Fourteen years of manifestations and factors of health insurance fraud, 2006-2020: a scoping review.

Background: Healthcare fraud entails great financial and human losses; however, there is no consensus regarding its definition, nor is there an inventory of its manifestations and factors. The objective is to identify the definition, manifestations and factors that influence health insurance fraud (HIF).

Methods: A scoping review on health insurance fraud published between 2006 and 2020 was conducted in ACM, EconPapers, PubMed, ScienceDirect, Scopus, Springer and WoS.

[Health insurance coverage: the peruvian case since the universal insurance act].

Objective.: To describe the trends in health insurance coverage (HIC) in Peru during the period 2009-2017 and evaluate associations with demographic, social and economic factors.

Materials And Methods.

[Information technologies intended to solve contingencies in the Peruvian subsidized health system affiliation: "Resuelve tu afiliación"].

The National Health Authority (SUSALUD) has developed an online platform, "ReSUelve tu afiliación", with the intent to solve the problems with health service access experienced by Peruvian citizens who hold health insurance policies through institutions that manage health insurance funds (IAFAS). This platform virtually articulates the main IAFAS in Peru, which receives requests from any user requiring an update on his/her affiliation status to be resolved within 24 hours. Nearly 8 months after the implementation of this platform, more than 55 thousand applications have been resolved, thus ensuring timely access to health services under the corresponding user coverage form.

[Challenges to decentralization and local participation within the health rights protection framework: Experience of the SUSALUD Northern Macro-regional Intendance].

In Peru, health protection rights and the National Health Authority (SUSALUD) coexist with the aim to ensure that every Peruvian may exercise his/her rights. According to the L.D.

[A risk-based monitoring model for health care service institutions as a tool to protect health rights in Peru].

Objectives.: To describe the monitoring model of the Health Care Service Institutions (HCSI) of the National Health Authority (NHA) and assess the factors associated with risk-adjusted normative compliance (%RANC) within the Peruvian Health System (PHS).

Materials And Methods.

[Institutional differences in the ineffective access to prescription medication in health care centers in Peru: analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD 2014)].

Objectives To estimate the prevalence of ineffective access to drugs (IAD) and associated factors in patients receiving a prescription in an outpatient clinic in Peru. Materials and Methods We performed a secondary data-analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD 2014), a two-stage population-based study carried out in health care centers of the Ministry of Health and Regional Governments (MOHRG), Social Security (EsSalud), Armed Forces and Police (AFP) and the private sector across all 25 regions of Peru. IAD was defined as incomplete or no dispensing of any prescribed medication in the health care center pharmacy.