The challenge of ensuring elderly people can access their health insurance entitlements: a mixed methods study on the Republic of Srpska’s Protector of Patients’ Health Insurance Entitlements

Abstract

Introduction Healthcare utilisation requires knowing one’s entitlements and how to access them (navigation) and having access to grievance redressal when entitlements are denied. To ensure citizen access to and use of health insurance entitlements, the Health Insurance Fund established an initiative called the Protector of Patients’ Health Insurance Entitlements (PPHIE). PPHIEs are supposed to provide patient navigation and grievance redressal services. This paper explores to what extent this initiative meets its objectives and is used by the elderly in rural areas. Methods This study employed a mixed methods approach. We conducted in-depth interviews with elderly patients in rural areas, PPHIEs, health providers and health insurance managers (N=39), as well as focus groups (N=5) and a household survey (N=715) with elderly rural patients. Qualitative data were analysed using content analysis, and the household survey results were analysed using descriptive statistics. Results The majority of elderly patients were not aware of the PPHIE initiative and instead received patient navigation support from their healthcare providers. The PPHIE programme was poorly publicised among the population. Although PPHIEs had a mandate to pursue grievance redressal they rarely did so, and their role in the system was more symbolic than functional. Conclusion While healthcare providers have (by default) filled the navigation role left by inactive PPHIEs, the grievance redressal role remains unfilled. Information about health insurance entitlements and access to grievance redressal must be provided through visible, accessible and efficient mechanisms that should be continuously monitored and improved.

Does mobile renewal make health insurance more responsive to clients? A case study of the National Health Insurance Scheme in Ghana

“…In other contexts, poor understanding of entitlements or difficult-to-navigate benefits have been found to reduce access to healthcare and can deter users from starting or renewing health insurance 16 17. Conversely, high health insurance literacy is associated with increased utilisation of health services 16.…”

“…In other contexts, poor understanding of entitlements or difficult-to-navigate benefits have been found to reduce access to healthcare and can deter users from starting or renewing health insurance 16 17. Conversely, high health insurance literacy is associated with increased utilisation of health services 16. Community engagement programmes have been used to increase client’s understanding of their health insurance rights and entitlements, thereby overcoming barriers to retention and increasing access to services and financial protection 18–20…”

“…16 17 Conversely, high health insurance literacy is associated with increased utilisation of health services. 16 Community engagement programmes have been used to increase client's understanding of their health insurance rights and entitlements, thereby overcoming barriers to retention and increasing access to services and financial protection. [18][19][20] Increasing access to mobile phones and mobile banking, along with advancements in mobile technologies, have prompted innovations across health systems and payment for health services.…”

“… 16 17 Conversely, high health insurance literacy is associated with increased utilisation of health services. 16 Community engagement programmes have been used to increase client’s understanding of their health insurance rights and entitlements, thereby overcoming barriers to retention and increasing access to services and financial protection. 18–20 …”