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Dear Readers,

Health Insurance is a form of insurance where the insurer pays the medical bills of the person who is insured, if the medical treatment is covered by the insurance policy. There are other factors that may have an impact on the responsibility of the insurer to pay. These include deductibles, co-payments, and in-network care providers. There are some countries that consider health Insurance as a basic right of all citizens and the government provides it at no cost to everyone.

This Sitenews uses a general approach to the understanding of health insurance including introduction, definition and the benefits in the field of ophthalmology and general. This issue introduces you to the Role of health insurance,Scheme of health insurance;Community based health insurance and Insurance policies in eye care.

This issue also covers Fraud in health insurance and and also provides the History and evaluation of health insurance

We wish you an experience of learning that is very practical. Your feedback will help us improve.

Please send in your feedback at eyesite@aravind.org.

Regards,
Library Team
The Issue Features...
HEALTH INSURANCE
Vol. 7, Issue 7, June - July 2011
•   Introduction
•   Role of Health Insurance
•   Scheme of health insurance
•   Community-Based Health Insurance
•   Insurance policy in eye care
•   Frauds in Health Insurance
•   History of Health Insurance
•   Talk to Us
•   Past Issues

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  • HEALTH INSURANCE - AN INTRODUCTION

  • Health is wealth. Is that true? Of course, everyone wants to be healthy and this is why we say health is the greatest wealth in the world. Apart from a balanced meal, exercise, and so on, we need to have a health insurance to be in good health. Health insurance is, basically, a promise by an insurance company or health plan to provide or pay for health care services in exchange for payment of premiums.

  • DEFINITIONS OF HEALTH INSURANCE TERMS

  • Health Insurance Surveys approved set of definitions for use in Federal surveys collecting employer-based health insurance data. The BLS National Compensation Survey currently uses these definitions in its data collection procedures and publications.

  • NATIONAL HEALTH INSURANCE OPHTHALMIC BENEFITS

  • Ophthalmic benefits as part of the Insurance Act administrated by medical practitioners with a knowledge of ophthalmology is likely to come into partial operation very shortly, it would be as well to give a short account of the negotiations which have led up to their adoption and to the conditions under which they are administrated.



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  • THE ROLE OF INSURANCE IN HEALTHCARE SYSTEM IN DEVELOPING COUNTRIES

  • This article examines the role that health insurance system can play as a supplement to the governments effort (or in partnership with the government) to provide health care services to the population as a social and economic upliftment measure.

  • PRIVATE HEALTH INSURANCE: IMPLICATIONS FOR DEVELOPING COUNTRIES

  • This paper shows that private health insurance is more widespread than public debates may lead us to believe. Many developing countries have private health insurance markets which are serving their middle class; and may also afford some degree of financial protection for the poor. Many developed countries use supplementary private insurance to fill gaps in their publicly funded systems and pay for increasing health services demand.



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    a) National
  • DELIVERING MICRO HEALTH INSURANCE THROUGH THE NATIONAL RURAL HEALTH MISSION

  • This paper highlights the challenges in financing health in India and examines the role of health insurance in addressing these. It proposes an operational framework for developing sustainable health insurance models under the National Rural Health Mission, responding to the contextual needs of different states.

    b) International
  • THE FINANCIAL PROTECTION EFFECT OF GHANA NATIONAL HEALTH INSURANCE SCHEME: EVIDENCE FROM A STUDY IN TWO RURAL DISTRICTS

  • This study confirms the positive financial protection effect of health insurance in Ghana. The effect is stronger among the poor group than among general population. The results are encouraging for many low income countries who are considering a similar policy to expand social health insurance. Ghanas experience also shows that instituting insurance by itself is not adequate to remove fully the out-of-pocket payment for health. Further works are needed to address the supply sides incentives and quality of care, so that the insured can enjoy the full benefits of insurance.

  • THE EFFECT OF HEALTH INSURANCE REFORM ON THE NUMBER OF CATARACT SURGERIES IN CHONGQING, CHINA

  • Cataracts are the leading cause of blindness in China, and poverty is a major barrier to having cataract surgery. In 2003, the Chinese government began a series of new national health insurance reforms, including the New Cooperative Medical Scheme (NCMS) and the Urban Resident Basic Health Insurance scheme (URBMI). These two programs, combined with the previously existing Urban Employee Basic Health Insurance (UEBMI) program, aimed to make it easier for individuals to receive medical treatment. This study reports cataract surgery numbers in rural and urban populations and the proportion of these who had health insurance in Chongqing, China from 2003 to 2008.

  • NATIONAL HEALTH INSURANCE SCHEME ACCREDITED SECONDARY HEALTH CARE PROVIDER




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  • COMMUNITY HEALTH INSURANCE IN INDIA: AN OVERVIEW

  • The purpose of this paper is to describe Indian Community Health Insurance schemes, and where data are available, their impact it is intended to serve as an update on earlier work. In India, community health insurance has a long history. The earliest such scheme was started in Kolkata in 1952 as part of a students movement. The Students Health Home (SHH) caters to the students in the schools and universities of West Bengal. Currently there are more than 20 documented CHI programmes, of which five were initiated in the past three years.

  • COMMUNITY-BASED HEALTH INSURANCE IN LOW-INCOME COUNTRIES: A SYSTEMATIC REVIEW OF THE EVIDENCE

  • This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge.

  • HEALTH INSURANCE IN INDIA

  • This article gives a brief overview of health insurance and review some of the existing health insurance programmes in our country. It helps the planner and manager to design and implement a robust programme that takes the needs of the people and the technical requirements into account.

  • COMMUNITY-BASED HEALTH INSURANCE IN DEVELOPING COUNTRIES: A STUDY OF ITS CONTRIBUTION TO THE PERFORMANCE OF HEALTH FINANCING SYSTEMS

  • This article focuses an overview of the main factors influencing the performance of CHI on these financing subfunctions and discusses a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.



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  • HEALTH INSURANCE POLICY _US

  • The purpose of this booklet is to give you an overview of how you may be affected by health insurance coverage changes found in four Federal laws: The Health Insurance Portability and Accountability Act of 1996 (HIPAA); The Mental Health Parity Act of 1996 (MHPA); The Newborns and Mothers Health Protection Act of 1996 (NMHPA); The Womens Health and Cancer Rights Act of 1998 (WHCRA).

  • HEALTH INSURANCE COVERAGE AND USE OF EYE CARE SERVICES

  • This study pointed out that Americans with vision problems who had health insurance accessed eye care services at a rate higher than or equal to that of their Canadian counterparts. The gap in access between Canadians and Americans without health insurance narrowed after adjustments for income level and optional vision insurance.

  • REPORTED EYE CARE UTILIZATION AND HEALTH INSURANCE STATUS AMONG US ADULTS

  • Trends in annual medicare expenditures for glaucoma surgical procedures from 1997 to 2006. This article Findings suggest that while the overall number of glaucoma surgical procedures is increasing, payments have been decreasing. Clinical and technological advancements and reimbursement decisions may influence surgeons preferences and, therefore, costs to Medicare

  • VISION CARE INSURANCE:

  • EyeMed Vision Care provides comprehensive vision care benefits to help ensure you and your dependents receive quality eye care from a network of professional eye care providers.

  • VISION CARE: FOCUSING ON THE WORKPLACE BENEFIT

  • This report explores the value of vision benefits for both employees and employers. Healthy vision for employees means better quality of life while for employers it can mean a healthier workforce, higher productivity and fewer absences. Offering vision coverage can be an additional way to attract quality employees.



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  • HEALTH INSURANCE FRAUD: AN OVERVIEW

  • Studies show that health care fraud is a serious challenge affecting both public and private insurers. This article provides us the definition of fraud and explains the real significance of the term in the realm of health insurance. Different types of fraudulence in health insurance and the legal provisions to combat the same are explained in detail.

  • OPHTHALMOLOGIST CHARGED IN HEALTH CARE FRAUD SCHEME INVOLVING MORE THAN $3 MILLION IN FRAUDULENT CLAIMS

  • This article narrates the story of an ophthalmologist charged in health care fraud scheme investigated by the U.S. Department of Health and Human Services Office of Inspector General and the Federal Bureau of Investigation



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  • IN SICKNESS AND IN HEALTH: THE HISTORY OF HEALTH INSURANCE

  • Practices of insurance, broadly speaking, have long histories related to contracts and procedures designed to protect people from loss of property. Guarantees on property loans and insurance based on carefully distributed shipping wares are modes of insurance dating back to the second millennium B.C., and life insurance has a long and distinctive history that reflects humankinds awareness of its own mortality.

  • HISTORY OF HEALTH INSURANCE

  • This link takes the readers to the official website of East Coast Health Insurance company and it also introduces before you the history of private health insurance.

  • NATIONAL HEALTH INSURANCEA BRIEF HISTORY OF REFORM EFFORTS IN THE U.S.

  • This news letter (issue) highlights the major national health reform efforts that were undertaken in the 1900s. It describes the economic and political context in which each reform was forwarded and the key reasons it failed to achieve universal coverage.



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