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Comments on the planned extension of health protection to all employees and self-employed in the formal sector, and voluntary coverage, by 2030, of informal sector workers.

Health status indicators. --- Poverty. --- Social health.

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Adolescents are at a critical life stage where they will soon be able to contribute to the wellbeing of humankind, or do it great harm. Consequently, it is vital that the challenges and possibilities of adolescence be well understood and addressed.

Youth, Aboriginal Australian --- Health and hygiene --- Social conditions --- Indigenous Youth --- Social Health Determinants --- Northern Territory --- Aboriginal Adolescents --- Don Dale Prison

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Adolescents are at a critical life stage where they will soon be able to contribute to the wellbeing of humankind, or do it great harm. Consequently, it is vital that the challenges and possibilities of adolescence be well understood and addressed.

Youth, Aboriginal Australian --- Indigenous Youth --- Social Health Determinants --- Northern Territory --- Aboriginal Adolescents --- Don Dale Prison --- Health and hygiene --- Social conditions

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This paper draws lessons from anti-fraud experiences in social health insurance programs of six selected countries across the income spectrum: Indonesia, the Philippines, Republic of Korea, Croatia, Turkey, and the United States. A standardized questionnaire was used to collect information on how the programs prevent, detect, and deter fraud. The questionnaire was supplemented by a literature review and conversations with key informants. The analysis summarizes similarities and differences in the legal framework, institutional mechanisms, and capacity to manage fraud. Across all countries, the primary responsibility for managing fraud lies with the public entity that administers the program. In terms of capacity, all program-administering agencies have dedicated anti-fraud units and staff. In addition, all countries have specific anti-fraud policies and guidelines that address fraud and have a clear operational and legal definition of fraud. In terms of preventing fraud, the use of pre-authorization screening for high-end procedures is common. For detecting fraud, most countries use anti-fraud 'hotlines' and encourage other forms of reporting of suspected fraudulent behavior; the use of 'red flags'-triggers that identify suspicious claims based on deviations from norms, is also common. The level of sophistication in using data analytics to detect potential fraud, however, varies across countries. Social health insurance programs in higher-income countries are more likely to use advanced statistical and data-mining techniques compared to those in lower-income countries. All programs across all countries undertake post-reimbursement medical claims and beneficiary audits. In terms of deterring fraud, sanctions often include the use of financial penalties, cancellation of contracts, and criminal prosecutions; however, in most countries, public providers are not penalized and prosecuted to the same degree as private providers.

Administrative procedures --- Crime and society --- Fraud --- Health care services industry --- Health economics and finance --- Health insurance --- Health, nutrition and population --- Industry --- Poverty reduction --- Services and transfers to poor --- Social accountability --- Social development --- Social health insurance

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A cluster randomized controlled trial was undertaken, testing two sets of interventions to encourage enrollment in the Philippines' Individual Payer Program. Of 243 municipalities, 179 were randomly assigned as intervention sites and 64 as controls. In early 2011, 2,950 families were interviewed; unenrolled Individual Payer Program-eligible families in intervention sites were given an information kit and a 50 percent premium subsidy until the end of 2011. In February 2012, the "non-compliers" had their voucher extended, were re-sent the enrollment kit, and received Short Message Service (SMS) reminders. Half were told that in the upcoming end-line interview the enumerator could help complete the enrollment form, deliver it to the insurer, and have identification cards mailed. The control and intervention sites were balanced at baseline. In the control sites, 9.9 percent (32/323) of eligible individuals had enrolled by January 2012, compared with 14.9 percent (119/801) in intervention sites. In the sub-experiment, enrollment was 3.4 percent (10/290) among eligible non-compliers and who did not receive assistance but 39.7 percent (124/312) among those who did. A premium subsidy combined with information can increase voluntary enrollment in a social health insurance program, but less than an intervention that reduces the enrollment burden; even that leaves enrollment below 50 percent.

Communities & Human Settlements --- Health Economics & Finance --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Housing & Human Habitats --- Law and Development --- Social Health Insurance --- Voluntary Enrollment