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Article
Publication date: 25 September 2019

Bishwajit Nayak, Som Sekhar Bhattacharyya and Bala Krishnamoorthy

Social health insurance framework of any country is the national identifier of the country’s policy for taking care of its population which cannot access or afford quality…

Abstract

Purpose

Social health insurance framework of any country is the national identifier of the country’s policy for taking care of its population which cannot access or afford quality healthcare. The purpose of this paper is to highlight the strategic imperatives of digital technology for the inclusive social health models for the BoP customers.

Design/methodology/approach

A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance CXOs was conducted with a semi-structured questionnaire. Using MaxQDA software, the interview transcripts were analyzed by means of thematic content analysis technique and patterns identified based on the expert opinions.

Findings

A framework for the strategic imperatives of digital technology in social health insurance emerged from the study highlighting three key themes for technology implementation in the social health insurance sector – analytics for risk management, cost optimization for operations and enhancement of customer experience. The study results provide key insights about how insurers can enhance the coverage of BoP population by leveraging technology.

Social implications

The framework would help health insurers and policymakers to select strategic choices related to technology that would enable creation of inclusive health insurance models for BoP customers.

Originality/value

The absence of specific studies highlighting the strategic digital imperatives in social health insurance creates a unique value proposition for this framework which can help health insurers in developing a convergence in their risk management and customer delight objectives and assist the government in the formulation of a sustainable social health insurance framework.

Details

International Journal of Sociology and Social Policy, vol. 39 no. 9/10
Type: Research Article
ISSN: 0144-333X

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Article
Publication date: 4 April 2019

Sanusi Bintang, Mujibussalim Mujibussalim and Fikri Fikri

The purpose of this study is to explain the need for the implementation of decentralization of Indonesia social health insurance (INA-Medicare), with particular emphasis…

Abstract

Purpose

The purpose of this study is to explain the need for the implementation of decentralization of Indonesia social health insurance (INA-Medicare), with particular emphasis for Aceh Province. First, it discusses the inconsistency of Act on National Social Security System (ANSSS) to the 1945 Constitution, because certain rules in ANSSS are contrary to the 1945 Constitution. This weakens the practice of broader regional autonomy, lessens the importance of public service quality in health care and ignores specific cultural and religious values of the regional people. Then, it explains provisions on central and regional government authority in the 1945 Constitution, Act on Regional Autonomy and Act on Governing of Aceh. Later, it explores current law and practice of INA-Medicare under the national social security system and the centralized administering body. Finally, it provides reasons for decentralization of INA-Medicare, as the solution.

Design/methodology/approach

This study uses doctrinal legal research. It relies on both primary and secondary legal authorities. In additions, it also uses sociolegal research by relying on non-legal materials, including empirical data from books, journals and newspapers. Analysis of legal authorities is by legal reasoning process, whereas analysis of non-legal materials is by qualitative approach.

Findings

This study argues that the decentralization of INA-Medicare is more suitable for Aceh Province because of several reasons, including implementing broader regional autonomy, improving public service quality in health care and implementing the principle of sharia social health insurance.

Originality/value

The study is original because it focuses on a specific regional area of Aceh Province, Indonesia. It concentrates on specific legal issues and provides unique reasons for argumentation. Therefore, it provides important specific information for journal readers.

Details

International Journal of Law and Management, vol. 61 no. 2
Type: Research Article
ISSN: 1754-243X

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Article
Publication date: 1 November 2002

Rowena Jacobs and Maria Goddard

This paper examines some of the key features of social health insurance systems by drawing on experiences in Germany, Switzerland, France and The Netherlands. These…

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Abstract

This paper examines some of the key features of social health insurance systems by drawing on experiences in Germany, Switzerland, France and The Netherlands. These countries have all implemented a variety of reforms, including some competition between health insurers in order to meet some of their health care objectives. The paper highlights some of the strengths and weaknesses inherent in these systems and how they perform on a number of criteria and suggests a number of trade‐offs which policymakers will have to grapple with to attain some of their (often competing) health system goals of efficiency, choice, solidarity and equity. This paper should provide useful information for countries with health care systems in transition or those considering adopting aspects of social health insurance systems.

Details

International Journal of Social Economics, vol. 29 no. 11
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 13 August 2018

Yen-Han Lee, Timothy Chiang, Mack Shelley and Ching-Ti Liu

The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government…

Abstract

Purpose

The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform.

Design/methodology/approach

Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported.

Findings

The authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals.

Practical implications

The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity.

Originality/value

This study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 7
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 30 May 2018

Nicolas R. Ziebarth

This chapter reviews the existing empirical evidence on how social insurance affects health. Social insurance encompasses programs primarily designed to insure against…

Abstract

This chapter reviews the existing empirical evidence on how social insurance affects health. Social insurance encompasses programs primarily designed to insure against health risks, such as health insurance, sick leave insurance, accident insurance, long-term care insurance, and disability insurance as well as other programs, such as unemployment insurance, pension insurance, and country-specific social insurance programs. These insurance systems exist in almost all developed countries around the world. This chapter discusses the state-of-the art evidence on each of these social insurance systems, briefly reviews the empirical methods for identifying causal effects, and examines possible limitations to these methods. The findings reveal robust and rich evidence on first-stage behavioral responses (“moral hazard”) to changes in insurance coverage. Surprisingly, evidence on how changes in coverage impact beneficiaries’ health is scant and inconclusive. This lack of identified causal health effects is directly related to limitations on how human health is typically measured, limitations on the empirical approaches, and a paucity of administrative panel data spanning long-time horizons. Future research must be conducted to fill these gaps. Of particular importance is evidence on how these social insurance systems interact and affect human health over the life cycle.

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Article
Publication date: 1 December 2020

Jairous Joseph Miti, Mikko Perkio, Anna Metteri and Salla Atkins

The purpose of this paper is to establish the main factors influencing willingness to pay for health insurance and pension schemes among informal workers in low- and…

Abstract

Purpose

The purpose of this paper is to establish the main factors influencing willingness to pay for health insurance and pension schemes among informal workers in low- and middle-income countries (LMICs). Historically, informal economy workers have been excluded from social protection coverage. There is a growing need, interest and policy discourse in LMICs to extend social security to informal economy workers. However, little is known about informal workers' willingness to pay (WTP) for social security services in different LMIC settings.

Design/methodology/approach

The authors conducted a systematic review and searched five databases from 1987 to 2017. Included papers focused on “social security”, “social insurance”, “pension”, “informal economy”, “informal sector” and “informal workers” in LMICs. Authors conducted independent data appraisal and data extraction. A total of 1790 papers were identified. After exclusion, 34 papers were included in the analysis. Given the heterogeneous results, the authors performed a narrative synthesis to consolidate the findings of the different studies.

Findings

In total, 34 studies from 17 countries were included in the review, out of which 23 studies focused on health insurance, 7 studies on pension schemes and 4 studies on social security in general. The study showed that income and trust were associated with WTP for both health insurance and pension schemes. In addition, family size, age, education and residential area were common factors for both forms of social security. For health insurance, experience of sickness, attitude and presence of medical doctors as well as distance from the healthcare facility all played a role in determining WTP. For pension schemes, low and flexible contribution rates, benefit package, government subsidies and quality of administration of the schemes influenced enrolment and contributions.

Research limitations/implications

More evidence is needed for WTP for pensions among informal workers.

Practical implications

The findings show that socio-economic differences, scheme-type (health or pension) and level of trust influence WTP for health insurance or pension among informal sector workers. The review results suggest that the factors influencing WTP for health insurance and pensions interplay in a complex web of relations. More evidence is needed on WTP for pensions among informal workers.

Social implications

Further studies are particularly needed on the interrelationship of the influences to WTP, including gender issues, access barriers and socioeconomic factors, among program design issues for social security.

Originality/value

This paper is based on a systematic review methodology and contributes to the discourse on extending social security to informal economy workers based on evidence from various countries.

Details

International Journal of Social Economics, vol. 48 no. 1
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 10 January 2020

Nuzulul Kusuma Putri and Ernawaty Ernawaty

Today, viral marketing is popular as a highly effective marketing strategy with a low cost for mass targeting. This is suitable for the Universal Health Coverage campaign…

Abstract

Purpose

Today, viral marketing is popular as a highly effective marketing strategy with a low cost for mass targeting. This is suitable for the Universal Health Coverage campaign which seeks to attract the whole nation’s population to voluntarily register with social health insurance. It uses the target market itself as a weapon and the marketing content as a bullet. This study aims to determine the exact viral marketing content for the Universal Health Coverage campaign in Indonesia.

Design/methodology/approach

Viral marketing content is formulated based on the feelings of the target market toward social health insurance. Qualitative content analysis was conducted to identify the media framing and the audience’s response. Two of the biggest online news websites were analysed to determine the media framing. The audience’s response was identified through a Facebook group discussion.

Findings

This study shows that negative media framing makes people question the benefit of participating in social health insurance. Considering the local wisdom of Indonesia, helping poor people through social health insurance would be the best viral marketing content.

Research limitations/implications

Because of the limited number of sources focused on the audience’s responses that have been analysed, the variations in the audience response could not be captured completely. Researchers should also analyse other audience channels (social media and messenger application) besides Facebook.

Practical implications

The paper includes implications for the future marketing agenda of insurance providers in relation to engaging the community.

Originality/value

This study operationally introduced how to use the media channel selected and audience framing in designing an effective viral marketing content in health-care marketing.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 14 no. 1
Type: Research Article
ISSN: 1750-6123

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Article
Publication date: 19 December 2016

Aidin Aryankhesal, Manal Etemadi, Zahra Agharahimi, Elham Rostami, Mohammad Mohseni and Zeinab Musavi

Exemption from hospital charges may appear as an essential policy in order to support the poor. Such policies can function for the fulfillment of governments’ social- and…

Abstract

Purpose

Exemption from hospital charges may appear as an essential policy in order to support the poor. Such policies can function for the fulfillment of governments’ social- and justice-based responsibilities in public hospitals. The purpose of this paper is to investigate the pattern of offering discounts to the poor and the effect of Iran’s recent Health Sector Evolution Plan on it.

Design/methodology/approach

The authors conducted analytical research longitudinally on the data related to cash discounts offered to the poor within a teaching hospital. Data were collected through the period of four months, September to December 2013, before the establishment of the Health Sector Evolution Plan, and in the similar months through 2014, after the establishment of the Health Sector Evolution Plan, in order to compare the amount of cash discounts. The type of insurance, length of stay, amount of discounts offered to patients, and total costs of hospital charges were studied and compared by referring to the social working department. Data were analyzed using the χ2-test, Mann-Whitney U test, ANOVA, and regression analysis aided by SPSS 20.

Findings

The number of patients offered discounts or exempted from payment in 2014 reduced compared to the number in 2013. The highest rate of demand for discounts was related to patients covered by Emdad Committee followed by those who had no insurance. The ratio of discount to cost in the oncology ward was higher than other groups.

Originality/value

The results of the present study can contribute to the plans of health system policy makers in organizing measures for supporting poor patients toward accessing healthcare services.

Details

International Journal of Human Rights in Healthcare, vol. 9 no. 4
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 23 August 2013

Hector Hidalgo, Maxwell Chipulu and Udechukwu Ojiako

The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance

Abstract

Purpose

The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector.

Design/methodology/approach

Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile.

Findings

Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer.

Practical implications

As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance.

Originality/value

As it is clear that a “community-rated” health insurance provision philosophy impacts on insurance firm's ability to charge “market” prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 15 June 2012

Mary Docherty, Qi Cao and Hufeng Wang

The purpose of this paper is to provide an overview of the organisational and procedural arrangements for healthcare reform in China, and describe the role of social

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742

Abstract

Purpose

The purpose of this paper is to provide an overview of the organisational and procedural arrangements for healthcare reform in China, and describe the role of social values in the relevant decision‐making process.

Design/methodology/approach

An analysis of recent developments aimed at achieving universal coverage in China was undertaken in the context of describing the influence of underlying social values.

Findings

The key underlying social value was found to be social solidarity. Other values were implicit rather than explicitly stated, and were subservient to the overall aim of comprehensive coverage.

Originality/value

The paper shows that China is embarking on the largest‐scale health reforms in the world. There is an eagerness to share experiences with other countries in an attempt to ensure the success of the reforms. There is an increasing understanding of the need to make the values underpinning the reforms more explicit and, in particular, those concerned with efficiency and appropriateness.

Details

Journal of Health Organization and Management, vol. 26 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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