Implementation Of Casemix System As Prospective Provider Payment Method In Social Health Insurance A Case Study Of Acheh Provincial Health Insurance

Author : Prof Dr Syed Mohamed Aljunid,Dr Irwan Saputra
Publisher : Partridge Publishing Singapore
Page : 147 pages
File Size : 48,5 Mb
Release : 2022-11-20
Category : Business & Economics
ISBN : 9781543771985

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Implementation of Casemix System as Prospective Provider Payment Method in Social Health Insurance: a Case Study of Acheh Provincial Health Insurance by Prof Dr Syed Mohamed Aljunid,Dr Irwan Saputra Pdf

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.

Author : Syed Aljunid,Eka Yoshida Syukri
Publisher : Partridge Publishing Singapore
Page : 114 pages
File Size : 45,6 Mb
Release : 2020-11-26
Category : Health & Fitness
ISBN : 9781543761726

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Using Casemix System for Hospital Reimbursement in Social Health Insurance Programme by Syed Aljunid,Eka Yoshida Syukri Pdf

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.

Author : Dr Syed M. Aljunid,Dr Saad A. Ali Jadoo
Publisher : Partridge Publishing Singapore
Page : 152 pages
File Size : 41,8 Mb
Release : 2017-09-19
Category : Medical
ISBN : 9781543742909

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Development of Pharmacy Service Weights in the Implementation of Casemix System for Provider Payment by Dr Syed M. Aljunid,Dr Saad A. Ali Jadoo Pdf

This book outlines the use of the casemix system as a provider payment tool in the health system with special focus on cost of pharmacy services of in-patient care. Casemix system, which is traditionally called Diagnosis Related Groups or DRG in more advanced economies, is now being implemented in many developing countries that plan to or have embarked on social health insurance programs as a source of the health funding. Extensive research has been carried out by the authors involving 13,673 patients that were prescribed with 111,794 items of drugs and admitted to one of the premier teaching hospital in Malaysia. Data from this research was vigorously analysed to impute the pharmacy service weights of all relevant casemix groups. This book provides the best reference for pharmacy service weights that can be used as a guide for effective implementation of the casemix system in any country in the world that plans to use the system.

Author : OECD,World Health Organization
Publisher : OECD Publishing
Page : 132 pages
File Size : 48,6 Mb
Release : 2015-11-02
Category : Electronic
ISBN : 9789290617327

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Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions by OECD,World Health Organization Pdf

The report focuses on a review of the implementation experience of case-based and DRG mechanisms in the Asia and Pacific region, drawing particularly on research in Australia, Japan, New Zealand, the Republic of Korea, Singapore and Thailand.

Author : Huihui Wang,Nathaniel Otoo,Lydia Dsane-Selby
Publisher : World Bank Publications
Page : 68 pages
File Size : 49,8 Mb
Release : 2017-08-14
Category : Business & Economics
ISBN : 9781464811180

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Ghana National Health Insurance Scheme by Huihui Wang,Nathaniel Otoo,Lydia Dsane-Selby Pdf

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.

Author : Jeremy Lim
Publisher : Unknown
Page : 128 pages
File Size : 53,5 Mb
Release : 2014-01-01
Category : Electronic
ISBN : 9881410525

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Magician of 1919 by Jeremy Lim Pdf

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.

Author : OECD
Publisher : OECD Publishing
Page : 264 pages
File Size : 45,9 Mb
Release : 2015-09-24
Category : Electronic
ISBN : 9789264233386

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Fiscal Sustainability of Health Systems Bridging Health and Finance Perspectives by OECD Pdf

The health systems we enjoy today, and expected medical advances in the future, will be difficult to finance from public resources without major reforms. Public health spending in OECD countries has grown rapidly over most of the last half century. These spending increases have contributed to ...

Author : Anonim
Publisher : World Bank Publications
Page : 202 pages
File Size : 54,7 Mb
Release : 2009-01-01
Category : Medical
ISBN : 9780821380079

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Health Financing in Indonesia by Anonim Pdf

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.

Author : Alberto G. Romualdez (Jr.),WHO Regional Office for the Western Pacific
Publisher : Unknown
Page : 140 pages
File Size : 46,9 Mb
Release : 2011
Category : Electronic
ISBN : 9290615583

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The Philippines Health System Review by Alberto G. Romualdez (Jr.),WHO Regional Office for the Western Pacific Pdf

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of reform and policy initiatives in progress or under development in a specific country. Each profile is produced by country experts in collaboration with an international editor. In order to facilitate comparisons between countries, the profiles are based on a common template used by the Asia Pacific and European Observatories on Health Systems and Policies. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a profile.

Author : Anonim
Publisher : Unknown
Page : 100 pages
File Size : 48,9 Mb
Release : 1983
Category : Diagnosis
ISBN : MSU:31293012091082

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Diagnosis Related Groups (DRGs) and the Medicare Program by Anonim Pdf

Author : Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty
Publisher : World Bank Publications
Page : 348 pages
File Size : 40,6 Mb
Release : 2009-01-01
Category : Medical
ISBN : 9780821378243

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Designing and Implementing Health Care Provider Payment Systems by Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty Pdf

Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need.The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.

Author : Reinhard Busse,Alexander Geissler,Wilm Quentin,Miriam Wiley
Publisher : McGraw-Hill Education (UK)
Page : 490 pages
File Size : 52,7 Mb
Release : 2011-11-16
Category : Medical
ISBN : 9780335245581

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EBOOK: Diagnosis-Related Groups in Europe: Moving towards transparency, efficiency and quality in hospitals by Reinhard Busse,Alexander Geissler,Wilm Quentin,Miriam Wiley Pdf

Diagnosis Related Group (DRG) systems were introduced in Europe to increase the transparency of services provided by hospitals and to incentivise greater efficiency in the use of resources invested in acute hospitals. In many countries, these systems were also designed to contribute to improving – or at least protecting – the quality of care. After more than a decade of experience with using DRGs in Europe, this book considers whether the extensive use of DRGs has contributed towards achieving these objectives. Written by authors with extensive experience of these systems, this book is a product of the EuroDRG project and constitutes an important resource for health policy-makers and researchers from Europe and beyond. The book is intended to contribute to the emergence of a ‘common language’ that will facilitate communication between researchers and policy-makers interested in improving the functioning and resourcing of the acute hospital sector. The book includes: A clearly structured introduction to the main ‘building blocks’ of DRG systems An overview of key issues related to DRGs including their impact on efficiency, quality, unintended effects and technological innovation in health care 12 country chapters - Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Portugal, Spain and Sweden Clearly structured and detailed information about the most important DRG system characteristics in each of these countries Useful insights for countries and regions in Europe and beyond interested in introducing, extending and/ or optimising DRG systems within the hospital sector

Author : Dorland
Publisher : Elsevier Health Sciences
Page : 488 pages
File Size : 43,8 Mb
Release : 2015-07-24
Category : Medical
ISBN : 9780323442541

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

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).

Author : John Deshaies,Samuel Korper,Estelle Siker
Publisher : Unknown
Page : 316 pages
File Size : 45,8 Mb
Release : 1971
Category : Childbirth
ISBN : IND:30000053852475

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Health Information System-II by John Deshaies,Samuel Korper,Estelle Siker Pdf

Author : Stanley Jablonski
Publisher : Hanley & Belfus
Page : 128 pages
File Size : 41,9 Mb
Release : 2004-09
Category : Medical
ISBN : 1560536519

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Dictionary of Medical Acronyms and Abbreviations by Stanley Jablonski Pdf

This dictionary lists acronyms and abbreviations occurring with a reasonable frequency in the literature of medicine and the health care professions. Abbreviations and acronyms are given in capital letters, with no punctuation, and with concise definitions. The beginning sections also include symbols, genetic symbols, and the Greek alphabet and symbols.