Health services for catastrophic patients through the national health insurance program: literature review
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Introduction. Achieving universal health coverage, also known as UHC, has emerged as an essential global health policy, especially in addressing the burden of spending on major (catastrophic) diseases. However, catastrophic health expenditures are not always synonymous with high healthcare costs. However, a major disaster for low-income households is financing that is not entirely covered by insurance. Objective. This study aims to provide data on the effects of national health insurance on disaster victims in various nations. Materials and Methods. this research is a literature study; electronic searches were carried out in five databases, Pro-quest, Google Scholar, JACC, Science Direct, and Pubmed, for relevant research published between 1986 and 2022. Only 102 articles were relevant. After screening by reading abstracts and viewing all articles, concerning the impact of catastrophic disease health insurance, only 12 articles were declared eligible from 2017 to 22. Results. The review results show that most health insurance positively affects disasters, as seen from the decrease in the incidence of CHE and the risk of OOP spending in a country. Income is a CHE factor in LMICs notwithstanding unfortunate preventive ways of behaving. Conclusion. This study concludes that health insurance impacts those who need treatment, especially those who suffer from costly diseases or catastrophic diseases. Even though insurance is a poverty alleviation factor, without a good economic status, health services will still be an obstacle for a person to access health services. Furthermore, factors other than insurance cause poverty, namely small expenses such as accommodation and transportation that are not covered.
Cummins J, Mahul O. Catastrophe Risk Financing in Developing Countries. 2008. DOI: https://doi.org/10.1596/978-0-8213-7736-9
Baeza C, Packard TG. Beyond survival: protecting households from health shocks in Latin America.
UN Economic and Social Council. Progress towards the Sustainable Development Goals: Report of the Secretary-General. Geneva, 2016.
Marten R, Mcintyre D, Travassos C, et al. An assessment of progress towards universal health coverage in Brazil, Russia,
India, China, and South Africa (BRICS). The Lancet 2014; 384: 2164–2171. DOI: https://doi.org/10.1016/S0140-6736(14)60075-1
Savedoff W, De FD, Smith A, et al. Universal Health Coverage 2 Political and economic aspects of the transition to universal health coverage. The Lancet 2012; 380: 924–932. DOI: https://doi.org/10.1016/S0140-6736(12)61083-6
World Health Organization. Health systems financing: the path to universal coverage. 2010.
Stevens P. Diseases of poverty and the 10/90 Gap.
ILO. Social Health Protection. Geneva, 2008.
HT HK, Saksena P, Xu K, et al. The financial burden from noncommunicable diseases in low- and middle-income countries:
a literature review. Health Res Policy Syst; 11.
Maeda A, Araujo E, Cashin C, et al. Universal Health Coverage for Inclusive and Sustainable Development: A Synthesis of 11 Country Case Studies. 2014. DOI: https://doi.org/10.1596/978-1-4648-0297-3
Jowett M, Kutzin J. Raising revenues for health in support of UHC: strategic issues for policy makers. https://doi.org/10.1080/13545701.2015. 1088658, 2015.
Wang H, Switlick K, Ortiz C, et al. Health Insurance Handbook. 2011. DOI: https://doi.org/10.1596/978-0-8213-8982-9
Robyn PJ, Hill A, Liu Y, et al. Econometric Analysis to Evaluate the Effect of Community-Based Health Insurance on Reducing Informal Self-Care in Burkina Faso. Health Policy Plan 2012; 27: 156–165. DOI: https://doi.org/10.1093/heapol/czr019
P. Jütting. A links open overlay panelJohannes. Do communitybased health insurance schemes improve poor people’s access to health care? Evidence from rural senegal. ELSEVIER 2004;32: 273–288. DOI: https://doi.org/10.1016/j.worlddev.2003.10.001
Saksena P, Antunes AF, Xu K, et al. Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection. Health Policy (New York) 2011; 99: 203– 209. DOI: https://doi.org/10.1016/j.healthpol.2010.09.009
Wang H, Yip W, Zhang L, et al. Community-based health insurance in poor rural China: the distribution of net benefits.
Health Policy Plan 2005; 20: 366–374. DOI: https://doi.org/10.1093/heapol/czi045
Devadasan N, Kent R, Damme K Van, et al. Community Health Insurance in India: An Overview. Econ Polit Wkly
; 39: 3179–3183.
Carrin G, Waelkens M-P, Criel B. Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Tropical Medicine & International Health 2005; 10: 799–811. DOI: https://doi.org/10.1111/j.1365-3156.2005.01455.x
BPJS Health. National Participation Data. 2019.
Napirah, Ryman M, Rahman A, et al. Factors related to the utilization of health services in the working area of the
Tambarana Health Center, Poso Pesisir Utara District, Poso Regency. Journal of City Development 2016; 4: 29–39. DOI: https://doi.org/10.14710/jpk.4.1.29-39
Nasaruddin H. Quality of Health Services at the Community Health Center, Pattallassang District, Gowa Regency. Journal
of Administration 2014; 1: 28–38.
Minsun S, Heui SJ. What quality factors matter in enhancing the perceived benefits of online health information sites?
Application of the updated DeLone and McLean Information Systems Success Model. Int J Med Inform; 137.
Matondang M, Rahmayati, T AM, et al. Factors Related To The Quality Of Health Services In Karadenan Puskesmas,
Cibinong District, Bogor Regency In 2018. Promotor Journal 2019; 2: 276–284. DOI: https://doi.org/10.32832/pro.v2i4.2240
Nugraheni W, Mubasyiroh R, Hartono R. The influence of Jaminan Kesehatan Nasional (JKN) on the cost of delivery
services in Indonesia. PLoS One; 15.
Lee HY, Oh J, Hoang VM, et al. Use of high-level health facilities and catastrophic expenditure in Vietnam: Can health
insurance moderate this relationship? BMC Health Serv Res; 19. Epub ahead of print 21 May 2019. DOI: 10.1186/s12913-019-4115-0. DOI: https://doi.org/10.1186/s12913-019-4115-0
Kumar R. Public-private partnerships for universal health coverage? The future of ‘free health’ in Sri Lanka. Globalization and Health; 15. Epub ahead of print 28 November 2019. DOI: 10.1186/s12992-019-0522-6. DOI: https://doi.org/10.1186/s12992-019-0522-6
Pandey A, Ploubidis GB, Clarke L, et al. Trends in catastrophic health expenditure in india: 1993 to 2014. Bull World Health Organ 2018; 96: 18–28. DOI: https://doi.org/10.2471/BLT.17.191759
Ng JYS, Ramadani RV, Hendrawan D, et al. National Health Insurance Databases in Indonesia, Vietnam and the
Philippines. Pharmacoecon Open 2019; 3: 517–526. DOI: https://doi.org/10.1007/s41669-019-0127-2
Pokharel R, Silwal PR. Social health insurance in Nepal: A health system departure toward the universal health coverage.
International Journal of Health Planning and Management 2018; 33: 573–580. DOI: https://doi.org/10.1002/hpm.2530
Poontirakul P, Tsusaka TW, Pal I, et al. Does insurance work? Dynamic assessment of insurance, poverty, and climatic hazard outcomes in Thailand. Clim Risk Manag; 37. Epub ahead of print 1 January 2022. DOI: 10.1016/j.crm.2022.100449. DOI: https://doi.org/10.1016/j.crm.2022.100449
Nikoloski Z, McGuire A, Mossialos E. Evaluation of progress toward universal health coverage in Myanmar: A national and subnational analysis. PLoS Med; 18. Epub ahead of print 1 October 2021. DOI: 10.1371/journal.pmed.1003811. DOI: https://doi.org/10.1371/journal.pmed.1003811
Dorjdagva J, Batbaatar E, Svensson M, et al. Does social health insurance prevent financial hardship in Mongolia?
Inpatient care: A case in point. PLoS One; 16. Epub ahead of print 1 March 2021. DOI: 10.1371/journal.pone.0248518. DOI: https://doi.org/10.1371/journal.pone.0248518
Doshmangir L, Bazyar M, Rashidian A, et al. Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage. International Journal for Equity in Health; 20. Epub ahead of print 1 December 2021. DOI: DOI: https://doi.org/10.1186/s12939-020-01372-4
Bodhisane S, Pongpanich S. The influence of the National Health Insurance scheme of the Lao People’s Democratic
Republic on healthcare access and catastrophic health expenditures for patients with chronic renal disease, and the possibility of integrating organ transplantation into the health financing system. Health Res Policy Syst; 20. Epub ahead of print 1 December 2022. DOI: 10.1186/s12961-022-00869-4. DOI: https://doi.org/10.1186/s12961-022-00869-4
Jithitikulchai T, Feldhaus I, Bauhoff S, et al. Health equity funds as the pathway to universal coverage in Cambodia: Care
seeking and financial risk protection. Health Policy Plan 2021;36: 26–34. DOI: https://doi.org/10.1093/heapol/czaa151
Martínez GM, Vargas BJ, Bañuelos TF, et al. Public insurance program impact on catastrophic health expenditure on acute myocardial infarction. J Public Health (Bangkok) 2018; 158:47–54. DOI: https://doi.org/10.1016/j.puhe.2018.01.025
Grigorakis N, Floros C, Tsangari H, et al. Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece. Int J Health Econ Manag 2017; 17: 261–287. DOI: https://doi.org/10.1007/s10754-016-9203-7
Wang J, Zhu H, Liu H, et al. Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? International Journal Equity Health; 19. DOI: https://doi.org/10.1186/s12939-020-1145-5
Bodhisane S, Pongpanich S. The Impact of Community Based Health Insurance in Enhancing Better Accessibility and
Lowering the Chance of Having Financial Catastrophe Due to Health Service Utilization: A Case Study of Savannakhet
Province, Laos. International Journal of Health Services 2017;47: 504–518.
Mekonen A, Gebregziabher M, Teferra A. The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study. PLoS One; 13. DOI: https://doi.org/10.1371/journal.pone.0205972
Akazilia J, McIntyre D, Kanmikia EW, et al. Assessing the catastrophic effects of out-of-pocket healthcare payments prior to the uptake of a nationwide health insurance scheme in Ghana. Glob Health Action; 10. DOI: https://doi.org/10.1080/16549716.2017.1289735
Li H, Jiang L. Catastrophic medical insurance in China. The Lancet; 390. DOI: https://doi.org/10.1016/S0140-6736(17)32603-X
Ma R, Huang L, Zhao D, et al. China critical illness insurance policy - the recent developments and prospects. Value Health; 17. DOI: https://doi.org/10.1016/j.jval.2014.08.461
Yin W. To accelerate the development of people’s health and promote the innovation of medical insurance system. People’s Daily. 2016.
Mills A, Ataguba J, Akazili J, et al. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. The Lancet 2012; 380:126–133. DOI: https://doi.org/10.1016/S0140-6736(12)60357-2
Harris B, Goudge J, Ataguba J, et al. Inequities in access to health care in South Africa. Journal Public Health Policy 2011; DOI: https://doi.org/10.1057/jphp.2011.35
Al-Hanawi MK, Chirwa GC. Economic Analysis of Inequality in Preventive Health Check-Ups Uptake in Saudi Arabia. Front
Public Health; 9. Epub ahead of print 17 September 2021. DOI: 10.3389/fpubh.2021.745356. DOI: https://doi.org/10.3389/fpubh.2021.745356
Kino S, Kawachi I. How much do preventive health behaviors explain education- and income-related inequalities in health? Results of Oaxaca–Blinder decomposition analysis. Ann Epidemiol 2020; 43: 44–50. DOI: https://doi.org/10.1016/j.annepidem.2020.01.008
Langenbrunner J, Patricio V, Wang S. Toward a healthy and harmonious life in China: stemming the rising tide of noncommunicable diseases. 2011.
Wagstaff A, Doorslaer E van. Catastrophe and Impoverishment in Paying for Health Care: With Applications to Vietnam
–1998. Health Econ 2003; 12: 921–934. DOI: https://doi.org/10.1002/hec.776
Xu K, Evans DB, Kawabata K, et al. Household Catastrophic Health Expenditure: A Multicountry Analysis. The Lancet 2003; 362: 111–117. DOI: https://doi.org/10.1016/S0140-6736(03)13861-5
Carrin G. Social Health Insurance in Developing Countries: A Continuing Challenge. Int Soc Secur Rev 2002; 55: 57–69. DOI: https://doi.org/10.1111/1468-246X.00124
Huang H, Shi J, Guo L, et al. Expenditure and financial burden for common cancers in China: a hospital-based multicentre cross-sectional study. The Lancet; 388. DOI: https://doi.org/10.1016/S0140-6736(16)31937-7
Akkhavong K, Paphassarang C, Phoxay C, et al. The Lao People’s Democratic Republic Health System Review.
Vientiane: WHO; 4.
Copyright (c) 2023 the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.