Background Nepal has made remarkable efforts towards social health protection over the past several years. In 2016, the Government of Nepal introduced a National Health Insurance Program (NHIP) with an aim to ensure equitable and universal access to healthcare by all Nepalese citizens. Following the first year of operation, the scheme has covered 5 percent of its target population. There ...

In the conditions of market infrastructure for the transformation of medical services, there is an objective need to build effective insurance protection of the population against risks associated with loss of health. Using a systematic approach, the problem of combining compulsory and voluntary health insurance is investigated, a theoretical conceptualization of the concept of “financial mecha...

Experience in European health insurance exchanges indicates that even with the best risk-adjustment formulas, insurers have substantial incentives to engage in risk selection. The potentially most worrisome form of risk selection is skimping on the quality of care for underpriced high-cost patients--that is, patients for whom insurers are compensated at a rate lower than the predicted health ca...

Background: Health insurance literacy is a nascent concept that has emerged mainly after the implementation of the law known as Obamacare in the United States. This study seeks to identify the themes of health insurance literacy in Iranian society. Methods: The study approach is qualitative. Data were collected using nine semi-structured interviews, ten focal group meetings with the presence o...

First-year insurer participation in the Health Insurance Marketplaces (HIMs) established by the Affordable Care Act is limited in many areas of the country. There are 3.9 participants, on (population-weighted) average, in the 395 ratings areas spanning the 34 states with federally facilitated marketplaces (FFMs). Using data on the plans offered in the FFMs, together with predicted market shares...

More than 35.6 million children were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in December 2016— accounting for just over half of total Medicaid and CHIP enrollment.1 Medicaid and CHIP are particularly important in rural areas where 77.1 percent of children in households with income below 200 percent of the federal poverty level (FPL) are covered by public insurance...

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has been praised and criticized for asserting federal authority to regulate health insurance. We review the history of federalism and insurance regulation and find that HIPAA is less of a departure from traditional federal authority than it is an application of existing tools to meet evolving health policy goals. This inter...