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Author: Syed Aljunid
Publisher: Partridge Publishing Singapore
ISBN: 1543761720
Category : Health & Fitness
Languages : en
Pages : 118
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Book Description
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: Syed Aljunid
Publisher: Partridge Publishing Singapore
ISBN: 1543761720
Category : Health & Fitness
Languages : en
Pages : 118
Get Book Here
Book Description
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: Evelyn Hovenga
Publisher: Academic Press
ISBN: 0128169788
Category : Science
Languages : en
Pages : 500
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Book Description
Measuring Capacity to Care Using Nursing Data presents evidence-based solutions regarding the adoption of safe staffing principles and the optimum use of operational data to enable health service delivery strategies that result in improved patient and organizational outcomes. Readers will learn how to make better use of informatics to collect, share, link and process data collected operationally for the purpose of providing real-time information to decision- makers. The book discusses topics such as dynamic health care environments, health care operational inefficiencies and costly events, how to measure nursing care demand, nursing models of care, data quality and governance, and big data. The content of the book is a valuable source for graduate students in informatics, nurses, nursing managers and several members involved in health care who are interested in learning more about the beneficial use of informatics for improving their services. Presents and discusses evidences from real-world case studies from multiple countries Provides detailed insights of health system complexity in order to improve decision- making Demonstrates the link between nursing data and its use for efficient and effective healthcare service management Discusses several limitations currently experienced and their impact on health service delivery
Author: Busse, Reinhard
Publisher: McGraw-Hill Education (UK)
ISBN: 0335245579
Category : Education
Languages : en
Pages : 490
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Book Description
Summary: The volumes in the European Observatory on Health Systems and Policies series focus on key issues for health policy-making in Europe. This book is a joint venture between the WHO/EO and the EuroDRG which addresses the challenges of using Diagnosis Related Group systems in Europe.
Author: Prof Dr Syed Mohamed Aljunid
Publisher: Partridge Publishing Singapore
ISBN: 154377198X
Category : Business & Economics
Languages : en
Pages : 147
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Book Description
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: Huihui Wang
Publisher: World Bank Publications
ISBN: 1464811180
Category : Business & Economics
Languages : en
Pages : 101
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Book Description
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:
Publisher:
ISBN:
Category : Diagnosis
Languages : en
Pages : 100
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Book Description
Author: Hong Wang
Publisher: World Bank Publications
ISBN: 082138953X
Category : Business & Economics
Languages : en
Pages : 141
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Book Description
Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well to provide financial risk protection.
Author: Kaveh G. Shojania
Publisher:
ISBN: 9781587632594
Category : Disaster hospitals
Languages : en
Pages : 7
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Book Description
Author: William A. Haseltine
Publisher: Brookings Institution Press
ISBN: 0815724160
Category : Business & Economics
Languages : en
Pages : 198
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Book Description
"Today Singapore ranks sixth in the world in healthcare outcomes well ahead of many developed countries, including the United States. The results are all the more significant as Singapore spends less on healthcare than any other high-income country, both as measured by fraction of the Gross Domestic Product spent on health and by costs per person. Singapore achieves these results at less than one-fourth the cost of healthcare in the United States and about half that of Western European countries. Government leaders, presidents and prime ministers, finance ministers and ministers of health, policymakers in congress and parliament, public health officials responsible for healthcare systems planning, finance and operations, as well as those working on healthcare issues in universities and think-tanks should know how this system works to achieve affordable excellence."--Publisher's website.
Author: National Academy of Engineering
Publisher: National Academies Press
ISBN: 0309120640
Category : Medical
Languages : en
Pages : 340
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Book Description
Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.
