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Introduction: Identifying and exploiting stewardship and financing challenges in Iran's health insurance system as an ecosystem is essential to achieving predetermined goals. This study aimed to determine the challenges and strategies in the Iranian health insurance ecosystem to provide relevant evidence to healthcare managers and policymakers to improve its functions and perform necessary reforms. Method: This qualitative study was conducted at the national level in Iran. Data were collected using semi-structured interviews and analyzed using the directed content analysis method. The study participants included managers and experts in health insurance and faculty of universities of medical sciences, who were selected by purposive sampling. Results: The challenges and strategies expressed by participants were categorized into two functions: stewardship and financing. Four main themes, ten subthemes, 22 challenges, and 24 strategies were identified in the stewardship function, along with three main themes, 12 subthemes, 17 challenges, and 16 strategies in the financing function. The major challenge in the Iranian health insurance ecosystem was the complexity and conflict of interests between multiple actors with different roles, which led to fragmentation, diverse structures, and a gap between other functions and objectives, hindering the effective functioning of the ecosystem. Conclusion: In order to deal with the challenges of the health insurance ecosystem, it is suggested to create a coherent insurance system through a single utility system, and by paying more attention to health-oriented services, the health insurance ecosystem becomes a health-oriented system instead of being treatment-oriented. In addition, in order to strengthen the governance of the country's health insurance ecosystem, the number of actors with multiple roles should be reduced and the roles of the actors should be clarified and separated in order to prevent conflicts of interest and structural corruption in this ecosystem. [ABSTRACT FROM AUTHOR]

Background: The costs associated with healthcare are of critical importance to both decision-makers and users, given the limited resources allocated to the health sector. However, the available scientific evidence on healthcare costs in low- and middle-income countries, such as Peru, is scarce. In the Peruvian context, the health system is fragmented, and the private health insurance and its financing models have received less research attention. We aimed to analyse user cost-sharing and associated factors within the private healthcare system. Methods: Our study was cross-sectional, using open data from the Electronic Transaction Model of Standardized Billing Data—TEDEF-SUSALUD, between 2021–2022. Our unit of analysis is the user's medical bills. We considered the total amount of cost-sharing, proportion of total payments as cost-sharing, and cost-sharing as a proportion of minimum salaries. We use a multiple regression model to perform the analyses. Results: Our study included 5,286,556 health services provided to users of the private health insurance in Peru. We found a significant difference was observed in the cost-sharing for hospitalization-related services, with an average of 419.64 soles per day (95% CI: 413.44 to 425.85). Also, we identified that for hospitalization-related services per day is, on average, 0.41 (95% CI: 0.41 to 0.41) minimum salaries more expensive than outpatient care, although cost-sharing per day of hospitalization represent on average only 14% of the total amount submitted. Conclusions: Our study provides a detailed overview of cost-sharing in the private healthcare system in Peru and the factors associated with them. Policymakers can use the study's finding that higher cost-sharing for inpatient hospitalization compared to outpatient care in private insurance can create inequities in access to healthcare to design policies aimed at reducing these costs and promoting a more equitable and accessible healthcare system in Peru. [ABSTRACT FROM AUTHOR]

The study examines the effect of health financing using insurance on child undernutrition, employing data from the 2018 Nigerian demographic and health survey. Undernutrition still contributes to child deaths in Nigeria, and health financing with regards to having health insurance, is yet to become a reality for many households. Despite several studies on the determinants of undernutrition, there remains the need for an examination of the effect of health financing, with a focus on health insurance. Using the NDHS, this study examined the effect of health insurance on the probability of child stunting and wasting. A limited dependent variable model was estimated using the maximum likelihood estimator; capturing urban and rural differentials, and an interaction model. The findings demonstrated a significant reduction in the likelihood of stunting in children both at national level and among rural households with health insurance. However, it significantly reduced the likelihood of wasting in children only among rural households. Not having a health insurance coverage, which was the case for a greater proportion of women, was found to significantly increase stunting, even among educated women; reduce wasting only if a woman is from a rich household; and increase wasting among rural households. Therefore, developing and implementing policies geared towards promoting wider and more inclusive health insurance coverage is important for improving child nutritional status and, consequently, the health status of children. [ABSTRACT FROM AUTHOR]

Catastrophic diseases are diseases that require high funding and, if accompanied by complications, will result in threats that can even endanger lives. One of the catastrophic diseases that is the focus of health insurance financing is kidney failure. Haemodialysis is a type of kidney replacement therapy for chronic kidney disease using special equipment. One method of financing haemodialysis procedures is the National Health Insurance Program. Hospitals, as health service providers for JKN participants, have an interest in the INACBG rates. Based on the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023 concerning Health Service Tariff Standards in the Implementation of the Health Insurance Program, there are changes to tariffs for haemodialysis services. With the current tariff changes, single-use and re-use services are divided into two different tariffs (the tariff for re-use haemodialysis services is 85% of the tariff for single-use haemodialysis services). The research was conducted at Siloam Hospital Bali. The data taken is secondary data originating from the Financial Division of Siloam Hospital Bali, the Medical Records Department of Siloam Hospital Bali, and the Haemodialysis Department of Siloam Hospital Bali during the period January–April 2023. The data collected and the hypothesis formulated in this research will be tested using the MANOVA (Multivariate Analysis of Variance) test method, using SPSS software. The research results show that there is a significant difference in total costs for re-use and single-use haemodialysis services; there is a significant difference in the total INACBG rates per patient for re-use and single-use haemodialysis services; and there is no significant difference in the difference between INACBG rates and total costs in re-use and single-use haemodialysis services. [ABSTRACT FROM AUTHOR]

Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020–2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure. [ABSTRACT FROM AUTHOR]

Achieving universal health coverage (UHC) involves difficult policy choices, and fair processes are critical for building legitimacy and trust. In 2021, The Gambia passed its National Health Insurance (NHI) Act. We explored decision-making processes shaping the financing of the NHI scheme (NHIS) with respect to procedural fairness criteria. We reviewed policy and strategic documents on The Gambia's UHC reforms to identify key policy choices and interviewed policymakers, technocrats, lawmakers, hospital chief executive officers, private sector representatives and civil society organizations (CSOs) including key CSOs left out of the NHIS discussions. Ministerial budget discussions and virtual proceedings of the National Assembly's debate on the NHI Bill were observed. To enhance public scrutiny, Gambians were encouraged to submit views to the National Assembly's committee; however, the procedures for doing so were unclear, and it was not possible to ascertain how these inputs were used. Despite available funds to undertake countrywide public engagement, the public consultations were mostly limited to government institutions, few trade unions and a handful of urban-based CSOs. While this represented an improved approach to public policy-making, several CSOs representing key constituents and advocating for the expansion of exemption criteria for insurance premiums to include more vulnerable groups felt excluded from the process. Overload of the National Assembly's legislative schedule and lack of National Assembly committee quorum were cited as reasons for not engaging in countrywide consultations. In conclusion, although there was an intent from the Executive and National Assembly to ensure transparent, participatory and inclusive decision-making, the process fell short in these aspects. These observations should be seen in the context of The Gambia's ongoing democratic transition where institutions for procedural fairness are expected to progressively improve. Learning from this experience to enhance the procedural fairness of decision-making can promote inclusiveness, ownership and sustainability of the NHIS in The Gambia. [ABSTRACT FROM AUTHOR]

Introduction: Iran is host to one of the largest urban refugee populations worldwide, about two million of whom are undocumented immigrants (UIs). UIs are not eligible to enroll in the Iranian health insurance scheme and have to pay out-of-pocket to access most health services. This increases the likelihood that they will delay or defer seeking care, or incur substantial costs if they do seek care, resulting in worse health outcomes. This study aims to improve understanding of the financial barriers that UIs face in utilizing health services and provide policy options to ensure financial protection to enhance progress towards UHC in Iran. Methods: This qualitative study was conducted in 2022. A triangulation approach, including interviews with key informants and comparing them with other informative sources to find out the complementary findings, was applied to increase data confirmability. Both purposive and snowball sampling approaches were used to select seventeen participants. The data analysis process was done based on the thematic content analysis approach. Results: The findings were explained under two main themes: the financial challenges in accessing health services and the policy solutions to remove these financial barriers, with 12 subthemes. High out-of-pocket payments, high service prices for UIs, fragmented financial support, limited funding capacity, not freeing all PHC services, fear of deportation, and delayed referral are some of the barriers that UIs face in accessing health care. UIs can get insurance coverage by using innovative ways to get money, like peer financing and regional health insurance, and by using tools that make it easier, like monthly premiums without policies that cover the whole family. Conclusion: The formation of a health insurance program for UIs in the current Iranian health insurance mechanism can significantly reduce management costs and, at the same time, facilitate risk pooling. Strengthening the governance of health care financing for UIs in the form of network governance may accelerate the inclusion of UIs in the UHC agenda in Iran. Specifically, it is necessary to enhance the role of developed and rich regional and international countries in financing health services for UIs. [ABSTRACT FROM AUTHOR]

Health insurance as a health financing mechanism especially in developing countries like India has a significant role. Private health Insurance is significant where the middle-income people get lesser options from the government to cover them for medical emergencies. Despite this; a significant portion of India's middle-income population is without any health insurance coverage. With this objective, an attempt was taken to investigate the Socio-Economic Variables, Health Insurance Knowledge, and Households' Perceptions of Health Insurance regarding the purchase of Private Health Insurance Policies. Data was obtained from middle-income households in seven Municipal Corporations in West Bengal. To identify 'Perception' variables Principal Component Analysis (PCA) is used and Logistic Regression Analysis showed Household income, Educational Qualification, Family Type, Health Insurance knowledge, and Households' perception of Quality of Service, Benefits, and Self-beliefs proved significant factors to influence the purchase of Private Health Insurance Policy. [ABSTRACT FROM AUTHOR]

Over half of the US population receives health insurance through an employer with premium contributions creating a flat "head tax" per worker, independent of their earnings. This paper develops and calibrates a stylized model of the labor market to explore how this uniquely American approach to financing health insurance contributes to labor market inequality. We consider a partial-equilibrium counterfactual in which employer-provided health insurance is instead financed by a statutory payroll tax on firms. We find that, under this counterfactual financing, in 2019 the college wage premium would have been 11 percent lower, noncollege annual earnings would have been $1,700 (3 percent) higher, and noncollege employment would have been nearly 500,000 higher. These calibrated labor market effects of switching from head tax to payroll tax financing are in the same ballpark as estimates of the impact of other leading drivers of labor market inequality, including changes in outsourcing, robot adoption, rising trade, unionization, and the real minimum wage. We also consider a separate partial-equilibrium counterfactual in which the current head tax financing is maintained, but 2019 US health care spending as a share of GDP is reduced to the Canadian share; here, we estimate that the 2019 college wage premium would have been 5 percent lower and noncollege annual earnings would have been 5 percent higher. These findings suggest that health care costs and the financing of health insurance warrant greater attention in both public policy and research on US labor market inequality. [ABSTRACT FROM AUTHOR]

The article discusses economic and political issues concerning health insurance coverage and financing in the U.S. Topics explored include the health insurance problems faced by the American public during the coronavirus disease 2019 (COVID-19) pandemic, the estimated percentage of uninsured Americans even after the enactment of the U.S. Affordable Care Act (ACA) in 2010, and the health care access of workers with employer-sponsored insurance.

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This article examines the political and economic dynamics of welfare markets in the USA. These marketplaces differ from other public–private welfare arrangements in that the state crafts and sustains these markets with the aim of using competition to promote cost-effective welfare provision. However, welfare markets face fundamental tensions between competition and stability that we trace to the allocation of risk between the state and private providers. Faced with the prospect of bearing potential losses, private firms often deploy instruments to reduce risk, lobby for risk protections from policymakers, or threaten to exit the market. The result is markets that are either non-competitive but stable, or competitive but unstable. In short, when policymakers create welfare markets they are riding a tiger, making themselves vulnerable to the functioning of markets over which they have imperfect control. We theorize and illustrate these dynamics through analyses of mortgage securitization, Medicare Advantage markets and the Obamacare health exchanges. This article contributes to the study of the US welfare state, speaks to the perils of marketized welfare in rich democracies and shows how market reforms can lead to unexpected state expansion. [ABSTRACT FROM AUTHOR]

Copyright of Public Health Forum is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Ethiopia has achieved impressive improvements in health outcomes and economic growth in the last decade but its total health spending is among the lowest in Africa. Ethiopia launched a Community-Based Health Insurance (CBHI) scheme in 2011 with a vision of reaching 80% of districts and 80% of its population by 2020. This study aimed to identify early achievements in scaling up CBHI and the challenges of such scale-up.Methods: We interviewed 18 stakeholders working on health financing and health insurance in Ethiopia, using a semi-structured interview guide. All interviews were conducted in English and transcribed for analysis. We performed direct content analysis of the interview transcripts to identify key informants' views on the achievements of, and challenges in, the scale-up of CBHI.Results: Implementation of CBHI in Ethiopia took advantage of two key "policy windows"-global efforts towards universal health coverage and domestic resource mobilization to prepare countries for their transition away from donor assistance for health. CBHI received strong political support and early pilots helped to inform the process of scaling up the scheme. CBHI has helped to mobilize community engagement and resources, improve access to and use of health services, provide financial protection, and empower women.Conclusion: Gradually increasing risk pooling would improve the financial sustainability of CBHI. Improving health service quality and the availability of medicines should be the priority to increase and sustain population coverage. Engaging different stakeholders, including healthcare providers, lower level policy makers, and the private sector, would mobilize more resources for the development of CBHI. Training for operational staff and a strong health information system would improve the implementation of CBHI and provide evidence to inform better decision-making. [ABSTRACT FROM AUTHOR]

The article discusses the constitutional responsibility of the state for financing statutory health insurance. In times of crisis such as the current COVID-19 pandemic, financing health insurance poses a financial burden. It is discussed whether and to what extent a constitutional justification for state financing responsibility can be established. Various approaches are considered, such as the trust of insured individuals in the willingness of the health insurance provider to provide services, and fundamental considerations such as the existence of a right to medical care. It is determined that state financing responsibility can be justified based on organizational and individual legal considerations. [Extracted from the article]

Purpose: The purpose of this study is to find funding sources for social health insurance in Sudan to cover vulnerable families. Design/methodology/approach: The concept of this paper is to look into the causality relationship between insured and directly paid poor people and their incomes through using the autoregressive distributed lag model (ARDL) and using a survey raw data carried out in 2010 in Sudan. Findings: The findings show that insured vulnerable people and income-generating activities have a significant positive relationship. The results, on the other hand, show a marginally negative effect on income for those who have directly paid poor people. Originality/value: Previous research on the position of zakat has focused primarily on its role in poverty alleviation and has given little consideration to its role in social security. This study is characterized by improving the possibility of changing the mechanism of distributing zakat funds in favor of health financing to maximize the benefit. [ABSTRACT FROM AUTHOR]

OBJECTIVE To describe and explore the experiences of hospital employees with the causes of fraud in the health insurance program at the hospitals. DESIGN AND SETTING This research was carried out at government hospitals in the Southeast Sulawesi Province in collaboration with BPJS Health, namely the Bahteramas Regional General Hospital and the Kendari City Regional General Hospital. Triangulation was carried out at BPJS Health, the Center for Health Insurance Financing at the Ministry of Health and the Center for Health Policy and Management at Gadjah Mada University, Yogyakarta. This research was conducted for one year, namely January 2020 to February 2021qualitative method with a phenomenological approach. Data collection methods were carried out through in-depth interviews, focus group discussions, and document studies. The number of participants in this study was 44 people consisting of doctors in charge of services, nurses, midwives, and case-mix team including coders who met the inclusion criteria. Data analysis used the Moustakas method. RESULT The causes of health insurance fraud in hospitals financial motives (the desire to get money or material or economic or welfare benefits, get high service services and low employee salaries), behavioral motives (low integrity, lifestyle and employee habits of committing fraud0, and social motives (kinship, humanitarian factors, avoiding conflict, social position, and the existence of pressure), internal controls (a weak monitoring system, poorly enforced regulations, unclear regulations and limited hospitals providing services, no monitoring and evaluation, and there are no sanctions for fraud perpetrators), revenue targets (hospitals income and increasing the number of claims), leadership (leadership style or weak leadership in the hospitals and the absence of transparency), incentive systems (poor distribution of incentives and the absence of transparency of services from hospitals management), National Health Insurance (NHI) regulations (dynamic regulations and the availability of the National Guidelines for Medical Services has not been fulfilled and there is no standard for readmission and fragmentation), the NHI financing system (inconvenience of the financing system and the adequacy of the INA-CBGs tariff calculation), and the BPJS Health system (inconvenience of the BPJS Health system and the BPJS Health system which makes it difficult). CONCLUSIONS The causes of health insurance fraud in hospitals can be explained by the gear fraud theory that Internal factors are the main cause and external factors predispose to health insurance fraud in hospitals. These internal and external factors interact with each other like the working mechanism of a gear. Understanding the theory of gear fraud will help formulate fraud prevention efforts in health insurance programs in hospitals that are more comprehensive and focus on eliminating the causes of fraud. [ABSTRACT FROM AUTHOR]

The catastrophic health expenditure (CHE) indicator has been used to measure the medical cost burden of households. Many countries have institutionalized their health insurance systems to reduce out-of-pocket payments, the main contributor to the financial burden. However, there is no method to estimate how the insurance coverage reduces the CHE. This study proposes an approach to evaluate the effectiveness of insurance in reducing the CHE impacts in terms of incidence and gap, which are based on a modified calculation method of CHE. Additionally, we apply these methods to data from the Korea Health Panel Survey (2011–2016). The results are as follows. First, under the setting of a threshold of 10%, the CHE incidence rate was 19.26% when the Korean national health insurance benefits reduced the CHE's incidence for 15.17% of the population in 2017. Second, the results of the concentration index of CHE showed that the intensity approach of CHE is better than the incidence approach. Third, the new approach we applied revealed that health insurance reduces the burden of CHE to some degree, although it was not an efficient way to reduce CHE. In conclusion, this study provides new policy approaches to save the finances of national health insurance and reduce the intensity of CHE at the same time by raising the low-cost burden of medical services and lowering that of high cost. Moreover, we suggest that policymakers should focus on income level of the households rather than specific diseases. [ABSTRACT FROM AUTHOR]

Outpatient medical care in Bulgaria is entirely private and is financed by the health insurance fund through capitation and fees. Emergency medical care is organized, managed and controlled by the Ministry of Health. It is financed from the state budget. Defects in the organization of the emergency care system have a negative impact on the adequate provision of emergency medical care in the country. [ABSTRACT FROM AUTHOR]

Background: Half of the global population is at risk for catastrophic health expenditure (CHE) in the event that they require surgery. Universal health coverage fundamentally requires protection from CHE, particularly in low- and middle-income countries (LMICs). Financial risk protection reports in LMICs covering surgical care are limited. We explored the relationship between financial risk protection and hospital admission among injured patients in Cameroon to understand the role of health insurance in addressing unmet need for surgery in LMICs. Methods: The Cameroon National Trauma Registry, a database of all injured patients presenting to the emergency departments (ED) of three Cameroonian hospitals, was retrospectively reviewed between 2015 and 2017. Multivariate regression analysis identified predictors of hospital admission after injury and of patient report of cost inhibiting their care. Results: Of the 7603 injured patients, 95.7% paid out-of-pocket to finance ED care. Less than two percent (1.42%) utilized private insurance, and more than half (54.7%) reported that cost inhibited their care. In multivariate analysis, private insurance coverage was a predictor of hospital admission (OR 2.17, 95% CI: 1.26, 3.74) and decreased likelihood of cost inhibiting care (OR 0.34, 95% CI: 0.20, 0.60) when compared to individuals paying out-of-pocket. Conclusion: The prevalence of out-of-pocket spending among injured patients in Cameroon highlights the need for financial risk protection that encompasses surgical care. Patients with private insurance were more likely to be admitted to the hospital, and less likely to report that cost inhibited care, supporting private health insurance as a potential financing strategy. [ABSTRACT FROM AUTHOR]

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Background: Accessibility of health care to students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health care to students with disabilities. This study, therefore, aims to explore the accessibility of health care to students with disabilities, in the quest of achieving universal health coverage in Ghana.Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data.Results: The study identified three themes - accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health care. The barriers faced by students with disabilities were unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health care.Conclusion: The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the National Health Insurance Scheme should be revised to adequately address the needs of people with disabilities. [ABSTRACT FROM AUTHOR]

The article analyzes the role that preventive health care can have in reducing the costs of health care for patients, insurance companies, and the broader economy. The increasing number of people with a chronic disease requiring continual medical attention is cited in the article as one of the primary reasons why coverage of preventive care by insurance companies should be publicly mandated. Attempts to promote preventive care in both the public and private sector are outlined, along with the economic incentives for both patients and health care providers.

According to European regulations on the coordination of social security systems, Bulgarian legislation, and the respective bilateral agreements, the National Health Insurance Fund should use its budget to guarantee the health care coverage of insured persons during their stay on the territory of other EU Member States, the European Economic Area, Switzerland, Macedonia, Serbia, and Montenegro. By making an analysis of the number and types of issued certificates, amounts paid and due, the cost structure, and the medical fiends in which medical care is most often used in other countries, the goal of the present work is to monitor trends based on the information available to date about the structure and scope of treatment sought in other countries, funded with public financing by the National Health Insurance Fund. The conclusions indicate that there are medical specialties and fields in which a significant share of people seeking scheduled treatment abroad receives treatment abroad. This points to the need to work toward the advancement of these diagnostic and treatment fields in Bulgaria by means of financing, scientific research, technologies, and staffing as to overcome the deficit and the need for Bulgarian citizens to seek scheduled treatment abroad. These parameters and trends should be an object of analysis of the institutions tasked with decision making and modification and of better resource management in the healthcare system by respecting citizens’ rights. [ABSTRACT FROM AUTHOR]

Copyright of Rehabilitation / Rehabilitacija is the property of University Rehabilitation Institute, Republic of Slovenia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This research paper seeks to answer the question: What tax or combination of taxes knowledgeable individuals think the South African government can use as a potential source of revenue to fund the proposed National Health Insurance? The research methodology adopted is of an exploratory interpretive nature as it deals with the opinions of respondents. This methodology is well suited to the research process as the goal is to obtain and explore knowledgeable individuals' opinions on what they perceive to be the best tax or combination of taxes which can be used as a potential source of revenue to finance the National Health Insurance fund. The method initially comprised a normative study, focusing on a literature review, the results of which were then used to create a self-developed questionnaire. This research aims to contribute to the body of knowledge which the South African government can consider when making a decision on a tax or combination of taxes as a possible method of financing. A sample of 91 people consisting of 40 tax practitioners (44%), 33 academics (36.2%) and 18 economists (19.8%) were asked to complete the questionnaire. The resultant data were subjected to various statistical analysis methods, including factor analysis, Kruskal-Wallis tests and Cluster analysis. The results reveal that (a) an increase in Value-Added tax is perceived as being justifiable, fair and efficient, while (b) an increase in taxes on individuals or an introduction of payroll taxes is not. The respondents suggest that funds be ring-fenced for National Health Insurance as this will increase accountability and prevent the funds from being expropriated during the budgetary process. [ABSTRACT FROM AUTHOR]

Huge differences between the territories that are divided into the city and district municipalities are found after examining theoretical and methodological literature, obtaining abundant statistical information on the status of health care institutions in Lithuania, disclosing the system of indicators describing that status, and taking into account the analysis of the data of all the statistic residents of the Territorial Health Insurance Funds (THIF) and those registered at the outpatient primary personal health care institutions (OPPHCI). The number of residents who have registered at the OPPHCI of city municipalities is different from the rates provided by the statistics. Therefore, in the calculation of health indicators, a meaningful selection of them will more accurately reflect the status of health care facilities. Of these indicators, it is important to select not only those that best describe the existing medical care level in the municipalities but those that are also informative. The system of indicators was selected on the basis of the Delphi method. This article analyzes the state of the health care institutions in Lithuania and the qualitative and quantitative indicators of health care and their evaluation at the municipal level. The authors of this article used multivariate statistical methods in evaluating the state of health care institutions. The reliability and the validity of the obtained results are verified by two models; thus, the stability and suitability of the models are tested in investigating the state of health care institutions in Lithuania. The final aim of the study is to evaluate the administrative units of different territories and, from the medical level perspective, identify the best performing and most lagging municipalities. [ABSTRACT FROM AUTHOR]

The article discusses the use of a comprehensive incentive approach to employee health care cost containment. A comprehensive approach would involve system controls to shrink the system as well as incentives for both providers and health care consumers to reduce utilization, be more price conscious, and provide services more quickly. Such incentives could encourage efficiency, restrain the rate of inflation in health services, and provide consumers with an unprecedented number of options and services.

Copyright of Public Health Forum is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although many people view the Patient Protection and Affordable Care Act (ACA) as a radical change in the way we finance health care in the U.S., in fact it is a continuation of the multifaceted system we've had for some time. The ACA includes a mix of public and private financing, with most Americans receiving insurance through their places of employment, while others will purchase private insurance as individuals. Some of these employers and individuals will purchase insurance through health exchanges. The ACA also retains roles for both state and federal governments. States will continue to participate in the Medicaid program, some with expanded eligibility. And most states will either develop state-run exchanges or partner with the federal government to do so. The health insurance exchange concept is a crucial component of the new multifaceted approach to financing health care. [ABSTRACT FROM AUTHOR]