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1.
Int J Health Serv ; 52(1): 168-173, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34668424

RESUMEN

The COVID-19 pandemic has wrought fundamental changes in the US workplace, placing employer-sponsored health insurance (ESI) in disarray. Before the pandemic, ESI was the single largest share of private health insurance in the country, including some 150 million Americans. Even before the pandemic, however, ESI had become increasingly volatile and more unaffordable for both employers and employees. During the pandemic, many workers found that they could work at home remotely. Job losses during the pandemic left many millions uninsured, with many jobs lost indefinitely. Today, many Americans are rethinking how and where they want to be involved in the workplace, while many businesses are considering a future when more people are working from home or being replaced by robots, placing ESI in further jeopardy. This article brings historical perspective to these problems, showing how the private health insurance industry has failed the public interest by being too fragmented and unreliable to be afforded or depended upon. Three major reform alternatives are described, only 1 of which-single-payer improved Medicare for All-can provide stable universal coverage that meets the needs of all Americans while being affordable for patients, families, and taxpayers.


Asunto(s)
COVID-19 , Planes de Asistencia Médica para Empleados , Humanos , Cobertura del Seguro , Seguro de Salud , Medicare , Pandemias , SARS-CoV-2 , Medicina Estatal , Estados Unidos , Cobertura Universal del Seguro de Salud
2.
Medicine (Baltimore) ; 100(41): e27457, 2021 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-34731120

RESUMEN

ABSTRACT: Human papillomavirus (HPV) vaccination in young women is low. Women aged 21 to 65 years in the United States (U.S.) have not reached the Healthy People 2020 objective of 93% for cervical cancer screening. The main aim of this study was to investigate the association between HPV vaccination status and cervical cancer screening among privately insured women aged 21 to 26 years in the U.S.This was a retrospective cohort study using the IBM MarketScan database (2006-2016). The study population included 190,982 HPV-vaccinated women and 763,928 matched unvaccinated women. Adjusted incidence rate ratio (IRR) and the 95% confidence intervals (CIs) were obtained using the generalized estimating equations models with a Poisson distribution.Among a total of 954,910 women included in the analysis, age (mean [SD]) was 23.3 [1.6] years. During 967,317 person-years of follow-up, a total of 475,702 incidents of cervical cancer screening were identified. The incidence density rates of cervical cancer screening were 461 per 1000 person-years (PY) for unvaccinated women and 787 per 1000 PY for those who received 3 doses of the HPV vaccine. After adjusting for other covariates, the IRR of cervical cancer screening was 34% higher among HPV-vaccinated women with at least one vaccine dose than unvaccinated women (adjusted IRR = 1.34, 95% CI: 1.33-1.35; P < .0001). The IRR of cervical cancer screening varied by the dose of HPV vaccination. There was evidence of a linear dose-response relationship between the number of HPV vaccine doses and cervical cancer screening (P-trend < .0001). Compared with unvaccinated women, the IRR of cervical cancer screening were 14%, 39%, and 60% higher among those who received 1, 2, and 3 doses of the HPV vaccine, respectively.In this large retrospective cohort study of privately insured women, HPV-vaccinated women were more likely to be screened for cervical cancer compared with unvaccinated women.


Asunto(s)
Tamizaje Masivo/estadística & datos numéricos , Neoplasias del Cuello Uterino/prevención & control , Cobertura de Vacunación/estadística & datos numéricos , Adulto , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Seguro de Salud/estadística & datos numéricos , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/inmunología , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
3.
Acad Pediatr ; 21(8S): S146-S153, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34740422

RESUMEN

Over the past 20 years, the United States greatly expanded eligibility for public health insurance under the Medicaid and Child Health Insurance Program programs. This expansion improved children's access to health care and their health, ultimately lowering preventable hospitalizations, chronic conditions, and mortality rates in the most vulnerable children at a cost that is 4 times lower than the average per capita cost for the elderly. They also had broader antipoverty effects, increasing economic security, children's educational attainments, and their eventual employment and earnings opportunities. However, in recent years, this progress has been rolled back in many states. Remarkably, although income eligibility cutoffs have remained largely constant, states have reduced child coverage through a number of administrative measures ranging from increased paperwork, to reduced outreach, new parental work requirements, changes to public charge rules for immigrants, and waivers of federal requirements to provide retroactive coverage to new applicants. The number of uninsured children was rising for the first time in decades even prior to the pandemic. With rising numbers who have lost their jobs in the pandemic-induced recession, it is more important than ever to defend and restore and improve access to public health insurance for our children.


Asunto(s)
Servicios de Salud del Niño , Medicaid , Anciano , Niño , Salud del Niño , Accesibilidad a los Servicios de Salud , Humanos , Seguro de Salud , Pobreza , Estados Unidos
4.
BMC Health Serv Res ; 21(1): 1212, 2021 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-34753465

RESUMEN

BACKGROUND: Health insurance is an essential aspect of healthcare. This is because it enables the insured to acquire timely and essential healthcare services, besides offering financial protection from catastrophic treatment costs. This paper seeks to establish gender differentials and determinants of health insurance coverage in Zambia. METHODS: The data used in this study was obtained from the 2018 Zambia Demographic and Health Survey. Data were analyzed using STATA 13.0 software and focused on descriptive and Probit regression analyses. RESULTS: The study reveals that for women and men, age, wealth category, education, and professional occupation are positively associated with health insurance while being self-employed in the agricultural sector negatively influences health insurance coverage for both sexes. Other variables have gender-specific effects. For instance, being in marital union and having a clerical occupation increases the probability of having health insurance for women while being in the services, skilled, and unskilled manual occupations increases the probability of having health insurance for men. Further, residing in rural areas reduces the probability of having health insurance for men. CONCLUSION: The study concludes that there are differences in factors that influence health insurance between women and men. Hence, this study highlights the need to enhance health insurance coverage by addressing the different factors that influence health insurance coverage among men and women. These factors include enhancing education, job creation, diversifying insurance schemes, and gender consideration in the design of National Health Insurance Scheme.


Asunto(s)
Seguro de Salud , Programas Nacionales de Salud , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Cobertura del Seguro , Masculino , Zambia/epidemiología
5.
Artículo en Inglés | MEDLINE | ID: mdl-34769847

RESUMEN

The aim of this study was to identify regional disparities in generic drug usage and to examine related factors. The database used for the analysis was the 2018 national health insurance claims data published on the Japanese Ministry of Health, Labour, and Welfare. The drugs that were targeted were a combination of brand-name and generic tetracycline ointments for periodontal treatment and lidocaine injection solution used for dental anesthesia. The usage of generic drugs was calculated and compared by prefecture based on the number of health insurance claims. The comparison of related factors was conducted using data from other national statistical survey. The results showed that the mean generic drug usage of tetracycline for periodontal treatment in all prefectures was 71.2 ± 8.1%, ranging from 45.8% to 85.3%. The mean generic lidocaine used for dental anesthesia was 47.6 ± 10.0%, ranging from 30.5% to 66.2%. The rank correlation coefficient between the two was 0.359 (p < 0.05), and the tendency of using both generic drugs was low in major metropolitan areas. Generic drug usage in Japan is low; thus, in order to reduce healthcare costs, generic drugs need to be actively used in dentistry.


Asunto(s)
Medicamentos Genéricos , Costos de la Atención en Salud , Odontología , Seguro de Salud , Japón
6.
J Insur Med ; 49(s1): 1-31, 2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34788842

RESUMEN

OBJECTIVE.­: To propose an insurance product called special needs insurance. The insurance will pay parents a lump sum up to $100,000 if they have a child that is born with or develops a special needs condition such as Down syndrome, cerebral palsy or autism. BACKGROUND.­: Raising a child is expensive; raising a child with a special need can be hundreds of thousands of dollars more expensive. These additional costs include direct costs that are not covered by health insurance and indirect costs such as the loss of earnings when a working parent must tend to a special needs child. METHOD.­: We analyze a gamut of birth and early childhood disabilities, both physical and cognitive, from the medico-actuarial perspective. We describe each condition using relevant medical literature and calculate prevalence rates from epidemiological studies (appendix A1-A15). After accounting for multiple births, we develop a final premium. RESULTS.­: We find that physical impairments are sufficiently well understood to guarantee a fixed payout, whereas cognitive impairments such as autism are less understood, and so for these we propose a cognitive fund that does not guarantee a fixed payout. We find that an average single premium of $4,600 allows the insurer to profitably pay out the proposed benefits. CONCLUSIONS.­: Raising a special needs child can put a significant strain on the affected family's budget. We propose an insurance product that provides relief through a large lump sum payout. Although no new insurance product can be guaranteed success, our analysis of this product gives an interested insurer reasonable justification to take on this new risk.


Asunto(s)
Parálisis Cerebral , Seguro de Salud , Niño , Preescolar , Familia , Humanos , Renta , Padres
7.
BMC Health Serv Res ; 21(1): 1264, 2021 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-34809613

RESUMEN

BACKGROUND: Decomposing health care spending by disease, type of care, age, and sex can lead to a better understanding of the drivers of health care spending. But the lack of diagnostic coding in outpatient care often precludes a decomposition by disease. Yet, health insurance claims data hold a variety of diagnostic clues that may be used to identify diseases. METHODS: In this study, we decompose total outpatient care spending in Switzerland by age, sex, service type, and 42 exhaustive and mutually exclusive diseases according to the Global Burden of Disease classification. Using data of a large health insurance provider, we identify diseases based on diagnostic clues. These clues include type of medication, inpatient treatment, physician specialization, and disease specific outpatient treatments and examinations. We determine disease-specific spending by direct (clues-based) and indirect (regression-based) spending assignment. RESULTS: Our results suggest a high precision of disease identification for many diseases. Overall, 81% of outpatient spending can be assigned to diseases, mostly based on indirect assignment using regression. Outpatient spending is highest for musculoskeletal disorders (19.2%), followed by mental and substance use disorders (12.0%), sense organ diseases (8.7%) and cardiovascular diseases (8.6%). Neoplasms account for 7.3% of outpatient spending. CONCLUSIONS: Our study shows the potential of health insurance claims data in identifying diseases when no diagnostic coding is available. These disease-specific spending estimates may inform Swiss health policies in cost containment and priority setting.


Asunto(s)
Gastos en Salud , Pacientes Ambulatorios , Atención Ambulatoria , Atención a la Salud , Costos de la Atención en Salud , Humanos , Seguro de Salud , Estados Unidos
9.
Yonsei Med J ; 62(12): 1155-1161, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34816646

RESUMEN

PURPOSE: This study analyzed the changes in the number of surgeries and surgical patterns due to the adoption and diffusion of new medical technology while focusing on radical prostatectomy. MATERIALS AND METHODS: Medical equipment status report data and the National Health Insurance claims data from 2007 to 2019 were used. A total of 62798 radical prostatectomies from 135 medical facilities were analyzed. Radical prostatectomy was classified into open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and robot-assisted laparoscopic radical prostatectomy (RARP) using the fee schedule codes. A linear mixed model was used to determine whether the adoption of a robotic surgical system had an effect on the number of surgeries and surgical patterns after adjusting for medical characteristics. RESULTS: The number of radical prostatectomies performed in Korea increased from 1756 in 2007 to 8475 in 2019. During this period, the proportion of RARP in total surgery increased from 17.5% to 74.3%. The mean number of surgeries at medical facilities adopting the robotic surgical system was 128.3, which was higher compared to 18.5 cases in medical facilities that did not adopt it. The adoption of a robotic surgical system increased the number of radical prostatectomy surgeries by 12.1 cases and the RARP share by 47.2% in a linear mixed model. CONCLUSION: The adoption and diffusion of robotic surgical systems in Korea increased the number of surgeries as well as the share of robotic surgery. It is necessary to manage a technology that is widely used in a state where its clinical effectiveness is uncertain.


Asunto(s)
Laparoscopía , Neoplasias de la Próstata , Procedimientos Quirúrgicos Robotizados , Humanos , Seguro de Salud , Masculino , Prostatectomía , Neoplasias de la Próstata/cirugía , Resultado del Tratamiento
11.
Health Aff (Millwood) ; 40(11): 1722-1730, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34724431

RESUMEN

In 2020 the COVID-19 pandemic caused millions to lose their jobs and, consequently, their employer-sponsored health insurance. Enacted in 2010, the Affordable Care Act (ACA) created safeguards for such events by expanding Medicaid coverage and establishing Marketplaces through which people could purchase health insurance. Using a novel national data set with information on ACA-compliant individual insurance plans, we found large increases in Marketplace enrollment in 2020 compared with 2019 but with varying percentage increases and spending risk implications across states. States that did not expand Medicaid had enrollment and spending risk increases. States that expanded Medicaid but did not relax 2020 Marketplace enrollment criteria also had spending risk increases. In contrast, states that expanded Medicaid and relaxed 2020 enrollment criteria experienced enrollment increases without spending risk changes. The findings are reassuring with respect to the ability of Marketplaces to buffer employment shocks, but they also provide cautionary signals that risks and premiums could begin to rise either in the absence of Medicaid expansion or when Marketplace enrollment is constrained.


Asunto(s)
COVID-19 , Intercambios de Seguro Médico , Humanos , Cobertura del Seguro , Seguro de Salud , Medicaid , Pandemias , Patient Protection and Affordable Care Act , SARS-CoV-2 , Estados Unidos
12.
J Headache Pain ; 22(1): 140, 2021 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-34800970

RESUMEN

BACKGROUND: Health care costs of migraine constitute a major issue in health economics. Several publications analyzed health care costs for adult migraine patients, based on questionnaires or secondary (health insurance) data. Although migraine often starts already in primary school age, data on migraine related costs in children is scarce. In this paper we aimed to assess the migraine-related health care costs in 6 to 11 year old children in Germany. METHODS: Using claims data of a large German health insurer (BARMER), overall annual health care costs of 6 to 11 year old children with a diagnosis of migraine in 2017 (n = 2597) were compared to a control group of 6 to 11 year old children without a headache diagnosis between 2013 and 2017 (n = 306,926). The association of migraine and costs was modeled by generalized linear regression (Gamma regression) with adjustment for sex, age and comorbidities. RESULTS: Children with migraine caused considerably higher annual per capita health care costs than children without a headache diagnosis (migraine group: € 1018, control group: € 618). Excess costs directly related to migraine amounted to € 115. The remaining excess costs were related to comorbidities, which were more frequent in the migraine group. Mental and behavioural disorders constituted the most expensive comorbidity, accounting for € 105 of the € 400 annual excess costs in the migraine group. CONCLUSION: 6 to 11 year old children with a migraine diagnosis cause significant direct and comorbidity related excess costs in the German health care system.


Asunto(s)
Costos de la Atención en Salud , Trastornos Migrañosos , Adulto , Niño , Grupos Control , Alemania/epidemiología , Cefalea , Humanos , Seguro de Salud , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/epidemiología
13.
BMC Health Serv Res ; 21(1): 1261, 2021 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-34802452

RESUMEN

BACKGROUND: Development in Eastern Indonesia tends to be left behind compared to other Indonesian regions, including development in the health sector. The study aimed at analyzing the health insurance ownership disparities in hospital delivery in Eastern Indonesia. METHODS: The study draws on secondary data from the 2017 Indonesia Demographic and Health Survey. The study population was women aged 15-49 years who had given birth in the last five years in Eastern Indonesia. The study analyzes a weighted sample size of 2299 respondents. The study employed hospital-based birth delivery as a dependent variable. Apart from health insurance ownership, other variables analyzed as independent variables are province, residence type, age group, marital status, education level, employment status, parity, and wealth status. The final stage analysis used binary logistic regression. RESULTS: The results showed that insured women were 1.426 times more likely than uninsured women to undergo hospital delivery (AOR 1.426; 95% CI 1.426-1.427). This analysis indicates that having health insurance is a protective factor for women in Eastern Indonesia for hospital delivery. There is still a disparity between insured and uninsured women in hospital-based birth deliveries in eastern Indonesia. Insured women are nearly one and a half times more likely than uninsured women to give birth in a hospital. CONCLUSION: The study concludes that there are health insurance ownership disparities for hospital delivery in eastern Indonesia. Insured women have a better chance than uninsured women for hospital delivery.


Asunto(s)
Seguro de Salud , Propiedad , Femenino , Hospitales , Humanos , Indonesia , Paridad , Embarazo
14.
Health Aff (Millwood) ; 40(11): 1706-1712, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34724427

RESUMEN

The Affordable Care Act (ACA) relies on insurers to offer health plans in the individual health insurance Marketplaces. Since the ACA's implementation, levels of Marketplace competition have varied, reaching a nadir in 2018. We examined the characteristics of counties that experienced changes in insurers' participation in the ACA Marketplaces from 2016 to 2021. Using data from the Kaiser Family Foundation and other sources, we found that 1,968 counties (accounting for 66 percent of the US population younger than age sixty-five) have more insurers in 2021 than in 2018, whereas only twelve counties (comprising 0.4 percent of the US nonelderly population) have fewer insurers. The number of counties with monopolist Marketplace insurers declined from 1,616 in 2018 to 294 in 2021. Recent Marketplace insurer gains were more likely in counties that lost insurers from 2016 to 2018 or had a monopolist insurer in 2018. Increased competition may lead to lower gross premiums in the ACA Marketplaces. Given the Biden administration's support for the ACA Marketplaces, it appears likely that the ACA individual health insurance market will be stable and profitable for the next several years.


Asunto(s)
Intercambios de Seguro Médico , Patient Protection and Affordable Care Act , Humanos , Aseguradoras , Cobertura del Seguro , Seguro de Salud , Estados Unidos
15.
Health Aff (Millwood) ; 40(11): 1713-1721, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34724430

RESUMEN

The Affordable Care Act provides tax credits for Marketplace insurance, but before 2021, families with incomes above four times the federal poverty level did not qualify for tax credits and could face substantial financial burdens when purchasing coverage. As a measure of affordability, we calculated potential Marketplace premiums as a percentage of family income among families with incomes of 401-600 percent of poverty. In 2015 half of this middle-class population would have paid at least 7.7 percent of their income for the lowest-cost bronze plan; in 2019 they would have paid at least 11.3 percent of their income. By 2019 half of the near-elderly ages 55-64 would have paid at least 18.9 percent of their income for the lowest-cost bronze plan in their area. The American Rescue Plan Act temporarily expanded tax credit eligibility for 2021 and 2022, but our results suggest that families with incomes of 401-600 percent of poverty will again face substantial financial burdens after the temporary subsidies expire.


Asunto(s)
Intercambios de Seguro Médico , Patient Protection and Affordable Care Act , Anciano , Costos y Análisis de Costo , Determinación de la Elegibilidad , Humanos , Cobertura del Seguro , Seguro de Salud , Persona de Mediana Edad , Estados Unidos
16.
Int J Public Health ; 66: 1604073, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34744596

RESUMEN

Objectives: Guidelines recommend colorectal cancer (CRC) screening by fecal occult blood test (FOBT) or colonoscopy. In 2013, Switzerland introduced reimbursement of CRC screening by mandatory health insurance for 50-69-years-olds, after they met their deductible. We hypothesized that the 2013 reimbursement policy increased testing rate. Methods: In claims data from a Swiss insurance, we determined yearly CRC testing rate among 50-75-year-olds (2012-2018) and the association with socio-demographic, insurance-, and health-related covariates with multivariate-adjusted logistic regression models. We tested for interaction of age (50-69/70-75) on testing rate over time. Results: Among insurees (2012:355'683; 2018:348'526), yearly CRC testing rate increased from 2012 to 2018 (overall: 8.1-9.9%; colonoscopy: 5.0-7.6%; FOBT: 3.1-2.3%). Odds ratio (OR) were higher for 70-75-year-olds (2012: 1.16, 95%CI 1.13-1.20; 2018: 1.05, 95%CI 1.02-1.08). Deductible interacted with changes in testing rate over time (p < 0.001). The increase in testing rate was proportionally higher among 50-69-years-olds than 70-75-year-olds over the years. Conclusions: CRC testing rate in Switzerland increased from 2012 to 2018, particularly among 50-69-years-olds, the target population of the 2013 law. Future studies should explore the effect of encouraging FOBT or waiving deductible.


Asunto(s)
Neoplasias Colorrectales , Detección Precoz del Cáncer , Anciano , Colonoscopía/economía , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/estadística & datos numéricos , Humanos , Formulario de Reclamación de Seguro/estadística & datos numéricos , Seguro de Salud/economía , Persona de Mediana Edad , Sangre Oculta , Mecanismo de Reembolso , Suiza
17.
Front Public Health ; 9: 752530, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34604168

RESUMEN

Under the context of rapid economic and social development, and growing demands for a better life, Chinese residents have been increasingly concerned with their health status and issues. In this study, the internal relations between the purchase of commercial insurance by residents and their health status are analyzed and studied with a polytomous logit model based on the data of Chinese General Social Survey (CGSS) in 2015. According to the research result, purchase of commercial insurance significantly improved the health status of residents, with an improving effect for rural residents apparently better than that among urban residents. In addition, purchase of commercial insurance can promote the health status of residents by increasing their household income. This research will provide an effective reference for the innovative development and medical reform of the commercial insurance of China in the future, which is theoretically and practically significant to the implementation of the Healthy China Strategy.


Asunto(s)
Estado de Salud , Población Rural , China , Humanos , Seguro de Salud , Modelos Logísticos
18.
BMC Health Serv Res ; 21(1): 1053, 2021 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-34610829

RESUMEN

BACKGROUND: Many internal migrants during the urbanization process in China are Migrant Parents, the aging group who move to urban areas to support their family involuntarily. They are more vulnerable economically and physically than the younger migrants. However, the fragmentation of rural and urban health insurance schemes divided by "hukou" household registration system limit migrant's access to healthcare services in their resident location. Some counties have started to consolidate the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS) as one Integrated Medical Insurance Schemes (IMIS) from 2008. The consolidation aimed to reduce the disparity between different schemes and increase the health care utilization of migrants. RESULTS: Using the inpatient sample of migrant parents from China Migrants Dynamic Survey in 2015, we used Ordinary Least Squares (OLS) for regression models. We found that the migrant parents covered by the IMIS are more likely to choose inpatient services and seek medical treatment in the migrant destination. We further subdivide Non-IMISs into NCMSs and URBMIs in the regression to alleviate the doubt about endogenous. The results revealed that the migrant parents in IMIS use more local medical services than both of them in URBMI and NCMS. CONCLUSIONS: The potential mechanisms of our results could be that IMIS alleviates the difficulty of seeking medical care in migrant destinations by improving the convenience of medical expense reimbursement and enhancing health insurance benefits.


Asunto(s)
Migrantes , China , Humanos , Seguro de Salud , Padres , Aceptación de la Atención de Salud
19.
Front Public Health ; 9: 724185, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34660517

RESUMEN

Using 2017 Migrant Dynamic Survey (CMDS) data, logistic regression models were developed to explore the family migration rate on health care participation of floating population. The analysis reveals that 68.69% of the floating population in China moves with at least one family member, but the local health insurance participation rate of them are relative low. However, family migration rate has a significant positive correlation with the health insurance participation of the floating population at the destination, which explains by family support and social integration mechanisms. The higher the degree of family migration, the higher the likelihood of participating in local health insurance system. Age, labor contract types, migration range and cities numbers, health records, and the accessibility of health resources have a significant negative correlation with health care participation of the floating population at the destination; gender, health, marriage, education, hukou types, monthly income, migration history, and move duration have a significant positive correlation. The effect of family migration rate on health care participation is weaker in group in which people are low-educated and signs non-fixed-term contract or gets bottom 50% monthly income or under the no-kids family structure. Potential policies informed by these findings are also explored.


Asunto(s)
Seguro de Salud , Migrantes , China , Humanos , Renta , Dinámica Poblacional
20.
BMC Health Serv Res ; 21(1): 1140, 2021 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-34686182

RESUMEN

BACKGROUND: Health insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania. METHOD: An explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems' responsiveness. Qualitative content analysis was used to analyse the data. RESULTS: Elderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare. CONCLUSIONS: The national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients´ communication skills and care rights is highly recommended.


Asunto(s)
Seguro de Salud , Pacientes no Asegurados , Anciano , Atención a la Salud , Femenino , Programas de Gobierno , Humanos , Lactante , Masculino , Tanzanía/epidemiología
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