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Tytuł:
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The challenge of ensuring elderly people can access their health insurance entitlements: a mixed methods study on the Republic of Srpska's Protector of Patients' Health Insurance Entitlements.
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Autorzy:
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Stojisavljević S; Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina .; Department of Public Health, University of Banja Luka Faculty of Medicine, Banja Luka, Bosnia and Herzegovina.
Đikanović B; Institute of Social Medicine, University of Belgrade Faculty of Medicine, Beograd, Serbia.
Vončina L; Independent Researcher, Zagreb, Croatia.
Scott K; Independent Research Consultant, Baltimore, Maryland, USA.; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Shroff Z; WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland.
Manigoda D; Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
Štrbac S; Public Health Institute of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
Bosančić B; Faculty of Agriculture, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.
Mathauer I; HGF, WHO, Geneva, Switzerland.
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Źródło:
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BMJ global health [BMJ Glob Health] 2022 Sep; Vol. 7 (Suppl 6).
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: [London] : BMJ Publishing Group Ltd, [2016]-
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MeSH Terms:
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Delivery of Health Care*
Insurance, Health*
Aged ; Health Personnel ; Humans ; Patient Acceptance of Health Care ; Rural Population
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References:
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Grant Information:
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001 International WHO_ World Health Organization
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Contributed Indexing:
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Keywords: Health insurance; Health policy
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Entry Date(s):
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Date Created: 20220915 Date Completed: 20220919 Latest Revision: 20221108
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Update Code:
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20240105
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PubMed Central ID:
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PMC9476123
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DOI:
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10.1136/bmjgh-2022-009373
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PMID:
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36109016
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Introduction: Healthcare utilisation requires knowing one's entitlements and how to access them (navigation) and having access to grievance redressal when entitlements are denied. To ensure citizen access to and use of health insurance entitlements, the Health Insurance Fund established an initiative called the Protector of Patients' Health Insurance Entitlements (PPHIE). PPHIEs are supposed to provide patient navigation and grievance redressal services. This paper explores to what extent this initiative meets its objectives and is used by the elderly in rural areas.
Methods: This study employed a mixed methods approach. We conducted in-depth interviews with elderly patients in rural areas, PPHIEs, health providers and health insurance managers (N=39), as well as focus groups (N=5) and a household survey (N=715) with elderly rural patients. Qualitative data were analysed using content analysis, and the household survey results were analysed using descriptive statistics.
Results: The majority of elderly patients were not aware of the PPHIE initiative and instead received patient navigation support from their healthcare providers. The PPHIE programme was poorly publicised among the population. Although PPHIEs had a mandate to pursue grievance redressal they rarely did so, and their role in the system was more symbolic than functional.
Conclusion: While healthcare providers have (by default) filled the navigation role left by inactive PPHIEs, the grievance redressal role remains unfilled. Information about health insurance entitlements and access to grievance redressal must be provided through visible, accessible and efficient mechanisms that should be continuously monitored and improved.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
