The impact of informal patient navigation initiatives on patient empowerment and National Health Insurance responsiveness in Indonesia

Making health insurance responsive to citizens: learning from six low-income and middle-income countries

BACKGROUND

Many low-income and middle-income countries have introduced public health insurance systems, whereby, thanks to government subsidies, selected groups are entitled to receive insurance coverage even if not paying direct contributions into the system. These efforts towards achieving universal health coverage were often undermined by difficulties in enrolment and registration, barriers to health service utilisation or complicated rules around service packages. Governmental and non-governmental accountability initiatives have been established to overcome these barriers in order to make health insurance programmes responsive and to empower citizens. This paper examines evidence and synthesizes lessons from 20 accountability initiatives in six selected countries to understand how these achieved (or not) these goals.

METHODS

We systematically analysed six final reports and five published papers which were part of a multicountry research programme from 2019 to end of 2022 studying accountability initiatives. Between June 2023 and September 2024, we systematically extracted data and synthesised findings from the reports and papers based on a conceptual framework, adapted from a framework developed by Molyneux, which had been adopted by the country teams to guide their studies. We coded the extracted data and identified the content, context and process factors that enabled or hindered the accountability initiatives in achieving their intended goals. We present and discuss factors that were present in at least two initiatives.

RESULTS

Governmental initiatives were in most instances established in conjunction with the health reforms that introduced the health insurance programmes they address. Whereas some of these initiatives were effective, many were undermined by poor outreach to citizens, inadequacy of resources, conflicts of interest and power imbalances and lack of fidelity to original design. Non-governmental initiatives often emerged to fill existing gaps in government services and programmes. Many of the non-governmental initiatives had several features which helped them in contributing to citizen empowerment, and these included embeddedness in and being trusted by the local communities, flexibility in operating and reaching out to people and the underlying motivation of people working in them.

CONCLUSIONS

The effective implementation of accountability initiatives requires transparency, trust-building measures, active outreach and community engagement and adequate resources. These elements can ensure that initiatives achieve their intended goal of enhancing citizens' access to their health insurance entitlements. Further research is needed to understand how best collaboration between governmental and non-governmental initiatives can be fostered to build synergies between the two toward the achievement of common goals.

Exploring the effects of digital technologies in health financing for universal health coverage: a synthesis of country experiences and lessons

The use of digital technologies (DTs) for health financing receives increased attention in policy, practice and research. However, not much robust evidence exists on their effects on the intermediate and final universal health coverage objectives. This paper seeks to contribute to evidence gathering, by synthesizing the findings from nine country case studies which covered diverse applications of DTs and identified their effects on health financing and universal health coverage objectives. This paper also draws on review papers on the use of DTs for health financing. Our synthesis reveals that DTs can support and simplify health financing tasks and thus contribute to enhanced efficiency and transparency and more equitable resource distribution. If well designed, DTs can help overcome challenges inherent in paper-based data systems and enable otherwise hardly implementable policy options, especially options that rely on near real-time exchange of data. Yet, the studies also point to various risks. Caution is for instance required when the use of DTs enhances inequities between population groups due to various digital divides. The findings point to a number of policy orientations. There is need to include the application of DTs for health financing in national digital health strategies and to develop health financing specific guidance and regulation. This is for instance necessary to avoid that DTs negatively affect financial protection. Clear stipulations related to equity will serve to ensure that positive effects accrue to vulnerable population groups. The future research agenda calls for more and methodologically robust evidence generation with a clear universal health coverage orientation.

[Utilizing Patient Navigation Model in the Whole-Process Management of Lung Cancer in the Context of Medical Consortiums in China: Insights and Reflections]

Patient navigation is an effective intervention measure to promote the integration of medical systems and services. By providing individualized, coordinated, and continuous care, patient navigation offers a way to address the problem of fragmented services across institutions and levels of care in the whole-process management of lung cancer, providing assistance to patients with complex healthcare needs. Herein, we reviewed the origin, the development, the models, and the application status of patient navigation in China and other countries. We also analyzed the considerations regarding introducing patient navigation in the whole-process management of lung cancer against the background of medical consortiums in China, discussing why patient navigation should be introduced, how to introduce patient navigation, as well as potential challenges and coping strategies. Patient navigation meets the current needs for equitable, accessible, systematic, continuous, and integrated prevention and treatment services for chronic diseases in the context of the Healthy China Strategy. It helps fill the gaps in the continuity and coordination of whole-process management of lung cancer patients in the context of medical consortiums. However, introducing patient navigation in medical consortiums involving multiple institutions and levels of care may face challenges, including incompatibility between the health information systems of different institutions, poor cross-institutional collaboration and communication, and limited resources. Further improvement is needed in medical informatization, coordination and communication mechanisms, and benefit distribution mechanisms within the medical consortiums. In this paper, we intend to provide insights and suggestions for developing patient navigation models that suit China's local characteristics and for promoting the implementation and development of whole-process management of lung cancer in the context of the medical consortium system.