Implementation of Casemix System as Prospective Provider Payment Method in Social Health Insurance: a Case Study of Acheh Provincial Health Insurance

Implementation of Casemix System as Prospective Provider Payment Method in Social Health Insurance: a Case Study of Acheh Provincial Health Insurance PDF

Author: Prof Dr Syed Mohamed Aljunid

Publisher: Partridge Publishing Singapore

Published: 2022-11-20

Total Pages: 147

ISBN-13: 154377198X

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The Government of Aceh Province in Indonesia has established the Social Health Insurance (SHI) called Jaminan Kesehatan Aceh (JKA) in 2006 that provide health coverage to all 4.6 million population of the province. Fee-for-service was initially used as the provider payment method in the programme until 2013. In 2014, in line with the National Health Insurance of Indonesia (Jaminan Kesehatan Nasional JKN), INA-CBG (Indonesia Case-Based Group) casemix system was adopted by JKA to replace the Fee-for-Service method. This book presents outcome of the evaluation done using a combination of qualitative and quantitative methods on the implementation of JKA programme. The quantitative study was conducted to assess income of three selected hospitals (Type B, C and D) reimbursed using INA-CBG groups covering more than 17,000 cases. Quantitative data analysis revealed that overall, the hospitals received 32.4% higher income when reimbursed with casemix system (INA-CBG) as compared to fee-for-service. Type D hospital is the biggest gainer with 81.0% increase in income. In conclusion, the use of Casemix (INA-CBG) as a prospective payment method has benefitted the hospitals a lot. It is hope that additional resources gained through this programme will allow the hospitals to provide optimum care to the population.

Using Casemix System for Hospital Reimbursement in Social Health Insurance Programme

Using Casemix System for Hospital Reimbursement in Social Health Insurance Programme PDF

Author: Syed Aljunid

Publisher: Partridge Publishing Singapore

Published: 2020-11-26

Total Pages: 114

ISBN-13: 1543761720

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Social Health Insurance (SHI) is one of the vehicles in achieving Universal Health Coverage. However, in many low- and middle-income countries, implementation of SHI failed to provide efficient and effective coverage due to poor provider payment method. Indonesia has introduced social health insurance in 2014. With the population of more than 270 million, Indonesia is the biggest country in the world that implemented SHI with casemix system (INA-CBG) as the prospective provider payment method. In this book, we presented an outcome of a study implemented in the largest hospital in Jakarta, Indonesia that compared the impact of using casemix system as provider payment method with fee-for-service. A total 32,227 outpatients and 8,270 inpatients medical records were reviewed and included in the study. In addition, a survey was also conducted among billing administrators to assess the cost of the billing process and their perceptions on the two reimbursement methods. The total hospital charges, length of stay of inpatients, rate of unnecessary admissions and cost of billing process were among the indicators of efficiency compared in the study between the two provider payment methods. The book provides comprehensive evidence to confirm the advantages of casemix system as an efficient provider payment method in SHI programme.

Magician of 1919

Magician of 1919 PDF

Author: Jeremy Lim

Publisher:

Published: 2014-01-01

Total Pages:

ISBN-13: 9789881410528

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Interest in Singapore's healthcare system has soared because of the country's impressive health statistics. However, how Singapore achieves these impressive results is made even more remarkable when we consider that the country spends only 4% of its GDP on healthcare, which is comparably half of what the UK spends. This book explains how Singapore manages to achieve such an impressive degree of efficiency in the delivery of quality healthcare services.

Dorland's Dictionary of Medical Acronyms and Abbreviations E-Book

Dorland's Dictionary of Medical Acronyms and Abbreviations E-Book PDF

Author: Dorland

Publisher: Elsevier Health Sciences

Published: 2015-07-24

Total Pages: 488

ISBN-13: 0323442544

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Medical acronyms and abbreviations offer convenience, but those countless shortcuts can often be confusing. Now a part of the popular Dorland’s suite of products, this reference features thousands of terms from across various medical specialties. Its alphabetical arrangement makes for quick reference, and expanded coverage of symbols ensures they are easier to find. Effective communication plays an important role in all medical settings, so turn to this trusted volume for nearly any medical abbreviation you might encounter. Symbols section makes it easier to locate unusual or seldom-used symbols. Convenient alphabetical format allows you to find the entry you need more intuitively. More than 90,000 entries and definitions. Many new and updated entries including terminology in expanding specialties, such as Nursing; Physical, Occupational, and Speech Therapies; Transcription and Coding; Computer and Technical Fields. New section on abbreviations to avoid, including Joint Commission abbreviations that are not to be used. Incorporates updates suggested by the Institute for Safe Medication Practices (ISMP).

Health Financing in Indonesia

Health Financing in Indonesia PDF

Author:

Publisher: World Bank Publications

Published: 2009-01-01

Total Pages: 202

ISBN-13: 0821380079

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In 2004 the Indonesian government made a commitment to provide its entire population with health insurance coverage through a mandatory public health insurance scheme. It has moved boldly already provides coverage to an estimated 76.4 million poor and near poor, funded through the public budget. Nevertheless, over half the population still lacks health insurance coverage, and the full fiscal impacts of the government's program for the poor have not been fully assessed or felt. In addition, significant deficiencies in the efficiency and equity of the current health system, unless addressed will exacerbate cost pressures and could preclude the effective implementation of universal coverage (Ue and the desired result of improvements in population health outcomes and financial protection. For Indonesia to achieve UC, systems' performance must be improved and key policy choices with respect to the configuration of the health financing system must be made. Indonesia's health system performs well with respect to some health outcomes and financial protection, but there is potential for significant improvement. High-level political decisions are necessary on key elements of the health financing reform package. The key transitional questions to get there include: [ the benefits that can be afforded and their impacts on health outcomes and financial protection; [ how the more than 50 percent of those currently without coverage will be insured; [ how to pay medical care providers to assure access, efficiency, and quality; [ developing a streamlined and efficient administrative structure; [ how to address the current supply constraints to assure availability of promised services; [ how to raise revenues to finance the system, including the program for the poor as well as currently uninsured groups that may require government subsidization such as the more than 60 million informal sector workers, the 85 percent of workers in firms of less than five employees, and the 70 percent of the population living in rural areas.

Injury Research

Injury Research PDF

Author: Guohua Li

Publisher: Springer Science & Business Media

Published: 2012-01-07

Total Pages: 672

ISBN-13: 1461415993

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Injury is recognized as a major public health issue worldwide. In most countries, injury is the leading cause of death and disability for children and young adults age 1 to 39 years. Each year in the United States, injury claims about 170,000 lives and results in over 30 million emergency room visits and 2.5 million hospitalizations. Injury is medically defined as organ/tissue damages inflicted upon oneself or by an external agent either accidentally or deliberately. Injury encompasses the undesirable consequences of a wide array of events, such as motor vehicle crashes, poisoning, burns, falls, and drowning, medical error, adverse effects of drugs, suicide and homicide. The past two decades have witnessed a remarkable growth in injury research, both in scope and in depth. To address the tremendous health burden of injury morbidity and mortality at the global level, the World Health Organization in 2000 created the Department of Injury and Violence Prevention, which has produced several influential reports on violence, traffic injury, and childhood injury. The biennial World Conference on Injury Control and Safety Promotion attracts a large international audience and has been successfully convened nine times in different countries. In the United States, the National Center for Injury Prevention and Control became an independent program of the federal Centers for Disease Prevention and Control in 1997. Since then, each state health department has created an office in charge of injury prevention activities and over a dozen universities have established injury control research centers. This volume will fill an important gap in the scientific literature by providing a comprehensive and up-to-date reference resource to researchers, practitioners, and students working on different aspects of the injury problem and in different practice settings and academic fields.

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