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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.

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.

Transition to Diagnosis-Related Group (DRG) Payments for Health

2019-12-19 Medical
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Release : 2019-12-19
Genre : Medical
Kind : eBook
Book Rating : 216/5 ( reviews)

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Book Synopsis Transition to Diagnosis-Related Group (DRG) Payments for Health by : Caryn Bredenkamp

Download or read book Transition to Diagnosis-Related Group (DRG) Payments for Health written by Caryn Bredenkamp. This book was released on 2019-12-19. Available in PDF, EPUB and Kindle. Book excerpt: This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.

Development of Pharmacy Service Weights in the Implementation of Casemix System for Provider Payment

2017-09-19 Medical
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Release : 2017-09-19
Genre : Medical
Kind : eBook
Book Rating : 904/5 ( reviews)

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Book Synopsis Development of Pharmacy Service Weights in the Implementation of Casemix System for Provider Payment by : Dr Syed M. Aljunid

Download or read book Development of Pharmacy Service Weights in the Implementation of Casemix System for Provider Payment written by Dr Syed M. Aljunid. This book was released on 2017-09-19. Available in PDF, EPUB and Kindle. Book excerpt: 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.

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
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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.

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