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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

2022-11-20 Business & Economics
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Release : 2022-11-20
Genre : Business & Economics
Kind : eBook
Book Rating : 98X/5 ( reviews)

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Book Synopsis 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

Download or read book Implementation of Casemix System as Prospective Provider Payment Method in Social Health Insurance: a Case Study of Acheh Provincial Health Insurance written by Prof Dr Syed Mohamed Aljunid. This book was released on 2022-11-20. Available in PDF, EPUB and Kindle. Book excerpt: 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

2020-11-26 Health & Fitness
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Release : 2020-11-26
Genre : Health & Fitness
Kind : eBook
Book Rating : 720/5 ( reviews)

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Book Synopsis Using Casemix System for Hospital Reimbursement in Social Health Insurance Programme by : Syed Aljunid

Download or read book Using Casemix System for Hospital Reimbursement in Social Health Insurance Programme written by Syed Aljunid. This book was released on 2020-11-26. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions

2015-11-02
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Release : 2015-11-02
Genre :
Kind : eBook
Book Rating : 322/5 ( reviews)

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Book Synopsis Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions by : OECD

Download or read book Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions written by OECD. This book was released on 2015-11-02. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Designing and Implementing Health Care Provider Payment Systems

2009-01-01 Medical
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Release : 2009-01-01
Genre : Medical
Kind : eBook
Book Rating : 244/5 ( reviews)

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Book Synopsis Designing and Implementing Health Care Provider Payment Systems by : Jack Langenbrunner

Download or read book Designing and Implementing Health Care Provider Payment Systems written by Jack Langenbrunner. This book was released on 2009-01-01. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Report to Congress

1989 Community health services
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Release : 1989
Genre : Community health services
Kind : eBook
Book Rating : /5 ( reviews)

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Book Synopsis Report to Congress by : United States. Health Care Financing Administration

Download or read book Report to Congress written by United States. Health Care Financing Administration. This book was released on 1989. Available in PDF, EPUB and Kindle. Book excerpt:

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