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As the United States' population grows via migration and immigration, with this rise in diverse identities, there has been increasing concern regarding disparities for undocumented immigrants living in the U.S. with limited access to the health system. Given the various constraints involving communication and social structures that undocumented immigrants face, a culture-centered approach is drawn on to investigating how this group goes about navigating a dominant health system given their restricted access. I explore co-constructed themes that emerged through conversations with undocumented immigrants, (people without papers as I call them in this work) living in the United States to gain an understanding as to the structural and cultural limitations faced by this group. By doing qualitative semi-structured interviews with local participants living in the South Florida region, I describe the various features of a complex U.S. health system that undocumented immigrants (people without papers) deemed as important obstacles that limit their willingness to interact with official medical spaces. This work draws on narratives and accounts to shed light on the intersection of disparities this group has to overcome in order to consider entering a medical space to receive the treatment they might need. The findings of this article highlighted the structural violence that certain subaltern groups, such as people without papers experience due to their limited access to foundational systems in their environment. [ABSTRACT FROM AUTHOR]

The communities of the world need health insurance services during and after COVID-19. This study aims to evaluate the perspectives on the service quality of health insurance companies by expanding the service quality model based on the disconfirmation expectation theory. This proposed model adds various factors like sales agents, trust, and service delivery to the service quality model. The questionnaires were distributed to health insurance policyholders. The descriptive research study, structural equation modelling, was used to analyse the data. Four hundred and eighteen respondents' data were collected using a convenient sampling method from June 2021 to December 2021. The dimension of service quality was confirmed, except for reliability. Reliability has shown a negative impact on consumer satisfaction. Trust seems to be the most influential dimension for consumer satisfaction in the proposed model. Service delivery has a positive impact on customer satisfaction, but sales agents have a negative impact on customer satisfaction. Hence, health insurance companies must improve the service quality of their sales agents. The novelty of this research paper lies in the expansion of the service quality model, based on the disconfirmation expectation theory, to evaluate the service quality of health insurance companies. [ABSTRACT FROM AUTHOR]

Health behavior has a substantial impact on health conditions. Illness prevention through good health behavior is the most economical and effective health protection strategy. From an institutional standpoint, while endowment insurance systems have been widely recognized as an important means of promoting individual's health and heightened by the current aging population situation, empirical analyses of whether and how endowment insurance affects health behavior are still limited. This paper uses China Family Panel Studies data from 2010 to 2020 to verify the relationship between the two. The results reveal that endowment insurance systems with different security levels have diametrically opposite effects on the behavior of the insured. Mediating effect analysis shows that the effect of basic endowment insurance is channeled by enhancing individuals' awareness of health risks, while the effect of supplementary endowment insurance is achieved by guiding residents to devote more time to work. In addition, the impact of the endowment insurance system is heterogenous over age, economic conditions and place of residence. This study uncovers the novel relationship between endowment insurance and health behavior and adds to the theoretical understanding of health behavior from the perspectives of policy feedback and behavioral public management. [ABSTRACT FROM AUTHOR]

Background:Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives:The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The  study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions:This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory  approach. [ABSTRACT FROM PUBLISHER]

Rural, low-income families are disproportionately impacted by health problems owing to structural barriers (e.g., transportation, health insurance coverage) and personal barriers (e.g., health literacy). This paper presents a Participatory Action Research (PAR) model of co-created Core Health Messages (CHMs) in the areas of dental health, food security, health insurance, and physical activity. The research project engaged a multi-disciplinary team of experts to design initial health messages; rural, low-income mothers to respond to, and co-create, health messages; and stakeholders who work with families to share their insights. Findings reveal the perceptions of mothers and community stakeholders regarding messages and channels of message dissemination. By using PAR, a learner engagement approach, the researchers intend to increase the likelihood that the CHMs are culturally appropriate and relevant to specific populations. The CHM-PAR model visually illustrates an interactive, iterative process of health message generation and testing. The paper concludes with implications for future research and outreach in a technological landscape where dissemination channels are dynamic. This paper provides a model for researchers and health educators to co-create messages in a desired format (e.g., length, voice, level of empathy, tone) preferred by their audiences and to examine dissemination methods that will best reach those audiences. [ABSTRACT FROM AUTHOR]

Success of the recently implemented Affordable Care Act hinges on previously uninsured young adults enrolling in coverage. How will increased coverage, in turn, affect health care utilization? This paper applies variable coefficient panel models to estimate the impact of insurance on health care utilization among young adults. The econometric setup, which accommodates nonlinear usage measures, attempts to address the potential endogeneity of insurance status. The main finding is that, for approximately one-fifth of young adults, insurance does not substantially alter health care consumption. On the other hand, another one-fifth of young adults have large moral hazard effects. Among that group, insurance increases the probability of having a routine checkup by 71-120%, relative to mean probabilities, and insurance increases the number of curative-based doctor office visits by 67-181%, relative to the mean number of visits. [ABSTRACT FROM AUTHOR]

With the introduction of highly effective and safe therapies with next-generation direct-acting antivirals (DAAs), that act without interferon, hepatitis C virus (HCV) infection remains the only treatable chronic infectious disease. The review aims to provide an overview of the therapy revolution with a description of specific DAAs, their mechanisms of action, a summary of the safety and efficacy of specific regimens, and a discussion of populations requiring special therapeutic approaches. DAAs are highly effective, safe, and easy to use. However, challenges such as access to health services and loss of patients from the cascade of care, especially in groups disproportionately affected by HCV infection, such as substance abusers, make it difficult to achieve the WHO's goal of HCV elimination. The proposed strategy to combat these difficulties involves a one-step approach to diagnosing and treating the infection, the availability of long-lasting forms of medication, and the development of an effective vaccine. The aforementioned opportunities are all the more important as the world is facing an opioid epidemic that is translating into an increase in HCV prevalence. This phenomenon is of greatest concern in women of childbearing age and in those already pregnant due to treatment limitations. Hepatitis C virus (HCV) is an insidious pathogen. Most people infected with HCV will develop chronic infections that may not give any symptoms for years or decades but eventually lead to liver disease and liver cancer. It is essential to diagnose infected individuals as soon as possible and start the treatment to increase the elimination of the virus from the organism and prevent harmful long-term effects. Fortunately, these goals are possible nowadays, and this is due to a remarkable example of translational research at work. The discovery of the virus in 1989 (for which Harvey J. Alter, Michael Houghton, and Charles M. Rice received the Nobel Prize in 2020) was followed by the rapid development of diagnostic tests and later by the introduction of the first interferon therapies, which had numerous shortcomings. The revolution started in 2011 when the first oral drugs that act directly on HCV (direct-acting antivirals, DAAs) were registered. Another giant leap for HCV treatment was made in 2018 when the combinations of DAAs that act on different HCV genotypes were introduced. In this paper, we review in detail the DAAs used to treat HCV infection and explain different combinations in which they can be used while showing their favorable safety profile, short-term and convenient treatment regimen, and impressive effectiveness in clearing HCV infection. Although we believe eliminating HCV is eventually reachable, we also argue that there is room for improvement. HCV testing and DAAs availability must improve in selected groups, including people without health insurance, prisoners, and drug addicts. There are still people living with chronic HCV infection without knowing it. Their identification and start of effective treatment is equal to savings in future medical care related to liver disease and cancer, not to mention benefits from the individual health perspective. In addition, and in line with a popular phrase that prevention is better than cure, it is reasonable to pursue the development of the HCV vaccine, which is currently unavailable. The last word on managing the health burden caused by this pathogen is yet to be said. [ABSTRACT FROM AUTHOR]

This paper aims to identify whether neighbors would influence the rural household's decision on commercial health insurance purchase by using a representative sample in west China. We applied an instrumental variable (IV) approach to measure the neighborhood effect, run multiple robustness checks and several heterogeneity analyses. The empirical results find that as neighbors' commercial health insurance purchases increase one unit, the focal family's possibility of purchase would increase by 0.420 units. These results may have some implications for policy-makers to develop the health insurance industry in rural areas more effectively. [ABSTRACT FROM AUTHOR]

Healthcare systems around the world are facing great challenges. This has included rising health care prices and its impact on healthcare expenditures and the concomitant effects on access to healthcare, particularly in emerging and developing countries. This study focuses on health care price developments and health expenditures in South Africa. The study identifies four major results. Firstly, South Africa's healthcare expenditures compare quite favourably with countries at similar levels of development. However, the efficiency of these expenditures lags those in comparable countries. Secondly, it was found that South Africa's healthcare price rises have exceeded those in advanced countries even though healthcare demand and expenditures in these countries are much higher than is the case in South Africa. Thirdly, healthcare rises exceeds those in other sectors of the South African economy. Finally, healthcare price changes adversely impact healthcare expenditures in South Africa. These results indicate that price considerations are critical to improving healthcare access in South Africa. The paper also highlights some non-price determinants of healthcare access that warrant attention by policymakers in South Africa. [ABSTRACT FROM AUTHOR]

High health care spending growth is regarded in all countries as a potential policy problem. The potential for patient cost-sharing to reduce spending levels has been studied extensively; however, there has been very little work on how cost-sharing may also influence spending growth. In this paper, we relate deductibles as a measure of cost-sharing to health care spending growth at the market level. We analyze a novel combination of US state-level panel datasets from 2002 to 2012 and find that higher deductible levels in private group insurance are associated with significantly lower spending growth, particularly for pharmaceuticals. We observe similar results in both OLS and instrumental variables models, where we use measures of employer and worker preferences as instruments for deductible levels. We theorize and conclude that cost-sharing affects spending growth by constraining the use of more costly new technology, a major driver of health care spending growth worldwide. [ABSTRACT FROM AUTHOR]

As a country, the United States spends significantly more on healthcare than other advanced industrialized countries, and Americans have comparably worse health outcomes. Both are developments of the last four decades. In this paper, we look at how change in antitrust and patent law and thus change in market power in the largest four subsectors of healthcare, hospitals, physician groups, prescription drugs, and net medical insurance, have contributed to the increasing cost of medical care in the United States. We show that the annual rent – the degree to which health care is overpriced as a result of market power – was between 2.47 and 4.30 percent of GDP in 2016 – truly a big cost for big medicine. [ABSTRACT FROM AUTHOR]

This paper addresses the cost imposed on an insurance market when individual applicants possess an information advantage over the insurers; in short, we examine the social cost of private information. When consumers differ significantly in terms of their riskiness, and their insurance companies cannot, or are not permitted to assess these differences, insurance companies will attempt to charge all consumers the same premiums for equivalent coverage; unless mechanisms can be designed to allow consumers to signal accurately and credibly their private assessments of their own riskiness, low-risk consumers will consider that they are being overcharged and many will drop out of the market. These consumers, who wish to buy insurance--albeit at a lower price--but who are not now insured, represent a loss of social welfare. As information asymmetries increase, more consumers determine that they are being overcharged, increasing the loss of social welfare. This paper addresses minimizing the loss of social welfare, or maximizing the extent to which the population is insured, in the presence of extremely different consumer risk profiles by examining plausible pricing and policy designs, in order to assess which design minimizes decreases in consumer participation in the insurance market. While unable to make selections among information regimes, which entail a wide range of complex and subjective social choices, the paper does make clear comparisons of alternative designs within each information regime. [ABSTRACT FROM AUTHOR]

This study aimed to identify socio-demographic determinants, risky behaviors and type of drug use, and the association with visiting by general practitioners (GP) in the last 12 months or outpatient service use among people who inject drugs (PWID). Studies in English published before November 1 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with visiting by GP or outpatient service use among PWID. After a detailed assessment of over 17,348 papers, a total of 13 studies met the eligibility criteria. Greater odds of visits to the GP in the last 12 months or outpatient service use was associated with (i) being younger, (ii) being female, (iii) employment status, (iv) having public health insurance, (v) individuals who shared needles, (vi) individuals who were prescribed benzodiazepines, (vii) history of taking prescribed mental health medications, (viii) individuals who got methadone maintenance treatment (MMT) and (X) individuals who had used primary care services. The present research findings highlighted that a significant proportion of the study participants used GP or outpatient service use/outpatient psychiatrist, suggesting that the focus should not be restricted to PWID. [ABSTRACT FROM AUTHOR]

Based on the data from one anonymous but renowned life insurance company in Taiwan, this paper focuses on a big data analysis using R programming language while adhering to the requisite conditions for the validity of using regression model to test the existence of the issue of information asymmetry in medical insurance. The log-linear regression model is adopted to fit with the data set and it is shown: There is a significantly non-linear positive relationship between the compensations and the insurance coverage, indicating that the issue of information asymmetry does exist among those claimants under discussion; the older those claimants were insured, the more they claimed; women claimed more medical compensation than men; those paying premiums quarterly claimed the highest. [ABSTRACT FROM AUTHOR]

Migrant workers are an important component of China's labor market, playing a vital role in economic development and social stability. In the face of significant health risks related to their work, migrant workers remain largely under-represented in China's health insurance system despite their eligibility to participate in several programs. To achieve China's goal of universal healthcare coverage, migrant workers are targeting populations. The objective of this paper is to understand the factors associated with migrant workers' participation in health insurance programs. This analysis draws from a survey of 3,342 migrant workers that was conducted by China Agricultural University in 2013. A multinomial logit model was performed to identify the determinants of migrant workers' health insurance participation. Our findings suggest that the highest rates of un-insurance were observed for females, the elderly, those with lower levels of education, income, or lower self-reported health status, and migrant workers in the construction industry. They are the most vulnerable populations and susceptible to various health and occupational hazards. Besides the high enrollment rates of migrant workers in the New Rural Cooperative Medical Scheme, the scheme's lack of portability needs a complete "Inter-province" balancing reimbursement networking platform to be built. Furthermore, establishing a multi-level medical security system that is accessible and affordable may serve the goal of improving health insurance participation among migrant workers. [ABSTRACT FROM AUTHOR]

The article presents several news related to various universities in the U.S. Indiana University of Pennsylvania has acquired the United Mine Workers of America District 2 Collection. The collection consists of almost 400 boxes and includes papers associated with the presidencies of John Brophy and James Mark and executive files including presidential correspondence, injunctions and other documents. The Knight Library at the University of Oregon has opened the Records of the International Woodworkers of America to researchers. The records, which span from 1936 to 1987 and till nearly 600 linear feet, consist primarily of correspondence, minutes, proceedings, negotiation files, expired contracts, legal and financial documents and officer and departmental records. In addition to the union's basic activities, such as organizing, negotiations, litigation, and strikes, the collection documents the conflict between the red bloc and white bloc forces in the union during the 1940s and 1950s. Papers from the presidency of Keith Johnson deal with Canadian softwood lumber imports, national health insurance, labor law reform, affirmative action, occupational safety and health and other issues.

How does the private sector structure the trajectory of a country's universal healthcare programme? Social scientists have long pointed to the importance of path dependence in shaping health reform. Yet, rarely have middle-income countries' experience with the private sector under Universal Health Coverage (UHC) been examined from comparative perspective. In this paper, we explore the changing landscape of the health sector in Brazil and Thailand before UHC reform and after. We find path-dependent processes at work that have pushed two countries that both adopted UHC reforms in divergent directions. In Brazil, a comparatively large and entrenched private sector that existed before reform has grown over time, and a sizable private health insurance industry has exerted powerful influence on health policy, weakening the public sector. In Thailand, constraints on private health insurance growth and sustained investment in public health infrastructure and governance have helped check the growth of private sector influence, although battles over health policy still remain contentious. The experiences of these countries offer lessons for policymakers seeking to achieve and maintain robust UHC programmes in other contexts. [ABSTRACT FROM AUTHOR]

The health and wellbeing of older adults have taken center-stage in global policy agendas in recent times. In 2003, Ghana introduced an insurance exemption policy to eliminate financial barriers to healthcare for older adults and other vulnerable population groups. Embedded within the National Health Insurance Scheme (NHIS), this policy ostensibly guarantees free healthcare for older adults at publicly-funded facilities across the country. In this paper, we applied the implementation problem framework to identify gaps in the implementation of the exemptions policy and their impact on the healthcare experiences of older adults. Our data collection involved qualitative interviews with a purposive sample of community-residing older adults, health workers, community leaders, and policymakers. Our thematic data analysis identified resource, substantive, bureaucratic, political, and administrative constraints in the policy implementation process which, in turn, affected quality healthcare delivery. While most of these constraints are general challenges confronting the NHIS, they serve to undermine the intent of the scheme's exemptions policy. In particular, despite the exemptions, older adults continued to pay out-of-pocket for certain categories of treatments and medications, creating as yet financial barriers to healthcare. We present policy recommendations for addressing these implementation challenges, including suggestions to decentralize, depoliticize, and financially liberate the operations of the NHIS. Ghana's health insurance scheme has not eliminated financial barriers to healthcare for older adults. Older Ghanaians reported unmet healthcare needs, despite implementation of health insurance. Resource, substantive, bureaucratic, and political constraints impede the policy implementation process. Measures are needed to decentralize and depoliticize the NHIS implementation process. [ABSTRACT FROM AUTHOR]

This paper explores the dynamics of access under the state-funded universal health insurance scheme in Chhattisgarh, India, and specifically the relationship between choice, affordability and acceptability. A qualitative case study of patients from the slums of Raipur City incurring significant heath expenditure despite using insurance, was conducted, examining the way patients and their families sought to navigate and negotiate hospitalisation under the scheme. Eight purposefully selected ('revelatory') instances of patients (and their families) utilising private hospitals are presented. Patients and their family exercised their agency to the extent that they could. Negotiations on payments took place at every stage, from admission to post-hospitalisation. Once admitted, however, families rapidly lost the initiative, and faced mounting costs, and increasingly harsh interactions with providers. The paper analyses how these outcomes were produced by a combination of failures of key regulatory mechanisms (notably the 'smart card'), dominant norms of care as a market transaction (rather than a right), and wider cultural acceptance of illegal informal healthcare payments. The unfavourable normative and cultural context of (especially) private sector provisioning in India needs to be recognised by policy makers seeking to ensure financial risk protection through publicly financed health insurance. [ABSTRACT FROM AUTHOR]

In developing countries and in particular in sub-Saharan Africa, social protection schemes tend to operate in silos. However, schemes targeting the same geographical areas may have synergies that have not yet been examined, and which are worth scrutinising. This paper contributes to this knowledge gap by examining the joint impacts of two social protection programmes in Ethiopia, that is, the Productive Safety Net Programme and a Community Based Health Insurance Scheme. Based on three rounds of individual level panel data and several rounds of qualitative interviews, we find that individuals covered by both programmes, as opposed to neither or only one of the two programmes, provide greater labour supply, have larger livestock holdings, and have a lower amount of outstanding loans. Furthermore, joint participation is associated with greater use of modern health care facilities as compared to participating only in the safety net programme. These results show that bundling of interventions enhances protection against multiple risks and that linking social protection schemes yields more than the sum of their individual effects. [ABSTRACT FROM AUTHOR]

In recent years, the mass media (such as TV shows and movies) plays an important role in communication with the general public. In this paper, we investigate the impact of a recent movie from China, 'Dying to Survive', on the demand for commercial health insurance. To explore this impact, a fixed-effect model and instrumental variable estimation are utilized, and the causal effect of movie-based health risk communication on commercial health insurance demand is studied. The result shows that the cumulative box office value of a movie has a significantly positive impact on the income from commercial health insurance premium, with a one- or two-day lag. This movie has encouraged viewers to purchase short-term commercial health insurance rather than long-term insurance. In addition, the heterogeneity of the impact exists for movie arrangement rate, average family size, urbanization rate, medical resource level, and per capita disposable income. The results show that sufficient health risk communication can improve the social 'visibility' of health risk. [ABSTRACT FROM AUTHOR]

The Consolidated Omnibus Reconciliation Act of 1985 (COBRA) contained provisions granting individuals the opportunity to continue employment-based insurance coverage following qualifying events which would otherwise cause the loss of coverage. In this paper, I examine the impact of COBRA coverage on young adult health insurance coverage following the loss of dependent status, a qualifying event. I use the 1984 to 1989 panels of the Survey of Income Program Participation in a difference-in-differences framework to provide the first estimates of COBRA's impact on young adult insurance status. I find that individuals in the affected age group were 4.5 percentage points more likely to be insured following COBRA going into effect. This increase is largely due to gains in employer sponsored insurance – particularly as a dependent – and is robust to a variety of sensitivity checks. I find considerable heterogeneity by sex; insurance gains are concentrated among young men. These findings suggest that COBRA's access to continued employer sponsored coverage after ageing out as a dependent reduced uninsurance among young adults. [ABSTRACT FROM AUTHOR]

They tell a story of persistent progress toward more context-appropriate strategic purchasing arrangements, often despite hurdles created by donor-driven health financing solutions that have proliferated in Africa over the past several decades. Keywords: Africa; purchasing framework; SPARC; strategic health purchasing EN Africa purchasing framework SPARC strategic health purchasing 1 7 7 12/27/22 20220401 NES 220401 Introduction This special issue of I Health Systems and Reform i , sponsored by the Strategic Purchasing Africa Resource Center (SPARC), provides an in-depth look at the current state of strategic health purchasing in Africa. The Strategic Purchasing Africa Resource Center SPARC was established in 2017 with funding from the Bill & Melinda Gates Foundation to serve as a "go-to" source of Africa-based expertise in strategic purchasing that provides on-demand support and practical evidence to overcome technical, institutional, and political obstacles to implementing effective strategic purchasing approaches. [Extracted from the article]

This paper explores the potential benefit of enforcements in Child Support policies to child mortality rates. Exploiting the sharp changes in Child Support laws across states and over the years 1975–1993, we find that adoption of a full set of policies reduces the child death rate by 23% relative to the mean. The results are robust across multiple subsamples and a variety of specifications. Three potential mechanisms of impact include better health utilization during the prenatal period, improved birth outcomes, and moving towards better-quality health insurance for children. [ABSTRACT FROM AUTHOR]

Most developing nations are facing rapid population aging with limited economic and social resources. In Ghana, a National Aging Policy (NAP) was promulgated by the government in 2010 to ensure the well-being of older adults. Since its passage, the NAP has yet to be funded and implemented. In this paper we synthesize key information on policies and programs targeted at older adults in Ghana and identify the challenges that are adversely impacting their welfare, including the non-implementation of the National Aging Policy. To give the NAP needed attention and promote its implementation, a national coordinating body exclusively devoted to older adults is an essential first step. Critical next steps are offered to promote the effective implementation of the NAP and ensure the well-being of older adults in Ghana. With its current foundation of support programs for older adults, Ghana has the opportunity to be the lead nation in Sub-Saharan Africa to establish a national level office dedicated to promoting older adults' well-being and including them in the nation's development efforts. [ABSTRACT FROM AUTHOR]

Reducing Out-of-pocket (OOP) health payments is an essential element to protect households from financial risks and eradicate extreme poverty. This paper aimed to provide a new approach for measuring catastrophic health expenditure (CHE) by redefining subsistence spending to comprise the minimum acceptable level of all necessities. The new approach defined OOP health expenditures as catastrophic payments if they undermine a household's ability to maintain essential needs that are not limited to food needs as assumed by the Capacity to pay (CTP) approach. The equivalence scale is estimated to reflect the dominant consumption patterns and the Cost of Basic Need Approach (CBN) is employed to measure the subsistence spending. We estimated the burden of OOP health payment on household living standards in rural Egypt using data from Household Income, Expenditure, and Consumption Survey in 2015. Rural areas exhibited a considerable incidence of catastrophic payments. Redefining subsistence spending better detected the incidence of catastrophic health expenditure among poor households. The distribution of CHE became highly regressive and demonstrated that catastrophic payments are more concentrated among poor households. Although poor households have incurred relatively small health payments compared to wealthy ones, this has threatened their standard of living. The highest incidence rates of CHE were also observed among uneducated, unemployed, female, elderly heads, among households with chronically ill members, and those who experienced outpatient services. The poor performance of the health insurance system in protecting vulnerable groups from catastrophic payments creates a critical need to redesign its policies and improve its service quality. [ABSTRACT FROM AUTHOR]

The exponential growth in the data collected in the form of electronic health records, registries, or wearable sensors has bought a big data revolution in the health industry. A large amount of information is required to be extracted from this substantially available data that provides numerous benefits such as improved quality of life, disease diagnosis, treatment and healthcare service delivery system. The big data generated in the healthcare is characterized by large volume, heterogeneity and speed. The other issues associated with the healthcare big data include non-uniform data, large number of variables, and need for real-time data analysis. In this paper, we examine the existing literature in all the databases within the ISI Web of Science with the purpose of reviewing the current research and develop a new agenda. Total 91 papers, classified in five research categories namely, general healthcare, clinical diagnosis and research, service delivery system, disease transmission and prevention, and health insurance were reviewed. Reviewing past work is focused on identifying areas where big data analytics (BDA) is being applied in healthcare management. The outcome of the review is a proposed framework on BDA capability and its impact on healthcare organization performance. [ABSTRACT FROM AUTHOR]

Neoliberalism is usually associated with pro-market values. This paper argues that more attention should be paid to the specific forms of market criticisms that unfold in neoliberal settings. We adapt Foucault's and Callon's notion of problematization to study recent policy reforms in Chile. The analysis shows a transition from a set of policies justified in terms of the virtues of the market to policy interventions based on a comparison between the situation in the specific area and ideal well-functioning markets. This transition, we propose, signals a particular mode of governing with its characteristic cognitive operation (areas of collective concerns are assessed in terms of market failures), apparatus (policy instruments oriented to remediate market failures), and the jurisdiction of a particular type of experts. [ABSTRACT FROM AUTHOR]

The development of health insurance exchanges within the Patient Protection and Affordable Care Act (ACA) legislation is one of the hottest health policy issues of this decade. With the surprise enrollment success of Kentucky’s exchange called “Kynect,” the influence of how marketing and branding have contributed to the embrace of the policy has garnered interest from scholars and practitioners alike. Driven by the utilization of in-depth interviews, this study found that Kynect’s success was aided by three emergent themes: frequent communication between the outsourced marketing firm, Doe-Anderson, and relevant stakeholders; the willingness to delegate all marketing and branding control to Doe-Anderson; and a multiparty commitment to developing and executing a campaign that would simultaneously adhere to public values and accentuate a feeling of localness to constituents across the state. The paper contributes to existing literature by providing an inside look at how a government can find marketing success against historical odds. [ABSTRACT FROM AUTHOR]

This paper describes the level of knowledge on and membership in PhilHealth (Philippine Health Insurance Corporation) among Overseas Filipino Workers (OFWs). It analytically examines the sociodemographic predictors of knowledge on and membership in PhilHealth. Results reveal that 76% of the respondents involved in the study are PhilHealth members. Generally, respondents' level of knowledge about the insurance is moderate. Results of regression analysis reveal that sex/gender (BETA = −.319) and income (BETA =.352) predict membership in PhilHealth. Meanwhile, income (BETA =.295) and marital status (BETA = −.164) predict the level of knowledge on PhilHealth. The results indicate that those with income above PhP40,000 (approximately USD785) are the ones knowledgeable about PhilHealth. Moreover, OFWs with partners are more knowledgeable about the insurance compared to those who are not married or without partners. The results offer several insights regarding PhilHealth membership among OFWs. First, OFWs with higher income tend to become members of PhilHealth. Second, women are less likely to become members, as many of them are working in the service sectors and are generally earning lower income than their male counterparts. This result indicates that women OFWs should be encouraged to become PhilHealth members, especially if their left-behind partners or husbands are not members. This is to ensure that left-behind family members will be able to access health services. [ABSTRACT FROM AUTHOR]

Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities). [ABSTRACT FROM AUTHOR]

Many recent papers have documented that there has been a steady decline in the fraction of workers in the US who receive health insurance through their employer. This paper presents an economic model of the labour market that is consistent with observed trends. The primary finding is that the trend is explained by a change in optimal compensation structures for workers due to the increase in the relative price of health care. The paper concludes with an application to the analysis of the increased prevalence of capitated contracts among employers. [ABSTRACT FROM AUTHOR]

This paper analyses the relationships between HIV/AIDS and education taking into account the appropriative nature of child income. Using a theoretical model, we show that considering remittances from one’s child as an insurance asset can reverse the usual negative relationship between disease prevalence and educational investment. This prediction confirms the results of an empirical study conducted on data compiled from the Demographic and Health Survey (DHS) database for 12 sub-Sahara African countries for children aged between 7 and 22-years-old. Using regional HIV prevalence as a measure of health risk, we find that the ‘sign of the slope’ between health risk and the enrolment of children is not constant. Splitting the data based on expected remittance patterns (for example rural versus urban), we obtain that the effect is most likely driven by household characteristics related to child income appropriation. [ABSTRACT FROM PUBLISHER]

This paper estimates the effect of cost sharing on the sustainability of the Ghana National Health Insurance Scheme (NHIS) from the point of view of enrollment, utilization, and financing. We use data from a nationwide survey to estimate the retention of subscribers and propensity to utilize the scheme's benefit package under a cost sharing policy. The estimates from the survey are used together with data on the Ghana NHIS, to estimate the patronage, and financial status of the Ghana NHIS had cost sharing been introduced. The result indicates that a 5% cost sharing rate would have kept the scheme in surplus between 2007 and 2015. In addition, the 5% cost sharing rate would have led to virtually no change in enrollment and would have reduced utilization rate by about 15%. It is also found that women have higher enrollment and utilization of health insurance than men under cost sharing. [ABSTRACT FROM AUTHOR]

The fraction of health-care costs financed from prepayment sources is a critical indicator of progress toward Universal Health Coverage. But it does not tell how prepayment varies with the level of health-care costs and between poorer and richer patients. This paper used survey data from the Philippines to estimate inpatient costs paid by the National Health Insurance Program (aka PhilHealth) in 2013–2017 when attempts were made to extend population, service and financial coverage. The mean fraction of the inpatient bill paid by PhilHealth increased by 21 percentage points. Expansions of population coverage do not appear to have been primarily responsible for this increase. Despite the introduction of a catastrophic cover benefit package, the fraction of inpatient costs that were prepaid increased more at lower costs than at higher costs. PhilHealth payments for inpatient care were pro-rich but became substantially less so, possibly because hospitals were no longer permitted to charge poor patients in excess of reimbursement ceilings. Overall, prepayment of inpatient costs increased and became more pro-poor, reflecting gains in insurance and equity. [ABSTRACT FROM AUTHOR]

The pharmaceutical or drug supply chain is the means through which prescription medicines are manufactured, stocked, and delivered to consumers. How the complexity and fragmentation of this supply chain shape or reshape the decisions and courses of action as well as risk aversions of its actors (stakeholders) is the question we address in reviewing recent literature presented at the 2021 AEA-ASSA economics convention. In doing so, we identify key aspects or dimensions of the supply chain that remain unexplored or under-explored in the empirical literature. All original research relevant to the pharmaceutical supply chain were selected from the AEA-ASSA convention panel sessions. Empirical evidence was thematically identified, and the theoretical and practical implications of findings on firm and stakeholder decision-making were analyzed. Stakeholder choices and risks in the action steps or stages of the supply chain are conditioned or framed by variables that are less prominent and seldom documented in the empirical literature. These include firm ownership and marketing, the provider's IT system, pricing and discounts negotiated by pharmacy benefit managers (PBMs), health insurance coverage, employer plan sponsorship, and hassle costs of drug prescribing and monitoring. On the other hand, prominent and well documented policy initiatives, like international reference pricing and renationalization or "decoupling" from global value chains, can have unintended effects on supply chain actors and end-users, including reverse redistribution. The continuing and changing multi-dimensional character of the supply chain adds to its complexity and fragmentation Organizational, operational, and value-adding measures to overhaul the drug supply chain and make it perform better have been proposed in the surveyed literature and elsewhere. Yet, aspects of the supply chain that bear a direct impact on firm short-term financial success typically assume precedence in evaluations of performance and effectiveness. Whether and to what extent the drug supply chain will change to cope and adapt to the major challenges and upheavals it currently faces are lingering questions. [ABSTRACT FROM AUTHOR]

Using data from the fourth wave of the National Study of Adolescent Health, this paper offers a preliminary investigation of factors implicated in the physical and mental health of bisexual individuals. The roles of sleep, socioeconomic status, feelings of disrespect, and reported lack of health insurance are considered. Further, this study examines depression as a psychological stress response and systemic inflammation as a physiological stress response. Systemic inflammation in this population was estimated using the biomarker C-reactive protein (CRP). Reported acute illness in the past month and blood pressure serve as measures of physical health outcomes. Analyses revealed a pattern of elevated CRP (>3mg/L) among participants who reported no health insurance coverage. For participants who reported no health insurance coverage and identified as mostly homosexual, bisexual, or mostly heterosexual, feelings of disrespect were associated both with their sleep outcomes as well as their total household income. Moreover, linear regression showed that CRP significantly predicted blood pressure values. These analyses serve to bring health disparities and specific considerations for individuals attracted to more than one gender further into scientific conversation. Suggestions for further study of bisexual minority stress and bisexual health are offered. [ABSTRACT FROM AUTHOR]

Millions of uninsured and underinsured individuals in the United States (US) face considerable barriers to care access. To address some of them, many cross the southern border with Mexico to utilise lower-cost healthcare. This paper uses 2010 and 2013 data from international travellers into Baja California (Mexico) to examine how Mexican border cities address the unmet healthcare needs from US residents. I argue that changes in health insurance entitlements under the ACA are unlikely to change the incentives to make use of health services south of the border. This study shows that healthcare supply in Mexico sometimes complements and others substitutes healthcare available to medical travellers in the US, since healthcare rendered in Mexico is rarely covered in the US or it is less expensive and of better quality from the patient perspective. Healthcare supply in Baja California for cross-border patients focuses on services that are rarely covered by US health insurance plans, such as dental services or long-term care. We conclude that affordability, cultural familiarity, perceived quality of care in Mexico, and geographic proximity, regardless of insurance coverage in the US, continue to be comparative advantages for healthcare providers in Mexican border cities. [ABSTRACT FROM AUTHOR]

With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity. [ABSTRACT FROM AUTHOR]

Ghana’s National Health Insurance Scheme, introduced in 2003, aims to remove financial barriers to health-care access and bridge the inequality gaps in health care. This paper reports on a study of the implementation process in four local government areas in southern and northern Ghana. The paper profiles key institutional actors and draws on qualitative interview data from 33 in-depth interviews. Findings highlight the gaps and challenges that have emerged in the implementation process. Issues of managerial capacity, inadequate and uneven distribution of medical facilities and health-care professionals, cost escalation, fraud and abuse, and reimbursement of providers threaten the sustainability of the scheme. [ABSTRACT FROM PUBLISHER]

With most sub-Saharan African countries facing problems of raising revenues for financing the delivery of an essential package of health services, there has been growing interest in social health insurance (SHI) as shown by efforts in Ghana, Kenya, Lesotho, Nigeria, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. While these health financing constraints are linked to broader public affairs of slow, or even negative macroeconomic growth, civil strife and political instability, there is little consensus on what should be the appropriate institutional arrangements and policies to mobilise resources for effective provision of essential health services. Given an observed inclination towards SHI, this paper provides some answers to the challenge of making it work in African countries. The paper discusses a number of policy choices and trade-offs that health planners may consider when implementing SHI to generate financing for the provision of essential health care benefits. [ABSTRACT FROM PUBLISHER]

To analyze randomized trials with imperfect compliance, a standard approach is to estimate the local average treatment effect in the sub-population of compliers using randomization status as an instrumental variable. Though quantile analysis has been popular in general, the local (or complier) quantile treatment effect (cQTE) as a causal estimand has received insufficient attention. In this paper, we map out the details for the estimation, inference, and sensitivity analysis of the cQTE in a completely nonparametric setting. We propose to estimate the cQTE using nonparametric plug-in estimators of the cumulative distribution functions for the potential outcomes of the compliers. The cQTE estimator is shown to be asymptotically normal, with asymptotic variance estimated through kernel-smoothed density estimators. The procedure is easily extended to adjust for discrete covariates for gains in statistical efficiency. Moreover, by exploiting the stochastic monotonicity of the quantile functional, we develop sensitivity bounds for the cQTE when key assumptions such as exclusion restriction and instrument monotonicity are violated. Extensive simulations show that the proposed methods provide valid inference of the target local estimand and outperform standard intent-to-treat tests, especially under low compliance rates and/or heterogeneous treatment effects. A recent study on a government-funded health insurance program in India is analyzed as an illustration. [ABSTRACT FROM AUTHOR]

The economist Edgar Sydenstricker, who spent most of his working life at the United States Public Health Service and at the Milbank Memorial Fund, examined a wide range of health economics issues. He contributed to the debate around the cause of the disease pellagra. This research was followed by many studies quantifying income-related health inequalities. Sydenstricker was heavily involved in the use of surveys to collect information and he was instrumental in the development of the first US National Health Survey. Other contributions include extending health insurance in the United States and methods of evaluating public health programs. [ABSTRACT FROM AUTHOR]

This paper examines the everyday experiences and perspectives of Muslim Ansaris (weavers) in urban north India with respect to the 'welfare state'. The case of a recent health insurance scheme, initiated by the Indian government, constitutes the paper's focus. Narratives around the scheme expressed by residents in a majority Muslim mohalla (neighbourhood) in Varanasi illustrate the ways in which the state's presence was more often experienced through its perceived absence and inaccessibility. But even whilst such experiences represented broader patterns of neglect, locally interpreted as the upshot of being India's largest religious minority, this community was not stricken by a sense of absolute alienation and nor did individual or collective actions exhibit outright disaffection towards the state. More appropriately, 'defensive agencies' informed by degrees of pragmatism, acceptance and resilience, were articulated in an effort to protect, as well as improve the future capacities and ambitions of the neighbourhood residents where the state had seemingly failed. The paper concludes however with a word of caution about celebrating such agency, and reflects on the potential for transformative politics by Muslims in urban India. [ABSTRACT FROM AUTHOR]

Between 1960 and 2016 per capita expenditures on retail pharmaceuticals increased from $85.12 to $922.50 in 2009 prices, while the share of spending covered by insurance programs grew to 86%. The introduction of new molecular entities followed only a weak upward trend. Following passage of the Hatch Waxman Act in 1984, the share of retail prescriptions dispensed as generics has expanded from 19% to almost 90%. By employing a three-equation Vector Auto-Regressive (VAR) model and Granger causality, this paper assesses empirically the interdependence among these variables. Our most important finding is that increases in insurance coverage on pharmaceuticals contributed significantly to the spending growth, which in turn led to further insurance expansion. In addition, introduction of new drugs also has contributed to enhanced insurance coverage. While the expansion of generic prescribing has had a strong negative effect on spending, this effect has been largely offset by rapid increases in coverage. [ABSTRACT FROM AUTHOR]

One of the key issues justice-involved individuals face is problematic substance use. In this paper, we explore whether health insurance coverage is associated with reductions in substance use issues among the justice-involved population. Using nationally representative data from the National Survey of Drug Use and Health and multivariate logistic regression models, our results suggest that health insurance is associated with reductions in heavy drinking and daily cigarette smoking among justice-involved individuals. These findings bolster support for the view that that policymakers should strive to increase access to health insurance coverage for justice-involved individuals. [ABSTRACT FROM AUTHOR]

Countries differ markedly in their approach towards healthcare systems. There are variations in how much is spent, how funding is organised (taxation or mandatory insurance premiums), who delivers care (the mix of public and private providers), and where care is delivered (the mix of at home, community, primary and secondary care). Almost all developed countries aim to have universal access to high-quality healthcare, but in most cases systems are struggling with the financial burden of meeting these aspirations. The competing pressures are obvious - the drivers of healthcare demand (changes in medical technology, increases in unit costs and rising patient expectations) are outpacing healthcare funding. This paper explores whether it is possible to satisfy the objectives of keeping pace with healthcare demand and providing access to health services in line with conventional views of equity, within public spending constraints. The paper draws on examples from the UK's National Health Service in particular, but also from other countries. [ABSTRACT FROM AUTHOR]

This paper explores the gendered impact of Chinese healthcare reforms, drawing attention to the complex and changing nature of gender inequities in China's current economic and social transformations. Using official and academic sources, it examines the reforms' impact on access to reproductive healthcare, the gendered effects of changes in health sector financing - particularly the collapse of insurance systems and rising costs of healthcare, and the implications of China's demographic transition on women's informal healthcare roles. This paper suggests areas that policy-makers, researchers, and activists should prioritize to address inequity, including developing public health policy based on the systematic monitoring of health impacts and trends from a gender perspective, strengthening rural medical facilities to meet the basic healthcare needs of rural populations (including sexual and reproductive health needs), and reforming the healthcare system together with social security systems to equitably cover the poor and the elderly. [ABSTRACT FROM AUTHOR]

As Leader of the Opposition in 1987, the current Prime Minister of Australia John Howard, stated unequivocally that he would dismantle Medicare at his first opportunity. By April 2000, the Health Minister in a Howard-led government proudly proclaimed to the Australian Parliament the Coalition was 'the best friend Medicare ever had'. Such a shift in ideology and policy position appears remarkable, overturning more than 60 years of conservative opposition to a universal, publicly funded, health care system. This paper traces the shift from the lead-up to the 1996 election until 2000, interrogating official policy texts to map how the Coalition reconfigured its own policy narrative about the Australian health care system. This paper argues that in order to understand contemporary reforms to the health care system, we must consider the way in which those reforms provide solutions to discursively, rather than objectively constructed, policy problems. [ABSTRACT FROM AUTHOR]

With policy makers facing the competing challenges of budget crises and pressures to expand Medicaid home and community-based service programs to populations including those with traumatic brain and spinal cord injuries (TBI/SCI), this paper addresses the need for information about the development of waiver programs for this target population. This study draws from the most recent and comprehensive available dataset to present national participation and expenditure trends for all TBI/SCI waivers for the period 1995-2002, it reports findings from a national survey of policies (e.g., eligibility criteria and cost controls) used on these waiver programs in 2002, and compares the Medicaid cost of serving this target group through institutional care and waiver programs. [ABSTRACT FROM AUTHOR]