The pivotal role and transformative impact of health insurance in enhancing healthcare accessibility, quality, and financial protection

Thamer Hamed Aljuaid; Khaleel Ahmad Alhrbi; Fahad Salem Alahmadi; Rami Mohammad Alsharif; Faiz Thani H Alanazi; Mazen Dakhel Saleh Aljohani

doi:10.53730/ijhs.v6nS10.15434

Authors

Thamer Hamed Aljuaid KSA, National Guard Health Affairs
Khaleel Ahmad Alhrbi KSA, National Guard Health Affairs
Fahad Salem Alahmadi KSA, National Guard Health Affairs
Rami Mohammad Alsharif KSA, National Guard Health Affairs
Faiz Thani H Alanazi KSA, National Guard Health Affairs
Mazen Dakhel Saleh Aljohani KSA, National Guard Health Affairs

Keywords:

Health insurance, healthcare accessibility, quality improvement, financial protection, universal health coverage, equity

Abstract

Background: Health insurance plays a transformative role in shaping healthcare systems by enhancing access, improving the quality of care, and mitigating financial burdens for individuals and families. Despite its significant contributions, disparities in coverage, administrative inefficiencies, and cost-containment challenges persist globally, limiting the full realization of its benefits. Aim: This paper aims to explore the pivotal role of health insurance in enhancing healthcare accessibility, improving care quality, and providing financial protection. It further identifies challenges within existing health insurance systems and proposes strategies for optimizing their impact. Methods: A comprehensive review of academic literature, case studies, and policy analyses was conducted. The study employed a comparative framework to evaluate various health insurance models across diverse settings, focusing on accessibility metrics, quality indicators, and financial protection indices. Results: Findings indicate that health insurance significantly improves healthcare utilization, especially among vulnerable populations, and reduces out-of-pocket expenditures. Insurance models emphasizing equity and integration, such as universal health coverage, are associated with better health outcomes and reduced financial risks. However, gaps in coverage, rising healthcare costs, and disparities in access remain critical challenges. Conclusion: Health insurance is a cornerstone of equitable healthcare systems, providing both improved access and financial protection.

Downloads

Download data is not yet available.

References

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1-10. DOI: https://doi.org/10.2307/2137284

Shi, L., & Singh, D. A. (2020). Delivering health care in America: A systems approach. Jones & Bartlett Learning.

World Health Organization. (2017). Tracking universal health coverage: 2017 global monitoring report. WHO Press. DOI: https://doi.org/10.1596/978-92-4-151355-5

Agarwal, R., Gao, G., DesRoches, C., & Jha, A. K. (2020). The digital transformation of healthcare: Current status and the road ahead. Health Affairs, 39(5), 755-764.

Cutler, D. M., & Summers, L. H. (2020). The COVID-19 pandemic and the $16 trillion virus. JAMA, 324(15), 1495-1496.

Smith, P. C., & Mossialos, E. (2020). Aging populations and rising healthcare costs: Policy challenges and solutions. The Lancet, 395(10239), 867-869.

Busse, R., & Blümel, M. (2017). Germany: Health system review. Health Systems in Transition, 19(4), 1-202.

Timmins, N. (2018). The five giants: A biography of the welfare state. HarperCollins.

Starr, P. (2017). The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. Basic Books.

Moon, M., & Mulvey, J. (2020). Medicare: A policy primer. Urban Institute Press.

World Health Organization. (2019). Universal health coverage: Moving towards better health. WHO Press.

Jamison, D. T., et al. (2018). Universal health coverage and intersectoral action for health: Key messages from Disease Control Priorities. The Lancet, 392(10161), 1108–1120. DOI: https://doi.org/10.1016/S0140-6736(17)32906-9

Agrawal, R., & Jain, R. (2020). Blockchain technology in health insurance: Opportunities and challenges. Journal of Digital Health, 9(3), 23-31.

Cutler, D. M., & Summers, L. H. (2020). The COVID-19 pandemic and the $16 trillion virus. JAMA, 324(15), 1495–1496.

Porter, M. E., & Lee, T. H. (2021). Value-based health care in four different health care systems. New England Journal of Medicine, 384(9), e43.

Lu, C., Chin, B., Lewandowski, J. L., Basinga, P., Hirschhorn, L. R., Hill, K., & Murray, M. B. (2020). Rwanda's evolving community-based health insurance system: Impacts and challenges. Health Policy and Planning, 35(7), 945–955.

Fuchs, V. R. (2021). Health care policy after the pandemic. Journal of Economic Perspectives, 35(3), 1–18.

Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2020). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA, 325(1), 532–540.

Karan, A., Yip, W., & Mahal, A. (2021). Extending health insurance to the informal sector in India: Lessons from a decade of experience. Health Policy and Planning, 36(4), 451–462.

Smith, J. P., & Wallace, D. E. (2019). Geographic disparities in health care access in rural America: Challenges and opportunities. The Milbank Quarterly, 97(1), 233–257.

Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis. The Lancet, 392(10160), 2203–2212.

Cheng, I. H., Wahidi, S., Vasi, S., & Russell, G. (2018). Immigrant health and the complexities of navigating health insurance systems. International Journal for Equity in Health, 17(1), 1–12.

Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2018). Resources for mental health: Scarcity, inequity, and inefficiency. The Lancet, 387(10021), 480–489.

Bashshur, R., Shannon, G., Krupinski, E., & Grigsby, J. (2020). The empirical foundations of telemedicine interventions in primary care. Telemedicine and e-Health, 26(3), 383–389.

Alley, D. E., Asomugha, C. N., Conway, P. H., & Sanghavi, D. M. (2021). Accountable health communities: Addressing social needs through Medicare and Medicaid. New England Journal of Medicine, 382(1), 8–11. DOI: https://doi.org/10.1056/NEJMp1512532

Rosenbaum, S. (2020). The ACA and the regulation of health insurance. Health Affairs, 39(2), 272–281.

Centers for Medicare & Medicaid Services. (2021). Value-based programs. CMS.gov.

Sabik, L. M., & Tarazi, W. W. (2020). Medicaid expansion and preventive care services. American Journal of Preventive Medicine, 59(4), 567–575.

Borsky, A., Zhan, C., Miller, T., Ngo-Metzger, Q., Bierman, A., & Meyers, D. (2018). The impact of the Affordable Care Act on access to preventive services. Health Affairs, 37(2), 271–277.

Knai, C., Pomeroy, L., Connolly, S., & Nolte, E. (2018). Adherence to clinical pathways and quality improvement in Europe. International Journal of Quality in Health Care, 30(6), 403–411.

Bashshur, R., Shannon, G., Krupinski, E., & Grigsby, J. (2020). Telemedicine and chronic disease management. Journal of Telemedicine and Telecare, 26(7), 484–490.

Wagstaff, A., Cotlear, D., Eozenou, P., & Buisman, L. R. (2019). Universal health coverage: Delivering quality health services for all. World Bank Group.

Greene, J., Hibbard, J. H., Sacks, R., Overton, V., & Parrotta, C. D. (2018). When patient activation levels change, health outcomes and costs change, too. Health Affairs, 37(3), 431–437. DOI: https://doi.org/10.1377/hlthaff.2014.0452

Blanchet, N. J., Fink, G., & Osei-Akoto, I. (2017). The effect of Ghana’s National Health Insurance Scheme on health care utilization. Ghana Medical Journal, 51(2), 110–120.

Lu, C., Chin, B., Lewandowski, J. L., Basinga, P., Hirschhorn, L. R., Hill, K., & Murray, M. B. (2020). Rwanda’s evolving community-based health insurance system. Health Policy and Planning, 35(7), 945–955.

van Oostrom, S. H., et al. (2019). Integrated care programs for chronically ill patients in the Netherlands. International Journal of Integrated Care, 19(3), 1–10.

Xu, K., Soucat, A., Kutzin, J., Brindley, C., Maele, N., & Cylus, J. (2018). Public spending on health: A closer look at global trends. World Health Organization.

Wagstaff, A., & Eozenou, P. H. V. (2021). Can universal health coverage reduce catastrophic health expenditures? A synthesis of evidence from 13 countries. Health Economics, 30(8), 1683–1697.

Lu, C., Chin, B., Lewandowski, J. L., Basinga, P., Hirschhorn, L. R., Hill, K., & Murray, M. B. (2020). Rwanda’s community-based health insurance: Achievements and challenges. Health Policy and Planning, 35(7), 945–955.

Kwon, S. (2020). Health insurance exclusion and health inequality: Global lessons. Journal of Health Policy, 124(6), 567–574.

Wharam, J. F., Ross-Degnan, D., & Donahue, A. M. (2019). High-deductible health plans and care-seeking behaviors. Journal of General Internal Medicine, 34(1), 45–52.

Karan, A., Yip, W., & Mahal, A. (2021). Fragmentation in health insurance and its impact on financial protection in India. Health Policy and Planning, 36(5), 467–480.

Ozawa, S., & Walker, D. G. (2020). The economic impact of cancer treatment coverage: Lessons from Japan. Health Affairs, 39(2), 234–242.

Borsky, A., Zhan, C., Miller, T., Ngo-Metzger, Q., Bierman, A., & Meyers, D. (2018). Preventive care under the Affordable Care Act. Health Affairs, 37(2), 271–277. DOI: https://doi.org/10.1377/hlthaff.2017.1248

Bashshur, R., Shannon, G., Krupinski, E., & Grigsby, J. (2020). The growing role of telehealth in reducing healthcare costs. Journal of Telemedicine and Telecare, 26(8), 601–610.

Busse, R., & Blümel, M. (2021). Tackling healthcare sustainability through value-based care in Germany. European Journal of Public Health, 31(3), 394–402.

World Health Organization. (2021). Universal health coverage: Ensuring access and financial protection. WHO Press.

Blanchet, N. J., Fink, G., & Osei-Akoto, I. (2020). Ghana’s National Health Insurance Scheme: Reducing financial barriers to healthcare. Ghana Medical Journal, 54(3), 135–144.

Karan, A., Yip, W., & Mahal, A. (2021). Extending health insurance to informal sector workers: Lessons from India. Health Policy and Planning, 36(5), 451–462.

Cheng, I. H., Wahidi, S., Vasi, S., & Russell, G. (2018). Immigrant health and barriers to health insurance access. International Journal for Equity in Health, 17(1), 1–12.

Rosenbaum, S. (2020). Navigating the complexities of the U.S. health insurance system. Health Affairs, 39(2), 272–281.

Blanchet, N. J., Fink, G., & Osei-Akoto, I. (2020). Fragmentation and inefficiencies in health insurance systems: Ghana’s case study. Ghana Medical Journal, 54(3), 135–144.

Himmelstein, D. U., & Woolhandler, S. (2020). Administrative costs in U.S. healthcare: Implications for reform. The Lancet, 395(10237), 812–813.

Porter, M. E., & Lee, T. H. (2021). Value-based healthcare: Aligning cost containment with quality improvement. New England Journal of Medicine, 384(9), e43.

Ikegami, N., & Campbell, J. C. (2020). Aging populations and health insurance sustainability in Japan. Health Economics, Policy and Law, 15(4), 413–425.

Sommers, B. D., & Kronick, R. (2018). The individual mandate: Impacts and policy lessons from the Affordable Care Act. Health Affairs, 37(3), 374–381.

Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Ensuring quality care in resource-constrained settings: Global lessons. The Lancet, 392(10160), 2203–2212. DOI: https://doi.org/10.1016/S0140-6736(18)31668-4

Bashshur, R., Shannon, G., Krupinski, E., & Grigsby, J. (2020). Digital health during the pandemic: Implications for health insurance. Telemedicine and e-Health, 26(9), 1012–1019.

Sparrow, M. K. (2019). Fraud and abuse in health insurance systems: Emerging trends and solutions. Journal of Public Administration, 44(3), 345–360.

Cutler, D. M., & Summers, L. H. (2020). Lessons from the COVID-19 pandemic for health insurance resilience. JAMA, 324(15), 1495–1496. DOI: https://doi.org/10.1001/jama.2020.19759