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Introduction: Zimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world. The perfomamce of PHI, known as Medical Aid Societies in Zimbabwe, requires close monitoring since market failures and weaknesses in public policy and regulation can affect overall health system performance. Despite the considerable influence of politics (stakeholder interests) and history (past events) in shaping PHI design and implementation, these factors are frequently sidelined when analyzing PHI in Zimbabwe. This study considers the roles of history and politics in shaping PHI and determining its impact on health system performance in Zimbabwe. Methods: We reviewed 50 sources of information using Arksey & O'Malley's (2005) methodological framework. To frame our analysis, we used a conceptual framework that integrates economic theory with political and historical aspects developed by Thomson et al. (2020) to analyze PHI in diverse contexts. Results: We present a timeline of the history and politics of PHI in Zimbabwe from the 1930s to present. Zimbabwe's current PHI coverage is segmented along socio-economic lines due to a long history of elitist and exclusionary politics in coverage patterns. While PHI was considered to perform relatively well up to the mid-1990s, the economic crisis of the 2000s eroded trust among insurers, providers, and patients. That culminated in agency problems which severely lessened PHI coverage quality with concurrent deterioration in efficiency and equity-related performance dimensions. Conclusion: The present design and performance of PHI in Zimbabwe is primarily a function of history and politics rather than informed choice. Currently, PHI in Zimbabwe does not meet the evaluative criteria of a well-performing health insurance system. Therefore, reform efforts to expand PHI coverage or improve PHI performance must explicitly consider the relevant historical, political and economic aspects for successful reformation. [ABSTRACT FROM AUTHOR]

An increasing interest in initiating and expanding social health insurance through labor taxes in low- and low-middle-income countries goes against available empirical evidence. This article builds on existing recommendations by leading health financing experts and summarizes recent research that makes the case against labor-tax financing of health care in low- and low-middle-income countries. We found very little evidence to justify the pursuit of labor-tax financing for health care in these countries and persistent evidence that such policies could lead to increased inequality and fragmentation of the health system. We recommend that countries considering such policies heed the evidence on labor-tax financing and seek alternative approaches to health financing: primarily using general taxes or, depending on the context, general taxes combined with adequately regulated insurance premiums. [ABSTRACT FROM AUTHOR]

Background: Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Methods: Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. Results: We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. Conclusions: China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding mechanisms. However, this study demonstrates that health systems governance may be critical to enable the development and operation of such schemes. Given that many LMICs are expanding health financing system to cover populations in rural areas or the informal sectors, we argue that strengthening specific practices in each governance domain could inform the adaptation of these schemes to other settings. [ABSTRACT FROM AUTHOR]

This article presents an institutionalist perspective on the relationship between policy failure and policy learning. It contributes both to our understanding of different patterns institutional change as well as the conditions for policy learning at the system-wide level. The first section elaborates the concept of policy failure in terms of type, value and timing. Next, how policy failure may trigger a process of deinstitutionalisation and in turn create conditions for subsequent policy learning is described. These contributions to theory are explored through selected evidence from the reform trajectory of Australian health insurance policy from the mid-1970s to late-1990s. [ABSTRACT FROM AUTHOR]

Introduction In order to alleviate the problem of "Kan Bing Nan, Kan Bing Gui" (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China. Methods Using the data from the fourth National Health Services Survey in Shaanxi province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents. Results For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively. Conclusions The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation. [ABSTRACT FROM AUTHOR]

This article presents an examination of Japan's epoch-making health-insurance reforms undertaken during the Asia-Pacific War between 1937 and 1945. These reforms culminated in amendments to the Health Insurance Law and the National Health Insurance Law in 1942, along with the enactment of the National Medical Treatment Law. The issues addressed in this article are, firstly, the kind of reforms of Japan's health-insurance programs that took place during this period, and secondly, the historical significance of these reforms. Focusing on three elements of the wartime health-insurance reforms – expansion of the number of insured people, transformation of payment system to physicians and provision of easy access to medical institutions – this article examines the following hypothesis: Japanese Health Insurance, established in 1922, which primarily aimed at maintaining and restoring workers’ health and physical work capability, and providing them with economic assistance during those times when they suffered from sickness or injury, was qualitatively transformed to quasi-public-assistance programs with financial dependence on the state during wartime, which established an institutional setting that contributed to the rise of health-insurance expenditure in the post-war era. [ABSTRACT FROM PUBLISHER]

This study examines the Indian health insurance market by empirically observing the provider’s perceptions and its relationship with the insured, the insurer and the third party administrators (TPAs). The study tries to find out the awareness level among the insured population and their attitude towards treatment cost. It then examines the role of TPAs and the impact of cashless services on the cost of treatment by studying a few cost drivers. Apart from studying the provider’s per-ceptions it also tries to look at some of the evidence of moral hazards and that of fraudulent activity. The findings suggest that the awareness level regarding policy terms and condition is low among the insured population and most of them do not care for the cost of treatment. The providers increase their rates quite frequently and prefer the middle income group for extending cashless benefits. The TPA model has not been successful in bringing down the claim cost but has helped in providing unbiased services including cashless benefits. The price structure of healthcare services are linked to the room rent category and most of the insured patients, who are more demanding, prefer staying in higher category rooms. The concept of cost-sharing by the insured will help tackle this issue to some degree. The Indian health insurance market is not immune from supply-side moral hazards and fraudulent activities and there is a need to craft different strategies to tackle them. There exists an opportunity for the insurance companies to build long-term relationships with the preferred healthcare providers by using technology and by understanding each other’s roles in serving the common client. [ABSTRACT FROM PUBLISHER]

Unlike pain practitioners, health care insurers in the United States are not expected to function according to a system of medical ethics. Rather, they are permitted to function under the business 'ethic' of cost-containment and profitability. Despite calls for balancing the disparate agendas of stakeholders in pain management in a pluralistic system, the health insurance industry has continued to fail to take the needs of suffering chronic pain patients into consideration in developing and enacting their policies that ultimately dictate the quality and quantity of pain management services available to enrollees. This essay examined these self-serving strategies, which include failure to reimburse services and certain medications irrespective of their evidence-bases for clinical efficacy and cost-efficiency; 'carving out' specific services from interdisciplinary treatment programs; and delaying and/or interrupting the provision of medically necessary treatment. Blatant and more subtle strategies utilized by insurers to achieve these ethically questionable goals are examined. Additionally, this essay addressed some of the insurance industry's efforts to delegitimize chronic pain and its treatment as a whole. The author concludes that the outlook for chronic pain sufferers is not particularly bright, until such time that a not-for-profit single-payer system replaces the current treatment/reimbursement paradigm. [ABSTRACT FROM AUTHOR]

The article focuses on a law highlighting health insurance for laborers in Germany that was enacted in 1883. Social laws from the time period of the German Empire (Kaiserreich) are discussed and a particular focus is given to the "Freie Hilfskassen" which are health insurance agencies that are financed and administrated by their members in order to give them freedom from corporate or state insurance companies.

Purpose – The purpose of this paper is to describe divergent recent developments in provision of reproductive health services to North Americans. Design/methodology/approach – Narrative review. Findings – Two North American countries with very different histories present similar governance challenges today. The challenge is to provide all women with the full range of reproductive health options to which they are legally entitled now. In Canada, those contraception and abortion options are covered under the medical service plan insurance but not always available in convenient locations. In USA, those options are not uniformly covered under health insurance plans due to statutory limitations. In Canada, where federal law limiting abortion was struck down as unconstitutional, the leader of one of its three major federal political parties sees the way forward being to limit his party to pro-choice candidates. In USA, where new laws limiting abortion have been introduced at an unprecedented rate, the judiciary is being asked to define the way forward. Originality/value – Clinical governance needs to balance the moral beliefs of individual providers against the rights of patients to have their lawful choices available within reasonable convenience. Progress has been made but needs are still not adequately met, in these North American examples. [ABSTRACT FROM AUTHOR]

The article discusses a speech by Dr. Walter Bogs on "Health Insurance for Retirees" and what differentiates those pensioned benefit recipients from others. Bogs sketched the history of German health insurance through its statutory reform in 1956 and the controversy over current employees' paying premiums to support the retired population's health care partly from pension insurance.

The article discusses family aid in German health insurance, which grants the entitlement of ill family members to medical benefits of the insured. The author reviews the history of such dependent medical benefits from 1911 forward. Inconsistencies in regulations cited show that the system in place has socially unfair effects. This family health insurance is said to be in need of legal reform.

The article presents a brief history of health insurance in Austria and its covered members, especially government officials, as well as its expansion into other areas and clients of social welfare, such as casualty insurance and the working citizenry. The structure of insurance administration is described as well as the conditions that obtain with the injury or death of a socially insured person.

The article offers information about the West German health insurance system for white collar workers in 1962. An overview of the health insurance system's history is given, including the passing of its first formative legislation in 1911. West German politician Franz Behren is noted for his efforts to make health insurance an element of national legislation. It is reported that the loss of health care recipients from East Germany has been made up by increased West German health care membership.