Private Health Insurance Participation for Universal Coverage in the National Health Insurance Era in Denpasar, Bali

Background: National health insurance is a government program that aims at fulfilling the basic needs of the citizens, particularly health. It aims at achieving universal coverage in Indonesia. In order to speed the attainment of the universal coverage and to enhance the service capacity, the Implementation Body of Social Insurance (BPJS) have collaborated with private health insurance agencies. The purpose of this study was to investigate the participation of private health insurance agency in the attainment of universal coverage in the national health insurance era. Subjects and Method: This was a qualitative study carried out in Bali, in July 2015. As many as 22 informants were recruited for this study, consisting of managers and agents of some private health insurance agencies. Data were collected by in-depth interview and analyzed by thematic analysis. Results: Most of the informants were keen in establishing good collaboration with BPJS. Private health insurance agencies were enthusiastic in collaborating for the attainment of universal health coverage through the so-called Coordination of Benefit (CoB). One of the common readily available advantageous feature in this collaboration was that health insurance agency and BPJS operate the similar system of health service delivery-that is managed care. This collaboration was expected to increase the number of participants, as it allows the participants to use the various health benefit products provided by the private health insurance agencies that have collaborated with BPJS. An obstacle being faced by private health insurance was that the CoB participants did not follow the service delivery pathway as implemented by the private health insurance. Consequently the benefits provided by the private health agencies had not been uptaken optimally. The health insurance agencies do not feel threatened, since they have separate segments of participant different from the national health insurance. Conclusion: Private health insurance agencies support the existence of national health insurance. In addition, they do not feel threatened, since they have separate segments of participant different from the national health insurance. They are optimistic that they will grow with BPJS along with the increasing public awareness on the importance of health insurance. Keywords: private health insurance, national health insurance, universal coverage, coordination of benefi

Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of primary health care? Perspectives of key stakeholders in northern Ghana

In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC.; Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC.; The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC.; This study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC

Unions and Upward Mobility for Service-Sector Workers

This report uses national data from the Current Population Survey (CPS) to show that unionization raises the wages of the typical service sector worker by 10.1 percent compared to their non-union peers. The study goes on to show that unionization also increases the likelihood that a service sector worker will have health insurance and a pension. The report also notes that workers with service jobs benefit as much from unionization as workers with manufacturing jobs

Unions and Upward Mobility for Service-Sector Workers

This report uses national data from the Current Population Survey (CPS) to show that unionization raises the wages of the typical service sector worker by 10.1 percent compared to their non-union peers. The study goes on to show that unionization also increases the likelihood that a service sector worker will have health insurance and a pension. The report also notes that workers with service jobs benefit as much from unionization as workers with manufacturing jobs.unions, service sector, wages, benefits, pension

Pengaruh Implementasi Kebijakan Program Jaminan Kesehatan Nasional (Jkn) Terhadap Kualitas Pelayanan Kesehatan Di Puskesmas Donggala Kabupaten Donggala

The purpose of this study is to determine the policy implementation effects of National Health insurance towards Health service quality at Donggala Publick Health Center in Donggala regency, both simultaneously and partially. The tipe of this study is descriptive quantitative with survey method, aims toanalyze the research data of number statistically, to determine the effect of variabel x to variabel y (Sugiyono 2007:11). The populationin this research was 95 respondent of service user who participated in the National Health Insurance at Donggala Publik Health Center. The sampling method in this study is random sampling. The result of this study using statistical test give the following conclusions: (1) implementaion of National health Insurance Program: corelation coeficient value was 0.000, with p < 0.05 at the 95% confidence level, simultaneously effected the Health servise quality at Donggala Publik Health Cetner; (2) Partialy, policy target and standartd (p = 0.000; r = 0.304) resource (p = 0.000; r = 0.208), and attitude / tendency (dispotition) of implementing agency (p = 0.016; r = 0,238) affected the Healt quality service; while characteristics of implemeting agencies (p = 0.175; r = 0.146), interagency comunication ( p = 0.205; r = 0,150) as well as economic, social and political environment ( p = 0.362; r = 0.088) did not affect the health service quality

Implementasi Kebijakan Jaminan Kesehatan Nasional (Jkn) Pada Dinas Kesehatan Kabupaten Sigi

The National Health Insurance Scheme in Sigi indicate the existence of problems in the process of implementation. Among the problems is the lack of health personnel and facilities in direct health care unit, which resulted in the process of service to participants of the National Health Insurance does not seem optimal. By looking at the phenomena, the authors conducted this research is intended to analyze the implementation of the National Health Insurance Program policies in the county. The location of this research include Sigi District Health Office, Torabelo hospitals, and health centers Biromaru. The theory used is the theory of public policy implementation of Van Metter and Van Horn. The research method uses a qualitative approach, as well as the selection of techniques used informants propusive sampling technique. The informants is 7(seven) people. Techniques in data collection are observation, interviews and documents. The results showed that the implementation of the program the National Health Insurance at the District Health Office Sigi has not yet overall effective, due to the availability of several types of resources are needed to support the implementation of the program is not adequate, as the lack of human resources is still not ideal for workload and responsibility that must be completed, the capacity of health care facilities and infrastructure available no longer in accordance with the number of visits of participants to be served. The consequences of an impact on the service process are not optimal for the participants of the National Health Insurance

Health Insurance Status and Perceived Quality of Health Service at Community Health Center, Sumenep, East Java

Background: Having health insurance is important for several reasons. As studies have shown, uninsured people receive less medical care and less timely care. They have worse health outcomes, and lack of insurance is a fiscal burden for them and their families. This study aimed to assess the relationship between health insurance status and perceived quality of health service at community health center, Sumenep, East Java. Subjects and Method: This was a cross-sectional study conducted at puskesmas (community health centers) in Sumenep, East Java. A total sample of 250 people who visited the puskesmas in Sumenep were selected for this study. The dependent variable was perceived quality of health services. The independent variables were health insurance status, sex, age, education, and job. The data were collected by questionnaire and analyzed by a multiple linear regression. Results: Member of health insurance (b= 6.21; CI 95% = - 2.75 to -9.68; p<0.001) and female (b= 1.35; CI 95%= -1.35 to -3.23; p<0.001) were associated with better perceived quality of health service. Age (b= 0.50; CI 95%= -2.24 to 3.25; p= 0.72), higher education (b= -0.94; CI 95% = -0.21 to 3.89; p= 0.53), and having a job (b= 0.94; CI 95% = -2.01 to 3.89; p= 0.52) were associated with poorer perceived quality of health services. Conclusion: Member of health insurance and female are associated with better perceived quality of health service. Age, higher education, and having a job are associated with poorer perceived quality of health services. Keywords: perceived quality of health service, national health insuranc

Pengaruh Kualitas Pelayanan Bpjs Kesehatan terhadap Kepuasan Pengguna Perspektif Dokter Rumah Sakit Hermina Bogor

The study aimed to analyze the perceptions of the doctors of Hermina Hospital Bogor on BPJS health service quality and satisfaction level of the national health insurance program and to analyze the effects of service quality on the doctors\u27 satisfaction. Questionnaires were utilized to obtain the primary data, while literature reviews were conducted to obtain the secondary data. The data were analyzed by using descriptive analysis and multiple regression analysis. The results of this research, in reference to the descriptive analysis of the perceptions of the doctors in Hermina Hospital Bogor on satisfaction and quality service of the National Health Insurance program, indicated that the program is considered unsuitable in its implementation. The results of multiple regression showed that the variables of BPJS service quality have influences on the satisfaction of the doctors of Hermina Hospital Bogor. Keywords: health service quality, satisfaction, hospita

Predictors of Dental Care Use: Findings From the National Longitudinal Study of Adolescent Health

Purpose To examine longitudinal trends and associated factors in dental service utilization by adolescents progressing to early adulthood in the United States. Methods The data source was the National Longitudinal Study of Adolescent Health from Waves I (1994–1995), II (1996), III (2001–2002), and IV (2007–2008). This was a retrospective, observational study of adolescents\u27 transition to early adulthood. We obtained descriptive statistics and performed logistic regression analyses to identify the effects of baseline and concurrent covariates on dental service utilization from adolescence to early adulthood over time. Results Dental service utilization within the prior 12 months peaked at age 16 (72%), gradually decreased until age 21 (57%), and remained flat thereafter. Whites and Asians had a 10–20 percentage points higher proportion of dental service utilization at most ages compared with Blacks and Hispanics. Dental service utilization at later follow-up visits was strongly associated with baseline utilization, with odds ratio = 10.7, 2.4, and 1.5 at the 1-, 7-, and 13-year follow-ups, respectively. These effects decreased when they were adjusted for current income, insurance, and education. Compared with Whites, Blacks were consistently less likely to report a dental examination. Conclusions Dental service utilization was highest in adolescence. Gender, education, health insurance, and income in young adulthood were significant predictors in reporting a dental examination. Blacks had lower odds of reporting a dental examination, either as adolescents or as young adults