Background Fragmentation in health insurance system may lead to inequity in financial access to and utilization of health care services. One possible option to overcome this challenge is merging the existing health insurance funds together. This article aims to review and compare the experience of South Korea, Turkey, Thailand and Indonesia regarding merging their health insurance funds. Methods This was a cross-country comparative study. The countries of the study were selected purposefully based on the availability of data to review their experience regarding merging health insurance funds. To find the most relevant documents about the subject, different sources of information including books, scientific papers, dissertations, reports, and policy documents were studied. Research databases including PubMed, Scopus, Google Scholar, Science Direct and ProQuest were used to find relevant articles. Documents released by international organizations such as WHO and World Bank were analyzed as well. The content of documents was analyzed using a data-driven conventional content analysis approach and all details regarding the subject were extracted. The extracted information was reviewed by all authors several times and nine themes emerged. Results The findings show that improving equity in health financing and access to health care services among different groups of population was one of the main triggers to merge health insurance funds. Resistance by groups enjoying better benefit package and concerns of workers and employers about increasing the contribution rates were among challenges ahead of merging health insurance funds. Improving equity in the health care financing; reducing inequity in access to and utilization of health care services; boosting risk pooling; reducing administrative costs; higher chance to control total health care expenditures; and enhancing strategic purchasing were the main advantages of merging health insurance funds. The experience of these countries also emphasizes that political commitment and experiencing a reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging are required to facilitate implementation of merging health insurance funds. Conclusions Other contributing health reforms should be implemented simultaneously or sequentially in both supply side and demand side of the health system if merging is going to pave the way reaching universal health coverage.
Background: This study aimed to compare the serum levels of procalcitonin in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the patients with chronic obstructive pulmonary disease (COPD) in the emergency ward of Afzalipour Hospital in Kerman. background: This study aimed to compare the serum levels of procalcitonin in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the patients with chronic obstructive pulmonary disease (COPD) in the emergency ward of Afzalipour Hospital in Kerman. Methods: This cross-sectional study was conducted on 45 patients with stable COPD and 45 patients with AECOPD. Patients were divided into four groups based on COPD severity assessment. Serum procalcitonin levels were measured using an ELISA kit. Results: The mean age of patients in the exacerbation and the stable group was 60.97±12.61 and 62.53±11.04 years, respectively. Serum procalcitonin levels in two exacerbation groups (215.22±19.84) were higher than stable groups (127.92±8.97) (P=0.001). The accuracy of this test for diagnosing acute attack in terms of AECOPD was 77%, and the serum procalcitonin level of 132.6 was found to be the best cut-off point to diagnose acute disease. The mean serum procalcitonin levels of stage D patients in the acute attack group were substantially higher than those of stages D and B patients in the stable group (P = 0.001). Serum procalcitonin levels were related to body mass index (P=0.01), post-bronchodilator FEV1/FVC (P=0.028), and the number of hospitalizations per year (P=0.001). By increasing the serum procalcitonin levels, BMI and number of admissions per year increase, and post-bronchodilator FEV1/FVC decreases. method: This cross-sectional study was conducted on 45 patients with stable COPD and 45 patients with AECOPD. Patients were divided into four groups based on COPD severity assessment. Serum procalcitonin levels were measured using an ELISA kit. Conclusion: The mean serum levels of procalcitonin in the group with attacks due to COPD was significantly higher than the stable group. result: The mean age of patients in the exacerbation and the stable group was 60.97±12.61 and 62.53±11.04 years, respectively. Serum procalcitonin levels in two exacerbation groups (215.22±19.84) were higher than stable groups (127.92±8.97) (P=0.001). The accuracy of this test for diagnosing acute attack in terms of AECOPD was 77%, and the serum procalcitonin level of 132.6 was found to be the best cut-off point to diagnose acute disease. The mean serum procalcitonin levels of stage D patients in the acute attack group were substantially higher than those of stages D and B patients in the stable group (P = 0.001).Serum procalcitonin levels were related to body mass index (P=0.01), post-bronchodilator FEV1/FVC (P=0.028), and the number of hospitalizations per year (P=0.001). By increasing the serum procalcitonin levels, BMI and number of admissions per year increase, and post-bronchodilator FEV1/FVC decreases. conclusion: The mean serum levels of procalcitonin in the group with attacks due to COPD was significantly higher than the stable group. other: -
Background: Fragmentation in health insurance system can obstruct reaching universal health coverage' objectives and may lead to inequity in financial and organizational access to health care services. One possible option to overcome this challenge is merging the existing insurance funds together. This article aims to review the experience of Turkey, Thailand, South Korea and Indonesia regarding merging which can be very useful for other countries which are looking for ways of enhancing their health systems.Methods: The present study is a cross-country comparative analysis. The first criterion to choose these countries was with experience of the policy of merging. The second criterion was diversity in health insurance systems. To find the most relevant documents about the subject, different sources of information were searched including books, scientific papers, reports, policy documents and documents published by international organizations such as WHO and World Bank. We followed snowball sampling method to reach out for further documents by checking the reference list of the most relevant documents. We also contacted the authors with the most relevant articles in the selected countries to introduce and provide us with more articles or publications about the subject.Results: The experience of Turkey, Thailand, South Korea and Indonesia show that different reasons may force policy makers to move towards merging and reducing the number of health insurance funds; different stakeholders may support or oppose merging based on the interests they may have in the current fragmented health insurance system; various positive and negative consequences may occur in the health system as the result of merging. The experience of these countries also emphasize that in order to accelerate and facilitate implementation process of merger and face less operational challenges, there should be some prerequisites such as experiencing reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging.Conclusions: Merging is not the panacea to all problems of health system and other contributing health reforms should be implemented simultaneously or sequentially in other aspects of health system if merging is going to pave the way reaching universal health coverage. Background 3In many countries with health insurance system, various insurance schemes coexist which lead to the fragmentation of health insurance schemes and reduction of risk pooling 1 . This fragmentation creates concerns regarding equity in access to health services among different groups of population as well as financial instability for small funds 2 . Fragmentation can also postpone reaching universal health coverage' objectives such as reduction the financial burden as it reduces the potential degree of risk redistribution from a given amount of prepaid funds 3 . Fragmentation as a concern in health insurance system 4,5 has been addressed in WHO' world health reports 2000WHO' world health reports , 2008WHO' ...
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