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  1. Progress toward universal health coverage in ASEAN
    Van Minh H, Pocock NS, Chaiyakunapruk N, Chhorvann C, Duc HA, Hanvoravongchai P, et al.
    Glob Health Action, 2014 Dec;7(1):25856.
    PMID: 28672540 DOI: 10.3402/gha.v7.25856
    Background The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC. Design Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and 'snowball' further data. Results We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency. Conclusions We believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations.
    Matched MeSH terms: Universal Coverage*
  2. Universal health coverage in 'One ASEAN': are migrants included?
    Guinto RL, Curran UZ, Suphanchaimat R, Pocock NS
    Glob Health Action, 2015 Jan;8(1):25749.
    PMID: 28156768 DOI: 10.3402/gha.v8.25749
    Background As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of citizenship and reimagine UHC systems that transcend national borders. Conclusions By enhancing migrant coverage, ASEAN countries can make UHC systems truly 'universal'. Migrant inclusion in UHC is a human rights imperative, and it is in ASEAN's best interest to protect the health of migrants as it pursues the path toward collective social progress and regional economic prosperity.
    Matched MeSH terms: Universal Coverage*
  3. Fulltext Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition
    Jamison DT, Alwan A, Mock CN, Nugent R, Watkins D, Adeyi O, et al.
    Lancet, 2018 03 17;391(10125):1108-1120.
    PMID: 29179954 DOI: 10.1016/S0140-6736(17)32906-9
    The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.
    Matched MeSH terms: Universal Coverage*
  4. Fulltext Universal Health Coverage Assessment Malaysia
    Ng CW
    Citation: Ng CW. Universal Health Coverage Assessment Malaysia. Kuala Lumpur: Global Network for Health Equity (GNHE); 2015
    Matched MeSH terms: Universal Coverage*
  5. Fulltext Universal coverage in an era of privatisation: can we guarantee health for all?
    Allotey P, Yasin S, Tang S, Chong SL, Cheah JC, Reidpath DD
    BMC Public Health, 2012;12 Suppl 1:S1.
    PMID: 22992275
    Matched MeSH terms: Universal Coverage*
  6. Fulltext A systematic review of the health-financing mechanisms in the Association of Southeast Asian Nations countries and the People's Republic of China: Lessons for the move towards universal health coverage
    Myint CY, Pavlova M, Thein KN, Groot W
    PLoS One, 2019;14(6):e0217278.
    PMID: 31199815 DOI: 10.1371/journal.pone.0217278
    We systematically review the health-financing mechanisms, revenue rising, pooling, purchasing, and benefits, in the Association of Southeast Asian Nations (ASEAN) and the People's Republic of China, and their impact on universal health coverage (UHC) goals in terms of universal financial protection, utilization/equity and quality. Two kinds of sources are reviewed: 1) academic articles, and 2) countries' health system reports. We synthesize the findings from ASEAN countries and China reporting on studies that are in the scope of our objective, and studies that focus on the system (macro level) rather than treatment/technology specific studies (micro level).The results of our review suggest that the main sources of revenues are direct/indirect taxes and out of pocket payments in all ASEAN countries and China except for Brunei where natural resource revenues are the main source of revenue collection. Brunei, Indonesia, Philippines, Malaysia, and Viet Nam have a single pool for revenue collection constituting a national health insurance. Cambodia, China, Lao, Singapore, and Thailand have implemented multiple pooling systems while Myanmar has no formal arrangement. Capitation, Fee-for-Service, DRGs, Fee schedules, Salary, and Global budget are the methods of purchasing in the studied countries. Each country has its own definition of the basic benefit package which includes the services that are perceived as essential for the population health. Although many studies provide evidence of an increase in financial protection after reforming the health-financing mechanisms in the studied countries, inequity in financial protection continue to exist. Overall, the utilization of health care among the poor has increased as a consequence of the implementation of government subsidized health insurance schemes which target the poor in most of the studied countries. Inappropriate policies and provider payment mechanisms impact on the quality of health care provision. We conclude that the most important factors to attain UHC are to prioritize and include vulnerable groups into the health insurance scheme. Government subsidization for this kind of groups is found to be an effective method to achieve this goal. The higher the percentage of government expenditure on health, the greater the financial protection is. At the same time, there is a need to weigh the financial stability of the health-financing system. A unified health insurance system providing the same benefit package for all, is the most efficient way to attain equitable access to health care. Capacity building for both administrative and health service providers is crucial for sustainable and good quality health care.
    Matched MeSH terms: Universal Coverage/economics*
  7. Fulltext Financing mechanisms applied for successful Universal Health Coverage in Malaysia, Thailand and Singapore - Lessons for Pakistan
    Jabeen R, Rabbani U, Abbas N
    J Pak Med Assoc, 2021 Nov;71(11):2611-2616.
    PMID: 34783745 DOI: 10.47391/JPMA.01204
    Universal health coverage is a global agenda and, currently for Pakistan, achieving this goal is a challenge because of a number of constraints. The current narrative review was planned to describe an overview of the provision of health insurance in Malaysia, Thailand and Singapore that have achieved universal health coverage, and to propose a roadmap for Pakistan. Literature search was conducted on Google Scholar and PubMed databases as well as on the World Bank website to retrieve relevant articles. The three studied countries achieved universal health coverage by gradually increasing allocation for health and through various mechanisms, such as health insurance schemes which covered different segments of the population, and partnerships with private-sector care-providers. Pakistan needs to prioritise health in policy agenda because health insurance is negligible in Pakistan. Additionally, Pakistan also needs to efficiently utilise partnerships with the private sector to further increase healthcare coverage.
    Matched MeSH terms: Universal Coverage*
  8. Enabling cross-country learning and exchange to support universal health coverage implementation
    Oliveira Hashiguchi L, Conlin M, Roberts D, McGee K, Marten R, Nachuk S, et al.
    Health Policy Plan, 2024 Jan 23;39(Supplement_1):i125-i130.
    PMID: 38253439 DOI: 10.1093/heapol/czad097
    As countries transition from external assistance while pursuing ambitious plans to achieve universal health coverage (UHC), there is increasing need to facilitate knowledge sharing and learning among them. Country-led and country-owned knowledge management is foundational to sustainable, more equitable external assistance for health and is a useful complement to more conventional capacity-building modalities provided under external assistance. In the context of external assistance, few initiatives use country-to-country sharing of practitioner experiences, and link learning to receiving guidance on how to adapt, apply and sustain policy changes. Dominant knowledge exchange processes are didactic, implicitly assuming static technical needs, and that practitioners in low- and middle-income countries require problem-specific, time-bound solutions. In reality, the technical challenges of achieving UHC and the group of policymakers involved continuously evolve. This paper aims to explore factors which are supportive of experience-based knowledge exchange between practitioners from diverse settings, drawing from the experience of the Joint Learning Network (JLN) for UHC-a global network of practitioners and policymakers sharing experiences about common challenges to develop and implement knowledge products supporting reforms for UHC-as an illustration of a peer-to-peer learning approach. This paper considers: (1) an analysis of JLN monitoring and evaluation data between 2020 and 2023 and (2) a qualitative inquiry to explore policymakers' engagement with the JLN using semi-structured interviews (n = 14) with stakeholders from 10 countries. The JLN's experience provides insights to factors that contribute to successful peer-to-peer learning approaches. JLN relies on engaging a network of practitioners with diverse experiences who organically identify and pursue a common learning agenda. Meaningful peer-to-peer learning requires dynamic, structured interactions, and alignment with windows of opportunity for implementation that enable rapid response to emerging and timely issues. Peer-to-peer learning can facilitate in-country knowledge sharing, learning and catalyse action at the institutional and health system levels.
    Matched MeSH terms: Universal Coverage*
  9. Fulltext Twenty years of traditional and complementary medicine regulation and its impact in Malaysia: achievements and policy lessons
    Park JE, Yi J, Kwon O
    BMC Health Serv Res, 2022 Jan 25;22(1):102.
    PMID: 35078459 DOI: 10.1186/s12913-022-07497-2
    BACKGROUND: Many countries are trying to integrate traditional and complementary medicine (T&CM) into their health care systems. However, it is not easy to integrate T&CM within a given health care system. This study aims to draw policy outcomes and lessons from the case of Malaysia, which has been making efforts for over 20 years to integrate various types of T&CM into the national health care system (NHS).

    METHODS: Documents were searched in major databases and websites using words such as Malaysia and T&CM, and additional documents were secured using snowballing techniques. Data were classified and organized according to the World Health Organization health systems framework.

    RESULTS: Malaysia has focused on managing the safety and quality of T&CM, and to that end it has been institutionalized by enacting specialized laws rather than by applying existing medical law directly. Malaysia was able to institutionalize T&CM by adopting a step-by-step approach that considered the appropriateness of administrative policies and measures.

    CONCLUSIONS: Malaysia's experiences in implementing its T&CM policies will raise practical implications for countries struggling to integrate their existing T&CM into the NHS and utilize it for universal health coverage.

    Matched MeSH terms: Universal Coverage*
  10. Three Case Studies in Making Fair Choices on the Path to Universal Health Coverage
    Voorhoeve A, Edejer TTT, Kapiriri L, Norheim OF, Snowden J, Basenya O, et al.
    Health Hum Rights, 2016 Dec;18(2):11-22.
    PMID: 28559673
    The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity, and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for those who are worse off in a number of dimensions (including health, access to health services, and social and economic status), and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting.
    Matched MeSH terms: Universal Coverage*
  11. Fulltext Financing universal coverage in Malaysia: a case study
    Chua HT, Cheah JC
    BMC Public Health, 2012;12 Suppl 1(Suppl 1):S7.
    PMID: 22992444 DOI: 10.1186/1471-2458-12-S1-S7
    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive care, in better managing escalating healthcare costs associated with the increasing trend of non-communicable diseases. In tandem, health financing policies need to infuse the element of cost-effectiveness to better manage the purchasing of new medical supplies and equipment. Ultimately, good governance and leadership are needed to ensure adequate public spending on health and maintain the focus on the attainment of universal coverage, as well as making healthcare financing more accountable to the public, particularly in regards to inefficiencies and better utilisation of public funds and resources.
    Matched MeSH terms: Universal Coverage/economics*
  12. Fulltext Achieving Universal Health Coverage: Learning from Chile, Japan, Malaysia and Sweden
    Savedoff WD, Smith AL
    Citation: Savedoff WD, Smith AL. Achieving Universal Health Coverage: Learning from Chile, Japan, Malaysia and Sweden. Maine, United States: Result for Development Institute; 2011

    Over the last hundred years, most countries have made substantial progress toward universal health coverage. The shared trends includes rising incomes, increasing total health expenditures and an expanding role for government in improving access to health care. Despite this, countries vary significantly in their particular routes to universal health coverage. These routes are shaped by prominent leaders and strong popular movements and framed by particular moral claims and world views. They are affected by unpredictable events related to economic cycles, wars, epidemics and initiatives in other public policy spheres. They are also influenced by a country’s own institutional development and experiences in other countries. As a result of these highly contingent paths, countries reach universal health coverage at different income levels and with disparate institutional arrangements for expanding health care access and mitigating financial risk. This paper examines the histories of attaining universal health coverage in four countries – Sweden, Japan, Chile and Malaysia. It shows that domestic pressures for universalizing access to health care are extremely varied, widespread, and persistent. Secondly, universal health coverage is everywhere accompanied by a large role for government, although that role takes many forms. Third, the path to universal health coverage is contingent, emerging from negotiation rather than design. Finally, universal health coverage is attained incrementally and over long periods of time. These commonalities are shared by all four cases despite substantial differences in income, political regimes, cultures, and health sector institutions. Attention to these commonalities will help countries seeking to expand health coverage today.
    Matched MeSH terms: Universal Coverage
  13. Fulltext Universal health coverage in Malaysia: issues and challenges
    Ng CW, Md Hairi NN, Ng CJ, Kamarulzaman A
    National Population Conference on the Inter-Relationship Between Population Dynamics and Development, 2014.
    Socioeconomic development in Malaysia, over the past few decades, has led to the improvement and expansion of the public healthcare system. This system has provided universal access to a low-priced package of comprehensive health care leading Malaysia to claim to have achieved universal health coverage (UHC). However, the Malaysian health landscape is changing rapidly. Provision of private care has grown especially in large urban towns, mainly in response to public demand. Thus far, private care has been predominantly bought and utilised by the rich but because of differentials in quality of care between the public and private sector, unabated expansion of the private health sector has the potential to adversely affect universal access to care. This effect may be accentuated in the coming years by demographic changes in the country specifically by the ageing of the population. This paper is intended to highlight challenges to UHC in Malaysia in the face of the changing health landscape in the country and to offer some suggestions as to how these challenges can be met.
    Matched MeSH terms: Universal Coverage
  14. Fulltext Investing in the health of girls and women: a best buy for sustainable development
    Remme M, Vassall A, Fernando G, Bloom DE
    BMJ, 2020 06 02;369:m1175.
    PMID: 32487585 DOI: 10.1136/bmj.m1175
    Matched MeSH terms: Universal Coverage
  15. Fulltext Proposal for development of a guideline in maintaining quality cancer care during and post-covid-19 in an upper middle-income country with universal health coverage
    Teoh SP, Bustamam RS, Mustapha FI, Yip CH, Saad M, Somasundaram S, et al.
    J Cancer Policy, 2021 Dec;30:100300.
    PMID: 35559796 DOI: 10.1016/j.jcpo.2021.100300
    BACKGROUND: During periods of high community transmission of COVID-19, the public hospitals in Malaysia, an upper middle-income country, have been forced to scale down elective surgeries, prioritize cancer treatments based on treatment benefits, and postpone non-emergency imaging procedures. These inevitably led to disruptions in cancer care delivery within the public health care system. This study aims to explore the facilitators and barriers faced by healthcare providers and cancer survivors in cancer care, and to co-design a guideline to maintain the delivery of cancer care amid the disaster situations.

    METHOD: In-depth interviews (IDIs) will be conducted with Malaysian healthcare providers and cancer survivors and findings will be analysed thematically. The insights will be used in a subsequent phase to co-design a guideline to maintain the delivery of quality cancer care in Malaysia via a three-round modified Delphi survey with a broad range of cancer stakeholders.

    EXPECTED RESULTS: Findings derived from IDIs and existing literature will be included for rating across three rounds by the expert panel. Feedback provided will be refined until consensus on the best practises for cancer care continuity during crises is achieved.

    CONCLUSION: The output of the present study is not only expected to ensure the continuity of delivery of high-quality cancer care in Malaysia during the ongoing pandemic but also to be adapted during unforeseen crises in the near future.

    POLICY SUMMARY STATEMENT: Collaborative work between policy makers, public health physicians, members of the multidisciplinary oncology team as well as cancer survivors is vital in developing an evidenced- based contingency plan for maintaining access to cancer care.

    Matched MeSH terms: Universal Coverage
  16. Fulltext Universal health coverage and the post-2015 agenda
    Touraine M, Gröhe H, Coffie RG, Sathasivam S, Juan M, Louardi el H, et al.
    Lancet, 2014 Sep 27;384(9949):1161-2.
    PMID: 25242037 DOI: 10.1016/S0140-6736(14)61419-7
    Matched MeSH terms: Universal Coverage/trends*
  17. Fulltext Healthcare is not universal if undocumented migrants are excluded
    Legido-Quigley H, Pocock N, Tan ST, Pajin L, Suphanchaimat R, Wickramage K, et al.
    BMJ, 2019 Sep 16;366:l4160.
    PMID: 31527060 DOI: 10.1136/bmj.l4160
    Matched MeSH terms: Universal Coverage*
  18. A Comparative Study on the Constitutional Right to Health in the Western Pacific Region Countries
    Choi S, Park S, Kim SY
    Asia Pac J Public Health, 2018 07;30(5):458-469.
    PMID: 30051720 DOI: 10.1177/1010539518789351
    We examined the constitutional provisions on the right to health in the Western Pacific region countries and compared universal health coverage (UHC) achievement. In 9 of the 11 countries, the constitution had provisions related to health rights, of which 7 countries also included details related to the health care system. Additionally, 5 countries also had provisions for the vulnerable. The countries with weak state obligation and no clear provisions on health rights (China and Laos) all recorded low UHC achievement scores. Australia and Malaysia, which do not have constitutional provisions regarding health, have achieved high UHC achievement scores. Constitution is the supreme law of a country and the basis for developing and implementing health and medical laws and policies. In addition, laws or constitutions that regulate the rights to health can help gain access to health care. Follow-up research related to the constitutional right to health will be needed.
    Matched MeSH terms: Universal Coverage/statistics & numerical data*
  19. Community Engagement in Support of Moving Toward Universal Health Coverage
    Allotey P, Tan DT, Kirby T, Tan LH
    Health Syst Reform, 2019;5(1):66-77.
    PMID: 30924744 DOI: 10.1080/23288604.2018.1541497
    Community engagement describes a complex political process with dynamic negotiation and renegotiation of power and authority between providers and recipients of health care in order to achieve a shared goal of universal health care coverage. Though examples exist of community engagement projects, there is very little guidance on how to implement and embed community engagement as a concerted, integrated, strategic, and sustained component of health systems. Through a series of case studies, this article explores the factors that enable community engagement particularly with a direct impact on health systems.
    Matched MeSH terms: Universal Coverage*
  20. Fulltext Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia
    Syafrawati S, Machmud R, Aljunid SM, Semiarty R
    Front Public Health, 2023;11:1147709.
    PMID: 37663851 DOI: 10.3389/fpubh.2023.1147709
    OBJECTIVE: To identify the incidence of moral hazards among health care providers and its determinant factors in the implementation of national health insurance in Indonesia.

    METHODS: Data were derived from 360 inpatient medical records from six types C public and private hospitals in an Indonesian rural province. These data were accumulated from inpatient medical records from four major disciplines: medicine, surgery, obstetrics and gynecology, and pediatrics. The dependent variable was provider moral hazards, which included indicators of up-coding, readmission, and unnecessary admission. The independent variables are Physicians' characteristics (age, gender, and specialization), coders' characteristics (age, gender, education level, number of training, and length of service), and patients' characteristics (age, birth weight, length of stay, the discharge status, and the severity of patient's illness). We use logistic regression to investigate the determinants of moral hazard.

    RESULTS: We found that the incidences of possible unnecessary admissions, up-coding, and readmissions were 17.8%, 11.9%, and 2.8%, respectively. Senior physicians, medical specialists, coders with shorter lengths of service, and patients with longer lengths of stay had a significant relationship with the incidence of moral hazard.

    CONCLUSION: Unnecessary admission is the most common form of a provider's moral hazard. The characteristics of physicians and coders significantly contribute to the incidence of moral hazard. Hospitals should implement reward and punishment systems for doctors and coders in order to control moral hazards among the providers.

    Matched MeSH terms: Universal Coverage*
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