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Sustainability of Healthcare Financing in Greece: A Relation Between Public and Social Insurance Contributions and Delivery Expenditures.

ABSTRACT: The economic crisis in Greece, which began in 2010 and lasted for 10 years, highlighted the serious problems and challenges of the Greek Social Health Insurance system. The reforms that mainly took place during the crisis provided a temporary solution. They focused on establishing a new National Organization for Healthcare Services (named EOPYY) and merging all the old insurance funds. This paper aims to examine whether this social health insurance fund has been sustainable in the long run. An actuarial model was created to project future expenses and revenues. Demographic and economic trends were considered, while it was assumed that medical technology remains unaltered. The assessment of the system solvency was based on the ratio (Revenue/Liabilities) calculated for each year, from 2020 to 2050. The results led to deficits, the amount and the time point in which they appear depends on how optimistic or pessimistic demographic and economic assumptions were. A new financial flow model was proposed to address the deficits. The results show that under the new model, the system remains solvent until 2050. The state subsidy amount on the employees' health insurance premium was estimated as a percentage of the employees' wage.

SUBMITTER: Mavridoglou G

PROVIDER: S-EPMC9158418 | biostudies-literature | 2022 Jan-Dec

REPOSITORIES: biostudies-literature

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Sustainability of Healthcare Financing in Greece: A Relation Between Public and Social Insurance Contributions and Delivery Expenditures.

Mavridoglou George G Polyzos Nikolaos N

Inquiry : a journal of medical care organization, provision and financing 20220101

The economic crisis in Greece, which began in 2010 and lasted for 10 years, highlighted the serious problems and challenges of the Greek Social Health Insurance system. The reforms that mainly took place during the crisis provided a temporary solution. They focused on establishing a new National Organization for Healthcare Services (named EOPYY) and merging all the old insurance funds. This paper aims to examine whether this social health insurance fund has been sustainable in the long run. An a ...[more]

PMID: 35635453

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Project description:BackgroundHealth financing in Ghana aims for universal access to healthcare, with both public and private insurance schemes playing vital roles. The National Health Insurance Scheme (NHIS) addresses out-of-pocket expenses but faces enrollment and trust issues. However, 12 licensed Private Health Insurance Schemes (PHISs) offer complementary services, enhancing healthcare access and quality through additional coverage and service delivery. This study aimed to assess the operations and performance of PHIS in Ghana.MethodsThe research utilized a qualitative descriptive design, focusing on registered PHIS providing services to Ghanaians. A convenient sampling technique was employed for data collection. Data was gathered through face-to-face interviews with participants until saturation was achieved. The data was thematically analyzed.ResultsThe study highlights the intricate regulatory framework governing PHISs in Ghana, emphasizing licensing and accreditation requirements. It revealed diverse operational strategies, including nationwide coverage and tailored policies for different clientele. Benefit packages varied, with distinct plans like the "X-scan plan" for medical imaging. Payment structures ranged from upfront payments to flexible options. PHIS's growth was driven by health concerns during the COVID-19 pandemic, strategic investments, and partnerships. Clientele for PHIS primarily resides in urban areas, focusing on sectors like education.ConclusionThe study assesses Ghana's PHI sector, highlighting its critical role in financing healthcare in Ghana. Findings reveal PHIS's diverse packages and flexible payments boost healthcare access and quality. We, therefore, recommend PHIS foster partnerships with National Health Insurance Authority (NHIA) accredited facilities, reduce non-payment risks, and ensure transparency to foster trust and accurate risk assessment, promoting sustainable growth and reliability in Ghana's Private Health Insurance (PHI) industry.

Project description:BackgroundHigh burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia.MethodsWe searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing.ResultsA total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia's health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments.ConclusionEthiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.

Project description:ObjectivesEnsuring access to care for all patients-especially those with life-threatening and chronic conditions-during a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic, many countries faced excess mortality partly attributed to disruptions in essential healthcare services provision. This study aims to estimate the utilization of public primary care and hospital services during the COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in the country.Study designThis is an observational study.MethodsA retrospective analysis of national secondary utilization and mortality data from multiple official sources, covering the first nine months of the COVID-19 epidemic in Greece (February 26th to November 30th, 2020), was carried out.ResultsUtilization rates of all public healthcare services during the first nine months of the epidemic dropped significantly compared to the average utilization rates of the 2017-19 control period; hospital admissions, hospital surgical procedures, and primary care visits dropped by 17.3% (95% CI: 6.6%-28.0%), 23.1% (95% CI: 7.3%-38.9%), and 24.8% (95% CI: 13.3%-36.3%) respectively. This underutilization of essential public services-mainly due to supply restrictions such as suspension of outpatient care and cancelation of elective surgeries-is most probably related to the 3778 excess non-COVID-19 deaths (representing 62% of all-cause excess deaths) that have been reported during the first 9 months of the epidemic in the country.ConclusionsGreece's healthcare system, deeply wounded by the 2008-18 recession and austerity, was ill-resourced to cope with the challenges of the COVID-19 epidemic. Early and prolonged lockdowns have kept COVID-19 infections and deaths at relatively low levels. However, this "success" seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the "hidden epidemic" of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and urgently strengthen public healthcare services to address it.

Project description:ObjectivesThis study aims to assess the impact of the subsidised community health insurance scheme in Senegal particularly on the poor.Design and settingThe study used data from a household survey conducted in 2019 in three regions, representing 29.3% of the total population. Inverse probability of treatment weighting approach was applied for the analysis.Participants1766 households with 15 584 individuals selected through a stratified random sampling with two draws.Main outcome measuresThe impact of community-based health insurance (CBHI) was evaluated on poor people's access to care and on their financial protection. For the measurement of access to care, we were interested in the use of health services and non-withdrawal from care in case of illness. To assess financial protection, we looked at out-of-pocket expenditure by type of provider and by type of service, the weight of out-of-pocket expenditure on household income, non-exposure to impoverishing health expenditure and non-exposure to catastrophic health expenditure.ResultsThe results indicate that the CBHI increases primary healthcare utilisation for non-poor (OR 1.36 (CI90 1.02-1.8) for the general scheme and 1.37 (CI90 1.06-1.77) for the special scheme for indigent recipients of social cash transfers), protect them against catastrophic (OR 1.63 (CI90 1.12-2.39)) or impoverishing (OR 2.4 (CI90 1.27-4.5)) health expenditures. However, CBHI has no impact on the poor's healthcare utilisation (OR 0.61 (CI90 0.4-0.94)) and do not protect them from the burden related to healthcare expenditures (OR: 0.27 (CI90 0.13-0.54)).ConclusionOur study found that CBHI has an impact on the non-poor but does not sufficiently protect the poor. This leads us to conclude that a health insurance programme designed for the general population may not be appropriate for the poor. A qualitative study should be conducted to better understand the non-financial barriers to accessing care that may disproportionately affect the poorest.

Dataset Information

Sustainability of Healthcare Financing in Greece: A Relation Between Public and Social Insurance Contributions and Delivery Expenditures.

Publications

Sustainability of Healthcare Financing in Greece: A Relation Between Public and Social Insurance Contributions and Delivery Expenditures.

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