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Xu J, Zhang T, Zhang H, Deng F, Shi Q, Liu J, Chen F, He J, Wu Q, Kang Z, Tian G. What influences the public's willingness to report health insurance fraud in familiar or unfamiliar healthcare settings? a cross-sectional study of the young and middle-aged people in China. BMC Public Health 2024; 24:24. [PMID: 38166821 PMCID: PMC10763160 DOI: 10.1186/s12889-023-17581-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Young and middle-aged people are important participants in the fight against health insurance fraud. The study aims to investigate the differences in their willingness to report health insurance fraud and the factors influencing it when it occurs in familiar or unfamiliar healthcare settings. METHODS Data were obtained from a validated questionnaire from 828 young and middle-aged people. McNemar's test was used to compare the public's willingness to report under the two scenarios. Chi-square tests and multiple logistic regression analysis were used to analyze the determinants of individuals' willingness to report health insurance fraud in different scenarios. RESULTS Young and middle-aged people were more likely to report health insurance fraud in a familiar healthcare setting than in an unfamiliar one (McNemar's χ²=26.51, P < 0.05). Their sense of responsibility for maintaining the security of the health insurance fund, the government's openness about fraud cases, and the perception of their ability to report had significant positive effects on the public's willingness to report in both settings (P < 0.05). In a familiar healthcare setting, the more satisfied the public is with government measures to protect whistleblowers, the more likely they are to report (OR = 1.44, P = 0.025). Those who perceive the consequences of health insurance fraud to be serious are more likely to report than those who perceive the consequences to be less serious (OR = 1.61, P = 0.042). CONCLUSION Individuals are more likely to report health insurance fraud in familiar healthcare settings than in unfamiliar ones, in which their awareness of the severity of the consequences of health insurance fraud and their perceived risk after reporting it play an important role. The government's publicizing of fraud cases and enhancing the public's sense of responsibility and ability to maintain the safety of the health insurance fund may be a way to increase their willingness to report, regardless of whether they are familiar with the healthcare setting or not.
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Affiliation(s)
- Jinpeng Xu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ting Zhang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongyu Zhang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Fangmin Deng
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qi Shi
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jian Liu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Fangting Chen
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jingran He
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zheng Kang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China.
| | - Guomei Tian
- Department of Nuclear Medicine, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Wang P, Li S, Wang Z, Jiao M, Zhang Y, Huang W, Ning N, Gao L, Shan L, Li Y, Wu Q. Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China. Front Public Health 2023; 11:1043153. [PMID: 37139382 PMCID: PMC10149763 DOI: 10.3389/fpubh.2023.1043153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Background The perceptions of the benefits of the basic medical insurance system among the insured not only reflect the system's performance but also the public's basic medical insurance policy literacy, valuable information for countries that have entered the stage of deepening reform. This study aims to examine the factors that affect the perceptions of the benefits of the basic medical insurance system in China, diagnose the key problems, and propose corresponding measures for improvement. Methods A mixed method design was used. Data for the quantitative study were obtained from a cross-sectional questionnaire survey (n = 1,045) of residents of Harbin who had enrolled for basic medical insurance system. A quota sampling method was further adopted. A multivariate logistic regression model was then employed to identify the factors influencing the perceptions of the benefits of the basic medical insurance system, followed by semi-structured interviews with 30 conveniently selected key informants. Interpretative phenomenological analysis was used to analyze the interview data. Results Approximately 44% of insured persons reported low perceptions of benefits. The logistic regression model showed that low perceptions of the benefits of the basic medical insurance system was positively correlated with the experience of daily drug purchases (OR = 1.967), perceptions of recognition with basic medical insurance system (OR = 1.948), perceptions of the financial burden of participation costs (OR = 1.887), perceptions of the convenience of using basic medical insurance for medical treatment (OR = 1.770), perceptions of the financial burden of daily drug purchases costs (OR = 1.721), perceptions of the financial burden of hospitalization costs (OR = 1.570), and type of basic medical insurance system (OR = 1.456). The results of the qualitative analysis showed that the key problem areas of perceptions of the benefits of the basic medical insurance system were: (I) system design of basic medical insurance; (II) intuitive cognition of the insured; (III) rational cognition of the insured; and (IV) the system environment. Conclusions Improving the perceptions of the benefits of the basic medical insurance system of the insured requires joint efforts in improving system design and implementation, exploring effective publicity methods of basic medical insurance system information, supporting public policy literacy, and promoting the health system environment.
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Affiliation(s)
- Peng Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Shuyi Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Zhizhen Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Yuchao Zhang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Weiqi Huang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ye Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- Research Center of Health Policy and Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
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Rahimisadegh R, Mehrolhassani MH, Jafari Sirizi M, Noori Hekmat S. The analysis of National Health Accounts and financial communications network in Iran health insurance ecosystem. BMC Health Serv Res 2022; 22:1552. [PMID: 36536357 PMCID: PMC9764588 DOI: 10.1186/s12913-022-08921-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND One of the major reforms in the health system of any country is the financing reform. Network analysis as a practical method for investigating complex systems allows distinguishing prominent actors in the relation networks. Leading to the identification of the effective actors and key links between them, the analysis of financial networks helps policymakers to implement reformations by providing appropriate evidence. This study aimed to design and analyze the network of National Health Accounts (NHA) and the cost network in the Iran health insurance ecosystem. METHODS The present study is a network analysis study based on the data from NHA, and both cost and referral rates that was conducted in 2021. Data, which was for the years 2014 to 2018 and related to NHA, was collected from the Statistical Center of Iran, and cost data and referral rates, which were both related to Basic Insurance Organizations (BIOs), were collected from statistical yearbooks. To analyze the network and identify the key actors, macro indicators, such as network size and density, and micro indicators, such as centrality indicators and the combined importance index, were used. RESULTS In the financing of the health system in Iran, insurance organizations, as agents and sources of financing, do not have a very good position, so direct payments have become a key element in the network of NHA. Providing treatment-oriented services is quite prior. Regarded to health services, hospitals and outpatient services, such as pharmacies and physicians are the key elements of cost and referral rates respectively. CONCLUSION Consisting of several organizations with different insurance policies and being supervised under different ministries, Iran's health financing system lacks a coherent structure. It is suggested to create a coherent insurance system by creating a single governance system and paying more attention to health-oriented instead of treatment-oriented services. The health insurance ecosystem has become a health-oriented system to reduce the direct payments as well as cost management.
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Affiliation(s)
- Rohaneh Rahimisadegh
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Somayeh Noori Hekmat
- grid.412105.30000 0001 2092 9755Health Foresight and Innovation Research Center,Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Bazyar M, Alipouri Sakha M, Gordeev VS, Mousavi B, Karmi A, Maniei R, Attari S, Ranjbar M. Criteria for the selection of complementary private health insurance: the experience of a large organisation in Iran. BMC Health Serv Res 2022; 22:1377. [PMCID: PMC9675121 DOI: 10.1186/s12913-022-08777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Expenses related to employee’s health benefit packages are rising. Hence, organisations are looking for complementary health financing arrangements to provide more financial protection for employees. This study aims to develop criteria to choose the most appropriate complementary health insurance company based on the experience of a large organisation in Iran. Methods This study was conducted in 2021 in Iran, in the Foundation of Martyrs and Veterans Affairs to find as many applicable criteria as possible. To develop a comprehensive list of criteria, we used triangulation in data sources, including review of relevant national and international documents, in-depth interviews of key informants, focus group discussion, and examining similar but unpublished checklists used by other organisations in Iran. The list of criteria was prioritised during focus group discussions. We used the best-worst method as a multi-criteria decision making method and a qualitative consensus among the key informants to value the importance of each of the finalised criteria. Findings Out of 85 criteria, we selected 28 criteria to choose an insurer for implementing complementary private health insurance. The finalised criteria were fell into six domains: (i) Previous experience of the applicants; (ii) Communication with clients; (iii) Financial status; (iv) Health care providers’ network; (v) Technical infrastructure and workforce; (vi) and Process of reviewing claims and reimbursement. Conclusion We propose a quantitative decision-making checklist to choose the best complimentary private health insurance provider. We invite colleagues to utilise, adapt, modify, or develop these criteria to suit their organisational needs. This checklist can be applied in any low- and middle-income country where the industry of complementary health insurance is blooming. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08777-7.
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Affiliation(s)
- Mohammad Bazyar
- grid.449129.30000 0004 0611 9408Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Minoo Alipouri Sakha
- National Center for Health Insurance Research, Tehran, Iran ,grid.411746.10000 0004 4911 7066Department of Health Education and Promotion, Deputy of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Vladimir Sergeevich Gordeev
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Queen Mary University of London, London, UK ,grid.8991.90000 0004 0425 469XDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Batool Mousavi
- grid.512307.2Prevention Department, Janbazan Medical and Engineering Research Centre (JMERC), Tehran, Iran
| | - Amir Karmi
- grid.512307.2Janbazan Medical and Engineering Research Centre (JMERC), Tehran, Iran
| | - Reza Maniei
- grid.512307.2Janbazan Medical and Engineering Research Centre (JMERC), Tehran, Iran
| | - Saeed Attari
- grid.512307.2Janbazan Medical and Engineering Research Centre (JMERC), Tehran, Iran
| | - Mohammad Ranjbar
- grid.412505.70000 0004 0612 5912Health policy and management research center, Department of Health Services Management, School of public health, shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Xu M, Gan D, Pan T, Sun X. Trends and characteristics of China's medical informatization policy from 1996 to 2020: a bibliometric analysis. ASLIB J INFORM MANAG 2021. [DOI: 10.1108/ajim-04-2021-0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeQualitative methods are not suitable to process high volumes of policy texts for exploring policy evolution. Therefore, it is hard to use qualitative methods to systematically analyze the characteristics of complex policy networks. So the authors propose a bibliometric research study for exploring policy evolution from time–agency–theme perspectives to excavate the rules and existing problems of China's medical informatization policy and to provide suggestions for formulating and improving the future medical informatization policies.Design/methodology/approachInitially, 615 valid samples are obtained by retrieving related China's medical informatization policy documents, and the joint policy-making agency network and the co-occurrence network models of medical informatization policies are defined, and then the authors research China's medical informatization policies from single-dimension and multi-dimension view.FindingsThe analysis results reveal that China's medical informatization policy process can be divided into four stages; the policy-making agencies are divided into four subgroups by community detection analysis according to the fast unfolding algorithm; the core policy theme keywords are identified based on the eigenvector centrality of the nodes in those networks; the focuses of theme terms are varied in different stages and the correlations between agencies and themes are gradually decentralized.Practical implicationsThese findings provide experience and evidence on leveraging informatics in the medical and healthcare field of China. Also, they can help scholars and practitioners better understand the current status and future directions of medical and healthcare informatics development in China and provide a reference to formulate and improve China's future medical informatization policies.Originality/valueThis study proposes a quantitative bibliometric-based research framework to describe transitions and trends of China's medical informatization policy.
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Doshmangir L, Bazyar M, Rashidian A, Gordeev VS. Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage. Int J Equity Health 2021; 20:37. [PMID: 33446202 PMCID: PMC7807408 DOI: 10.1186/s12939-020-01372-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/26/2020] [Indexed: 01/29/2023] Open
Abstract
Background Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. Methods This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Results Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. Conclusion To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.
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Affiliation(s)
- Leila Doshmangir
- Social Determinants of Health Research Center, Health Management & Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Policy& Management, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management& Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Bazyar
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran.
| | - Arash Rashidian
- Department of Science, Information and Dissemination, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Vladimir Sergeevich Gordeev
- Institute of Population Health Sciences, Queen Mary University of London, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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