity between insurance benefits and people's needs, (4) Political and legislative indifference, (5) Intractable and rapidly rising healthcare cost, (6) Morally reprehensible behaviours. CONCLUSIONS The challenges identified are diverse and therefore require a multifaceted approach. Regional collaborative efforts between countries will play an essential role in the progress towards UHC and in narrowing the inequity gap. At the national level, individual countries must work towards sustainable health financing strategies by leveraging innovative digital technologies and constantly adapting to dynamic health trends. REGISTRATION This study is registered with PROSPERO, under registration number CRD42022336624.
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Affiliation(s)
- Ming Yao Lim
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK.
| | - Hanin Farhana Kamaruzaman
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Scotland, UK
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Kaiser AH, Rotigliano N, Flessa S, Ekman B, Sundewall J. Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia. PLoS One 2023; 18:e0288269. [PMID: 37432943 DOI: 10.1371/journal.pone.0288269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
Achieving universal health coverage (UHC) is a priority of most low- and middle-income countries, reflecting governments' commitments to improved population health. However, high levels of informal employment in many countries create challenges to progress toward UHC, with governments struggling to extend access and financial protection to informal workers. One region characterized by a high prevalence of informal employment is Southeast Asia. Focusing on this region, we systematically reviewed and synthesized published evidence of health financing schemes implemented to extend UHC to informal workers. Following PRISMA guidelines, we systematically searched for both peer-reviewed articles and reports in the grey literature. We appraised study quality using the Joanna Briggs Institute checklists for systematic reviews. We synthesized extracted data using thematic analysis based on a common conceptual framework for analyzing health financing schemes, and we categorized the effect of these schemes on progress towards UHC along the dimensions of financial protection, population coverage, and service access. Findings suggest that countries have taken a variety of approaches to extend UHC to informal workers and implemented schemes with different revenue raising, pooling, and purchasing provisions. Population coverage rates differed across health financing schemes; those with explicit political commitments toward UHC that adopted universalist approaches reached the highest coverage of informal workers. Results for financial protection indicators were mixed, though indicated overall downward trends in out-of-pocket expenditures, catastrophic health expenditure, and impoverishment. Publications generally reported increased utilization rates through the introduced health financing schemes. Overall, this review supports the existing evidence base that predominant reliance on general revenues with full subsidies for and mandatory coverage of informal workers are promising directions for reform. Importantly, the paper extends existing research by offering countries committed to progressively realizing UHC around the world a relevant updated resource, mapping evidence-informed approaches toward accelerated progress on the UHC goals.
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Affiliation(s)
- Andrea Hannah Kaiser
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Niccolò Rotigliano
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Steffen Flessa
- Department of Health Care Management, University of Greifswald, Greifswald, Germany
| | - Björn Ekman
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Jesper Sundewall
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- HEARD, University of KwaZulu-Natal, Durban, South Africa
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Dubey S, Deshpande S, Krishna L, Zadey S. Evolution of Government-funded health insurance for universal health coverage in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100180. [PMID: 37383549 PMCID: PMC10305876 DOI: 10.1016/j.lansea.2023.100180] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 06/30/2023]
Abstract
India has run multiple Government-Funded Health Insurance schemes (GFHIS) over the past decades to ensure affordable healthcare. We assessed GFHIS evolution with a special focus on two national schemes - Rashtriya Swasthya Bima Yojana (RSBY) and Pradhan Mantri Jan Arogya Yojana (PMJAY). RSBY suffered from a static financial coverage cap, low enrollment, inequitable service supply, utilization, etc. PMJAY expanded coverage and mitigated some of RSBY's drawbacks. Investigating equity in PMJAY's supply and utilization across geography, sex, age, social groups, and healthcare sectors depicts several systemic skews. Kerala and Himachal Pradesh with low poverty and disease burden use more services. Males are more likely to seek care under PMJAY than females. Mid-age population (19-50 years) is a common group availing services. Scheduled Caste and Scheduled Tribe people have low service utilization. Most hospitals providing services are private. Such inequities can lead the most vulnerable populations further into deprivation due to healthcare inaccessibility.
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Affiliation(s)
- Sweta Dubey
- Association for Socially Applicable Research (ASAR), Pune, India
| | - Swasti Deshpande
- Association for Socially Applicable Research (ASAR), Pune, India
- Lalwani Mother and Child Care Hospital, Pune, India
| | - Lokesh Krishna
- Association for Socially Applicable Research (ASAR), Pune, India
- Department of Community Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, India
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre Pune, Maharashtra, India
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Jung H, Lee J. Estimating the effectiveness of national health insurance in covering catastrophic health expenditure: Evidence from South Korea. PLoS One 2021; 16:e0255677. [PMID: 34411126 PMCID: PMC8376031 DOI: 10.1371/journal.pone.0255677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
The catastrophic health expenditure (CHE) indicator has been used to measure the medical cost burden of households. Many countries have institutionalized their health insurance systems to reduce out-of-pocket payments, the main contributor to the financial burden. However, there is no method to estimate how the insurance coverage reduces the CHE. This study proposes an approach to evaluate the effectiveness of insurance in reducing the CHE impacts in terms of incidence and gap, which are based on a modified calculation method of CHE. Additionally, we apply these methods to data from the Korea Health Panel Survey (2011-2016). The results are as follows. First, under the setting of a threshold of 10%, the CHE incidence rate was 19.26% when the Korean national health insurance benefits reduced the CHE's incidence for 15.17% of the population in 2017. Second, the results of the concentration index of CHE showed that the intensity approach of CHE is better than the incidence approach. Third, the new approach we applied revealed that health insurance reduces the burden of CHE to some degree, although it was not an efficient way to reduce CHE. In conclusion, this study provides new policy approaches to save the finances of national health insurance and reduce the intensity of CHE at the same time by raising the low-cost burden of medical services and lowering that of high cost. Moreover, we suggest that policymakers should focus on income level of the households rather than specific diseases.
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Affiliation(s)
- Hyunwoo Jung
- Department of Health Administration, Graduate School·BK21 Graduate Program of Developing global Experts in Health Policy and Management, Yonsei University, Wonju, South Korea
| | - Junhyup Lee
- Department of Public Health Science, Korea University, Seoul, South Korea
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Kantamaturapoj K, Marshall AI, Chotchoungchatchai S, Kiewnin K, Patcharanarumol W, Tangcharoensathien V. Performance of Thailand's universal health coverage scheme: Evaluating the effectiveness of annual public hearings. Health Expect 2020; 23:1594-1602. [PMID: 33034411 PMCID: PMC7752199 DOI: 10.1111/hex.13142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Legislative provisions in Thailand's National Health Security Act 2002 mandate annual public hearings for providers, beneficiaries and other stakeholders in order to improve the performance of the Universal Health Coverage Scheme (UCS). OBJECTIVE This study aims to explore the annual public hearing process, evaluate its effectiveness and propose recommendations for improvement. METHOD In-depth interviews were conducted with 29 key informants from various stakeholder groups involved in annual public hearings. RESULTS The evaluation showed that the public hearings fully met the criteria of influence over policy decision and partially met the criteria of appropriate participation approach and social learning. However, there are rooms for improvement on public hearing's inclusiveness and representativeness of participants, adequacy of information and transparency. CONCLUSIONS Three recommendations were proposed a) informing stakeholders in advance of the agenda and hearing process to enable their active participation; b) identifying experienced facilitators to navigate the discussions across stakeholders with different or conflicting interests, in order to reach consensus and prioritize recommendations; and c) communicating policy and management responses as a result of public hearings to all stakeholders in a timely manner.
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Affiliation(s)
| | - Aniqa I. Marshall
- International Health Policy ProgramMinistry of Public HealthNonthaburiThailand
| | | | - Kamonwan Kiewnin
- International Health Policy ProgramMinistry of Public HealthNonthaburiThailand
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Panichkriangkrai W, Topothai C, Saengruang N, Thammatach-Aree J, Tangcharoensathien V. Universal access to sexual and reproductive health services in Thailand: achievements and challenges. Sex Reprod Health Matters 2020; 28:1805842. [PMID: 32895033 PMCID: PMC7887962 DOI: 10.1080/26410397.2020.1805842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Warisa Panichkriangkrai
- Researcher, International Health Policy Program, Ministry of Public Health, Mueang Nonthaburi, Thailand. Correspondence:
| | - Chompoonut Topothai
- Researcher, International Health Policy Program, Ministry of Public Health, Mueang Nonthaburi, Thailand. Correspondence:
- Medical Doctor, Department of Health, Ministry of Public Health, Mueang Nonthaburi, Thailand
| | - Nithiwat Saengruang
- Researcher, International Health Policy Program, Ministry of Public Health, Mueang Nonthaburi, Thailand. Correspondence:
| | | | - Viroj Tangcharoensathien
- Senior Advisor, International Health Policy Program, Ministry of Public Health, Mueang Nonthaburi, Thailand
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Dartanto T, Pramono W, Lumbanraja AU, Siregar CH, Bintara H, Sholihah NK, Usman. Enrolment of informal sector workers in the National Health Insurance System in Indonesia: A qualitative study. Heliyon 2020; 6:e05316. [PMID: 33163673 PMCID: PMC7609471 DOI: 10.1016/j.heliyon.2020.e05316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/10/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
One of the main challenges facing the expansion of universal health coverage (UHC) in developing countries like Indonesia is the high prevalence of those working in the informal sector who must voluntarily register in the National Health Insurance System (NHIS). This condition hinders some from being covered by the NHIS. Following Bourdieu's concepts of field, capital and habitus, this research aims to analyse some aspects that influence the decision of informal sector workers to join the NHIS in Indonesia. We conducted qualitative methods, including in-depth interviews of 29 informants and Focus Group Discussion (FGD) in the three selected regions of Deli Serdang (North Sumatera), Pandeglang (Banten) and Kupang (East Nusa Tenggara). Using thematic content analysis and several triangulation processes, this study found that three main factors influence the decisions of those working in the informal sector to join the NHIS: health conditions, family and peers, and existing knowledge and experience. The stories provided by the informants regarding their decision-making processes in joining NHIS also reveal the necessary and sufficient conditions that enable informal sector workers to join the NHIS, which are individual-specific and which may differ between people, depending on individual characteristics, regional socioeconomic and demographic characteristics and belief systems. These three factors are all necessary conditions to support the joining of informal sector workers into the NHIS. This study suggests that one possible route for expanding the UHC coverage of informal sector workers is through maximising the word-of-mouth effect by engaging local or influential leaders.
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Affiliation(s)
- Teguh Dartanto
- Research Cluster on Poverty, Social Protection and Development Economics, Department of Economics, Faculty of Economics and Business, Universitas Indonesia, Campus UI Depok, Depok, 16424, Indonesia
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Campus UI Salemba, Jakarta, 10430, Indonesia
| | - Wahyu Pramono
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Campus UI Salemba, Jakarta, 10430, Indonesia
| | - Alvin Ulido Lumbanraja
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Campus UI Salemba, Jakarta, 10430, Indonesia
| | - Chairina Hanum Siregar
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Campus UI Salemba, Jakarta, 10430, Indonesia
| | - Hamdan Bintara
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Campus UI Salemba, Jakarta, 10430, Indonesia
| | - Nia Kurnia Sholihah
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Campus UI Salemba, Jakarta, 10430, Indonesia
| | - Usman
- PT Sarana Multi Infrastruktur (Persero), Sahid Sudirman Center 47-48 floor, Jakarta, 10220, Indonesia
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Tangcharoensathien V, Mills A, Patcharanarumol W, Witthayapipopsakul W. Universal health coverage: time to deliver on political promises. Bull World Health Organ 2020; 98:78-78A. [PMID: 32015572 PMCID: PMC6986228 DOI: 10.2471/blt.20.250597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Anne Mills
- London School of Hygiene and Tropical Medicine, University of London, London, England
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