background: existence or non-existence of adverse selection in insurance market is one of the important cases that have always been considered by insurers. adverse selection is one of the consequences of asymmetric information. theory of adverse selection states that high-risk individuals demand the insurance service more than low risk individuals do. methods: the presence of adverse selection ...

the purposes of our study were to identify a drug entry process, collect, and prioritize criteria for selecting drugs for the list of basic health insurance commitments to prepare an “evidence based reimbursement eligibility plan” in iran.the 128 noticeable criteria were found when studying the health insurance systems of developed countries. four parts (involving criteria) formed the first que...

background: except in emergency cases, all patients should be seen first by a primary healthcare physician who decides whether a referral to secondary care is necessary. the present study examined the reasons for patient self-referral to specialists. methods: a random sample of 1036 individuals was selected from people attending public outpatient clinics and specialists’ offices in the private ...

The ability to obtain, understand and use the information needed to make wise health choices is known as health literacy. Low health literacy among members of populations with poor reading skills, limited mastery of the English language, members of ethnic or cultural minorities, and immigrants is likely a major contributor to health disparities in the US (Agency for Health Care Policy and Resea...

There are fragmentations in Iran’s health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fra...

Key findings. (1) Adjusted premiums in the individual market in states with prior approval authority combined with loss ratio requirements were lower in 2010-2013 than premiums in states with no rate review authority or file-and-use regulations only. (2) Adjusted premiums declined modestly in prior approval states while premiums increased in states with no rate review authority or with file-and...

background: with the increased range of medical insurance coverage in china, the proportion of medical expenditure shouldered by individuals is declining. the problem is the rapidly growing scale of medical expenditures challenges the sustainability of medical insurance funds. methods: this study used the heckman selection model, survival analysis, and ordered probit model to evaluate the effec...

The need for health care reforms and alternative financing mechanism in many low and middle-income countries has been advocated. This led to the introduction of the national health insurance scheme (NHIS) in Nigeria, at first with the enrollment of formal sector employees. A qualitative study was conducted to assess enrollee's perception on the quality of health care before and after enrollment...