Structural Factors Responsible for Universal Health Coverage in Low- and Middle-Income Countries: Results From 118 Countries

Ranabhat, Chhabi Lal; Jakovljević, Mihajlo; Dhimal, Meghnath; Kim, Chun Bae

doi:10.3389/fpubh.2019.00414

Cited by 77 publications

(62 citation statements)

References 39 publications

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“…However, it takes more time to implement universal healthcare (UHC) in the EM7 [27] because there is still no policy and program priority for health [28]. Except for the United States, the G7 countries have already achieved UHC [29].…”

Section: Discussionmentioning

confidence: 99%

Real GDP growth rates and healthcare spending – comparison between the G7 and the EM7 countries

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Background: Accelerated globalisation has substantially contributed to the rise of emerging markets worldwide. The G7 and Emerging Markets Seven (EM7) behaved in significantly different macroeconomic ways before, during, and after the 2008 Global Crisis. Average real GDP growth rates remained substantially higher among the EM7, while unemployment rates changed their patterns after the crisis. Since 2017, however, approximately one half of the worldwide economic growth is attributable to the EM7, and only a quarter to the G7. This paper aims to analyse the association between the health spending and real GDP growth in the G7 and the EM7 countries. Results: In terms of GDP growth, the EM7 exhibited a higher degree of resilience during the 2008 crisis, compared to the G7. Unemployment in the G7 nations was rising significantly, compared to pre-recession levels, but, in the EM7, it remained traditionally high. In the G7, the austerity (measured as a percentage of GDP) significantly decreased the public health expenditure, even more so than in the EM7. Out-of-pocket health expenditure grew at a far more concerning pace in the EM7 compared to the G7 during the crisis, exposing the vulnerability of households living close to the poverty line. Regression analysis demonstrated that, in the G7, real GDP growth had a positive impact on out-of-pocket expenditure, measured as a percentage of current health expenditure, expressed as a percentage of GDP (CHE). In the EM7, it negatively affected CHE, CHE per capita, and out-of-pocket expenditure per capita. Conclusion: The EM7 countries demonstrated stronger endurance, withstanding the consequences of the crisis as compared to the G7 economies. Evidence of this was most visible in real growth and unemployment rates, before, during and after the crisis. It influenced health spending patterns in both groups, although they tended to diverge instead of converge in several important areas.

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Section: Discussionmentioning

confidence: 99%

Real GDP growth rates and healthcare spending – comparison between the G7 and the EM7 countries

et al. 2020

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“…Hence, high coverage of health insurance with nominal dropout remains a challenge. It has been furthermore problematic due to existing mind set of the people, politics and governance at play [27,54]. In otherwords, it is cumulative challenge of people's awareness, available policies and political direction.…”

Section: Discussionmentioning

confidence: 99%

Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study

Ranabhat

Subedi²,

Karn³

2020

Cost Eff Resour Alloc

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Background Compared to other countries in the South Asia Nepal has seen a slow progress in the coverage of health insurance. Despite of a long history of the introduction of health insurance (HI) and a high priority of the government of Nepal it has not been able to push rapidly its social health insurance to its majority of the population. There are many challenges while to achieve universal health insurance in Nepal ranging from existing policy paralysis to program operation. This study aims to identify the enrollment and dropout rates of health insurance and its determinants in selected districts of Nepal. Methods The study was conducted while using a mixed method including both quantitative and qualitative approaches. Numerical data related to enrollment and dropout rates were taken from Health Insurance Board (HIB) of Nepal. For the qualitative data, three districts, Bardiya, Chitwan, and Gorkha of Nepal were selected purposively. Enrollment assistants (EA) of social health insurance program were taken as the participants of study. Focus group discussions (FGD) were arranged with the selected EAs using specific guidelines along with unstructured questions. The results from numerical data and focus group discussions are synthesized and presented accordingly. Results The findings of the study suggested variation in enrollment and dropout of health insurance in the districts. Enrollment coverage was 13,545 (1%), 249,104 (5%), 1,159,477 (9%) and 1,676,505 (11%) from 2016 to 2019 among total population and dropout rates were 9121(67%), 110,885 (44%) and 444,967 (38%) among total enrollment from 2016 to 2018 respectively. Of total coverage, more than one-third proportion was subsidy enrollment—free enrollment for vulnerable groups. The population characteristics of unwilling and dropout in social health insurance came from relatively well-off families, government employees, businessman, migrants’ people, some local political leaders as well as the poor class families. The major determinants of poor enrollment and dropout were mainly due to unavailability of enough drugs, unfriendly behavior of health workers, and indifferent behavior of the care personnel to the insured patients in health care facilities and prefer to take health service in private clinic for their own benefits. The long maturation time to activate health service, limited health package and lack of copayment in different types of health care were the factors related to inefficient program and policy implementation. Conclusion There is a high proportion of dropout and subsidy enrollment, the key challenge for sustainability of health insurance program in Nepal. Revisiting of existing HI policy on health care packages, more choices on copayment, capacity building of enrollment assistants and better coordination between health insurance board and health care facilities can increase the enrollment and minimize the dropout.

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“…Universal health coverage (UHC) has been championed by health policymakers around the world. However, reality lags far behind ensuring UHC in low-and middleincome countries (LMICs) [1] due to a range of factors [2][3][4][5][6]. The Social Health Insurance (SHI) initiatives have originated from Germany swept across Asia, Latin America and Africa to contribute for the reduction of healthcare finance scarcity and improvements of poor health.…”

Section: Introductionmentioning

confidence: 99%

Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation

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Background Ethiopia is currently planning to introduce Social Health Insurance (SHI) that will lead to universal health coverage and assist a country to achieve its health system’s objectives and to prevent the catastrophic health expenditure. But there is no evidence until now about the level of acceptance of the proposed SHI among government-owned companies’ employees. Therefore, this study was intended to assess the acceptance of SHI and associated factors among government-owned companies’ employees in northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from February 1 to April 30, 2019. A randomly selected 541 government-owned companies’ employees were participated in the study. A pretested self-administered structured questionnaire was used that consisted sociodemographic and economic, health status-related factors, attitude (measured by 12 items), organizational related factors and knowledge about SHI (measured by 11 items). Finally, binary logistic regression analysis was performed and in the multivariable logistic regression analysis, a significant level at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to identify factors statistically associated with SHI acceptance. Results Overall, 32% (95% CI: 27.7–36.2) of the government-owned companies’ employees accepted the proposed Ethiopian SHI scheme. Self-perceived health status (AOR: 8.55, 95% CI: 2.69–27.13), heard about SHI (AOR: 1.69, 95% CI: 1.12–2.54), coverage of medical healthcare cost (AOR: 0.60, 95% CI: 0.39–0.92), work experience (AOR: 0.49, 95% CI: 0.26–0.89) and quality of healthcare service at the facilities (AOR: 0.17, 95% CI: 0.04–0.71) were significantly associated with acceptance of SHI among government-owned companies’ employees. Conclusions One-third of the study participants accepted the proposed Ethiopian SHI scheme. Self-perceived health status, quality of healthcare service at health facilities, coverage of the medical cost by their organization, heard about SHI and work experience were the factors that affect acceptance of the proposed SHI among the government-owned company employees. Therefore, policymakers should devise a plan to promote the benefit packages of SHI for the formal sector employees to start the implementation.

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Structural Factors Responsible for Universal Health Coverage in Low- and Middle-Income Countries: Results From 118 Countries

Cited by 77 publications

References 39 publications

Real GDP growth rates and healthcare spending – comparison between the G7 and the EM7 countries

Real GDP growth rates and healthcare spending – comparison between the G7 and the EM7 countries

Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study

Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation

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