Future prospects of voluntary health insurance in Thailand

Voluntary health insurance schemes in Thailand are still under development and have yet to seriously address the questions of equity and efficiency, while private health insurance is limited to people who can afford the premium. One form of insurance, commonly known as the health insurance card scheme, was first introduced as the Health Card Program in 1983. This program is based on risk sharing of health expenditures, with no cost sharing, in a voluntary health insurance prepayment scheme. With the uncertain performance of the Thai economy, program sustainability and the efficient use of resources are major concerns. The Health Card Program needs enough enrollees to ensure a sufficient pool of risks. This study looks at health card purchase and utilization patterns, using data from Khon Kaen Province, and finds that employment, education levels and the presence of illness are significant factors influencing card purchase. The last factor is related to the problem of adverse selection of the program; families with symptoms of sickness are more likely to buy cards, resulting in greater use of health services. The results also show an improvement in accessibility to health care and a high level of satisfaction among card holders, both key objectives of the program. It is suggested that changes in the health card system could enable it to evolve into a community-based compulsory health insurance scheme for rural areas.     

Waiting times for elective surgery and the decision to buy private health insurance

More than 45% of Australians buy health insurance for private treatment in hospital. This is despite having access to universal and free public hospital treatment. Anecdotal evidence suggests that avoidance of long waits for public treatment is one possible explanation for the high rate of insurance coverage. In this study, we investigate the effect of waiting on individual decisions to buy private health insurance. Individuals are assumed to form an expectation of their own waiting time as a function of their demographics and health status. We model waiting times using administrative data on the population hospitalised for elective procedures in public hospitals and use the parameter estimates to impute the expected waiting time and the probability of a long wait for a representative sample of the population. We find that expected waiting time does not increase the probability of buying insurance but a high probability of experiencing a long wait does. On average, waiting time has no significant impact on insurance. In addition, we find that favourable selection into private insurance, measured by self-assessed health, is no longer significant once waiting time variables are included. This result suggests that a source of favourable selection may be aversion to waiting among healthier people.     

Health insurance and the bamako initiative in Burundi: Value for money?

Despite its a priori attractiveness, health insurance schemes are rare in developing countries. A recent external review of the Bamako Initiative in Burundi considered the extent to which the ‘Carte d'Assurance Maladie’ (CAM) has the potential to improve the quality of, and access to, health services. Although utilization of the CAM was found to be low overall, most of those visiting the health centres were in possession of a card, leading the team to conclude that health service utilization for curative care is extremely low. Focus group discussion revealed that users perceive the quality of health services to be poor, and that frequent shortages of basic drugs and supplies create uncertainty as to whether the CAM will provide good value for money, the shortage of basic drugs, the lack of community participation in the management of health services, and the fact that very little of the revenue from sales of the CAM is spent on health service provision provide possible explanations for the weak uptake of health insurance. Closing the link between the payment for health services and the financing of those services would contribute to an improvement in the quality and the confidence of the population in government health services.     

Evolutionary consequences of G9 rotaviruses circulating in Thailand

Infection with group A rotaviruses is the main cause of acute gastroenteritis in infants and young children worldwide. Rotavirus G9 is recognized as the fifth most predominant G genotype that spreads throughout the world. In this study, we describe the changing distribution of rotavirus G9 genotype in Chiang Mai, Thailand, from 1989 to 2005. Molecular genetic evolutionary analysis of the G9 rotavirus VP7 gene was performed. The G9 rotavirus in Thailand was first detected in Chiang Mai in 1989 with a low prevalence of 1.98%, but in 2000 and 2001 it had become the most predominant genotype, reaching prevalence of 75% and 92.2%, respectively. Then, the prevalence of G9 reached a peak of 100% in 2002 and decreased abruptly over the next 3 years, i.e. 16.7% in 2003, 32.1% in 2004, and 4.7% in 2005. Our phylogenetic analysis demonstrates that all the G9 rotaviruses circulating in Thailand belonged to lineage III, and clustered closely together based on the year of virus isolation. One amino acid change from Thr to Ile was observed in antigenic region C at position 208 between the G9 strains isolated in 1989 and the strains of 1997–2005. These findings provide the overall picture and genomic data of G9 rotaviruses circulating in Chiang Mai, Thailand.     

Moving towards universal health insurance in China: performance, issues and lessons from Thailand

China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of China's current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account China's particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform.     

基于第三方支付机构的居民健康卡应用研究

文章引入了第三方支付公司来发行居民健康卡,设计了第三方支付公司发行居民健康卡的总体规划,研究了政府管理机构、第三方支付公司和应用受理机构在整个解决方案中的角色,设计了居民健康卡发行体系和支付体系,实现了快捷地办理居民健康卡．方便、安全地进行账户充值以及高效、便捷地完成诊疗支付。     

JAVA卡技术在居民健康卡建设中的应用

自原卫生部2012年开始在全国范围倡导推进居民健康卡项目建设试点工作以来,江苏省对居民健康卡发放和应用工作给予了高度重视,根据原卫生部的统一部署和要求,在"十二五"期间实现"一人一卡一档",大力推进金融集成电路卡(IC卡)在公共服务领域实现一卡多用,积极探讨利用Java卡技术推进居民健康卡建设工作。     

The McCormick Family Planning Program in Chiang Mai, Thailand.

The McCormick Family Planning Program is a private, single-purpose program that has been offering contraceptive services to women in largely rural Chiang Mai province in Northern Thailand since 1963. In addition to two clinics in Chiang Mai city, the program operates a mobile unit, which visits service points throughout the province. An injectable contraceptive, DMPA, has been selected by about two-thirds of program acceptors since 1965, despite its prevalent side effect of amenorrhea. The service generates sufficient revenues, from relatively low fees for sterilization and contraception, to cover most operating costs. The program is seen as successful in providing rural women with contraceptives services. Aspects of the program--particularly the use of DMPA and the mobile service unit--are considered replicable in other settings.     

Public health care and private insurance demand: The waiting time as a link

This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990–91 as a complementary data set, following the Arellano–Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market. This revised version was published online in July 2006 with corrections to the Cover Date.     

重庆市居民健康卡建设模式研究

本文主要以居民健康卡建设模式出发,介绍了重庆市居民健康卡的建设特点,探讨了重庆市居民健康卡的系统架构、发卡思路与模式、以及卫生人口信息资源的整合。结合重庆本地情况,从实际应用的角度出发思考居民健康卡亟待解决的问题。     

Out-of-pocket health expenditure differences in Chile: Insurance performance or selection?

Chile has a mixed health system with public and private actors engaged in provision and insurance. This dual system generates important differences in health expenditure between private and public insurances. Selection is a preeminent feature of the Chilean insurance system. In order to explain the role of the insurance in out-of-pocket expenditures between households for different insurance schemes, decomposition methods are applied to disentangle the effect of household ‘composition and insurance’ degree of financial protection on health expenditures. Health expenditure patterns have not changed in the last 10 years with drugs, outpatient care, and dental health representing 60% of the health expenditure. Health expenditure/income is similar for different income groups in the public insurance, but decreases with income in households with private coverage, reflecting regressivity in health expenditure. On the other hand, health expenditure as share of expenditure increases with income for both groups.Per capita health expenditure in households with private coverage is four times the expenditure of households with public insurance; this gap is mostly explained by differences in households’ expenditure and demographics. Roughly 80% of the difference in expenditure is explained by the model, showing the role of selection in understanding the expenditure gap between insurance schemes.     

上海长宁区精神病患者双向转诊情况分析

目的寻找影响精神病患者双向转诊顺利实施中出现的问题,分析并提出解决的方法和途径。方法根据2008年1～6月我院门诊和出院患者数据,通过收集问卷与访谈结合的方法进行调查,分析转诊成功和未实现转诊的具体原因。结果2008年1～6月我区精神病患者自专科医院下转57名,占总出院人数的29％,自礼区卫生中心上转193名,占专科医院总门诊人数的1．72％。下转患者比例逐月下降。影响下转的主要因素为年龄不符合和患者及家属不理解而拒绝。结论双向转诊的顺利实施需要相关制度的保障。同时涉及到医院、社区和社会的各个方面,强调专科医院和社区卫生服务机构的重视和沟通、加强对社会、患者和家属的宣传教育都是促使双向转诊制度顺利运转的保障。     

Insuring against health shocks: Health insurance and household choices

This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investment in children's human capital during negative health shocks, which suggests that one benefit of health insurance could arise from reducing the use of costly smoothing mechanisms.     

Genotypic linkages of VP4, VP6, VP7, NSP4, NSP5 genes of rotaviruses circulating among children with acute gastroenteritis in Thailand

Rotavirus is the main cause of acute viral gastroenteritis in infants and young children worldwide. Surveillance of group A rotavirus has been conducted in Chiang Mai, Thailand since 1987 up to 2004 and those studies revealed that group A rotavirus was responsible for about 20-61% of diarrheal diseases in hospitalized cases. In this study, we reported the continuing surveillance of group A rotavirus in 2005 and found that group A rotavirus was detected in 43 out of 147 (29.3%) stool samples. Five different G and P genotype combinations were detected, G1P[8] (27 strains), G2P[4] (12 strains), G9P[8] (2 strains), G3P[8] (1 strain), and G3P[10] (1 strain). In addition, analysis of their genotypic linkages of G (VP7), P (VP4), I (VP6), E (NSP4), and H (NSP5) genotypes demonstrated that the rotaviruses circulating in Chiang Mai, Thailand carried 3 unique linkage patterns. The G1P[8], G3P[8], and G9P[8] strains carried their VP6, NSP4, NSP5 genotypes of I1, E1, H1, respectively. The G2P[4] strains were linked with I2, E2, H2 genotypes, while an uncommon G3P[10] genotype carried unique genotypes of I8, E3 and H6. These findings provide the overall picture of genotypic linkage data of rotavirus strains circulating in Chiang Mai, Thailand.     

建档立卡贫困户住院患者医保资金使用分析及建议

目的对建档立卡贫困户住院患者的医保结算费用进行聚类分析,为医保资金合理使用提供参考。方法以大同市某三级医院2018年1月1日-2020年12月31日建档立卡贫困户住院患者为研究对象,采用K-Means方法对其医保结算费用进行聚类分析。结果患者聚为5类:第1类为过度转诊患者;第2类为疾病在基层医疗机构无法确诊,需要向上转诊已明确诊断的患者;第3类为常见慢性病患者;第4类为反复住院的终末期患者;第5类为医保资金使用的重点人群。费用支付以基本医疗保险、大病保险和医保兜底保障为主。5类患者的年龄、性别、住院次数、诊断个数、危重程度、是否手术、住院天数和住院总费用以及分类医保结算费用的差异均有统计学意义（P＜0.05）。结论建档立卡贫困户的医疗保障政策在减轻患者疾病经济负担的同时,存在医保资金使用不合理问题。建议相关机构加强医保资金使用监督力度,规范患者就医行为,并通过多方努力,逐步建立医疗救助、商业保险、社会救助相结合的健康扶贫制度。     

妇幼保健院门诊“一卡通”系统建设实施效果研究

目的:探讨门诊"一卡通"在门诊就诊服务中的应用效果。方法:在门诊流程改造的基础上,实行门诊"一卡通"解决方案,比较上系统前后的各环节就诊耗时、患者满意度、印象打分、就医流程等。结果:实行门诊"一卡通"就诊模式后,就医流程得到明显的优化,交费等待时间、取药等待时间、治疗等待时间、全程接受治疗时间、非诊疗时间等都有不同程度的下降;信息化后门诊总体、儿科门诊、妇科门诊、产前门诊、儿保门诊满意度,以及病人整体印象打分,与信息化前对比均有不同程度的提高,差异有统计学意义(P<0.01)。结论:"一卡通"缩短了患者就医时间,提高了医生工作效率,增加了病人的满意度。     

How does membership in local savings groups influence the determinants of national health insurance demand? A cross-sectional study in Kisumu,Kenya

Background

Rotating savings and credit associations (ROSCAs) are highly active in many sub-Saharan African countries, serving as an important gateway for coping with financial risk. In light of the Kenya’s National Hospital Insurance Fund’s (NHIF’s) strategy of targeting ROSCAs for membership enrolment, this study sought to estimate how ROSCA membership influences the determinants of voluntary health insurance enrolment.

Methods

A cross-sectional survey of 444 households was carried out in Kisumu City between July and August 2016. A structured questionnaire was administered on health insurance membership, household attributes, headship characteristics and health-seeking behaviour. We assessed the influence of ROSCA membership on the associations between NHIF enrolment and the explanatory variables using univariate logistic regression.

Results

The study found that education was associated with NHIF demand regardless of ROSCA membership. Both ROSCA and non-ROSCA households with high socioeconomic status showed stronger health insurance demand compared with poorer households; there was, however, no evidence that the strength of this association was influenced by ROSCA status (p-value?=?0.47). Participants who were self-employed were significantly less likely to enrol into the NHIF if they did not belong to a ROSCA (interaction test p-value?=?0.03). NHIF enrolment was found to be lower among female-headed households. There was a borderline effect of ROSCA membership on this association, with a lower odds ratio amongst non-ROSCA members (p-value?=?0.09): the low treatment numbers amongst the insured infers that ROSCA membership may play a role on the association between gender and NHIF demand.

Conclusions

Our findings suggest that ROSCA membership may play a role in increasing health insurance demand amongst some traditionally under-represented groups such as women and the self-employed. However, the strategy of targeting ROSCAs to increase national health insurance enrolment may yield exiguous results, given that ROSCA membership is itself influenced by several non-observable factors – such as time-availability and self-selection. It is therefore important to anchor outreach to ROSCAs within a broader, multi-pronged approach that targets households within their social, economic and political realities.

     

银医一卡通解析与展望

本文论述"银医一卡通"银行卡与医疗ID号绑定、使用银行卡挂号就诊、费用发生地实时结算的运行机制;分析"银医一卡通"直接使用银行卡就诊结算,确保患者实名就诊结算,通用性强、覆盖范围广,省却充值及退卡,可提供多项人性化服务的优点。认为"银医一卡通"具有良好的应用前景,可以节省社会成本,缓解医院看病难,方便患者挂号、就诊和交费,使患者"一卡在手,走遍全国",还可以扩展银行卡的服务领域,提高经营业绩。同时,还对"银医一卡通"的发展和普及提出建议:一是需要社会的大力宣传,二是需要更多银行和医院的参加,三是需要政府的引导和推动。