Revenue and financing of patients with national health insurance by the social security organizing agency to improve health services

2020 ◽  
Vol 30 ◽  
pp. 276-279
Author(s):  
Syarifuddin Yusuf ◽  
Nuzul Achmar ◽  
Haniarti ◽  
Hasdiana ◽  
Mahkrajani Madjid ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
The Social ◽  
Improve Health

scholarly journals Revealing the Legal Protection of Patients Social Security Administration Agency of Health in Sanglah and Balimed Hospitals Denpasar

2020 ◽  
Vol 7 (2) ◽  
pp. 102-110
Author(s):  
RA Tuty Kuswardhani ◽  
I Nyoman Budiana
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
Legal Protection ◽  
The Elderly ◽  
National Formulary ◽  
Social Security Administration ◽  
Curative Therapy ◽  
The Social

Social Security Administration Agency of Health has a National National Health Insurance formulary, but in reality patients do not get drugs according to the National Health Insurance National Formulary. Therefore, the aims of this study are to determine the legal protection of patients of the Social Security Administration Agency of Health for the elderly in curative therapy in hospitals according to the national formulary of National Health Insurance at Sanglah Hospital and Balimed Hospital, and to know the responsibilities undertaken by the Social Security Administration Agency of Health in fulfilling its obligations for patients the Agency for the Implementation of the Social Health Insurance of the elderly in curative therapy in accordance with the national formulary of the National Health Insurance. This study uses a participatory observational (empirical-observational) empirical legal research method. Sampling with purposive sampling and data collection techniques using triangulation techniques. In principle, legal protection must refer to legal certainty, fairness and benefits for the population participating in the Social Security Administration Agency of Health for the elderly so that it is not impressed that Balimed Hospital and Sanglah General Hospital and the Social Security Administration Agency of Health make a service to consumers who are not good. The legal responsibility that should be obtained by the participants of the Social Security Administration Agency of Health for the elderly in Balimed Hospital and Sanglah Hospital Denpasar which is currently not maximally received by patients participating in the Social Security Administration Agency of Health for the elderly at Balimed Hospital and Sanglah Hospital.

scholarly journals International Constructions of Social Security and Public Health: Policy Intersections 1920–1970

Gesnerus ◽  
2017 ◽  
Vol 74 (2) ◽  
pp. 205-215
Author(s):  
James A. Gillespie
Keyword(s):  
Health Policy ◽  
Health Insurance ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
Social Insurance ◽  
Early Years ◽  
Health Security ◽  
Global Health Policy ◽  
The Social

The problems of national health insurance played a prominent, but shifting role in the formation of global health policy. This paper uses the work of Geneva based organizations from the end of the First World War to the 1970s to explore the crossing points between health policy and social security. From its formation the League of Nations Health Organisation had an uneasy dialogue with the social insurance and security approaches adopted by the International Labour Organization and the International Social Security Association. When the social insurance concerns of the interwar year broadened into ‘social security’, largely led by the ILO, this debate spilled over into conflicts over the leadership of global social policy and carried over into the early years of WHO. Conflicts centred on the difficult relationship between national health insurance and the other elements of what became the welfare state. The paper identifies the difficulties of constructing a global policy space for action on health security.

EQUITY IN HEALTH SERVICES

PEDIATRICS ◽  
1978 ◽  
Vol 61 (4) ◽  
pp. 624-624
Author(s):  
O. W. Anderson
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
Health Indicators ◽  
Equity In Health ◽  
The Public ◽  
Life Styles ◽  
Services Delivery ◽  
Improve Health

It is demonstrated that the increase in the use of physician and hospital services between 1963 and 1970 ... had no impact on health indicators as measured by disability days. It is often argued from results like these that a comprehensive national health insurance scheme would be a misallocation of resources in the public sector, if the objective is to improve health levels. Rather, it is argued, it would be a wiser policy to allocate fewer resources to a comprehensive curing system and more to programs designed to inculcate healthful life styles. Life styles do not lend themselves easily to manipulated change, at least in the short haul. Public opinion will dictate that the health services delivery system will have to cope with the deleterious effects of prevailing life styles somehow. I do not believe there will ever be a puritanic majority who are so healthy and ascetic that they can legislate against a minority who are hedonistic and unhealthy.... Differentiating between life style saints and sinners is then not a tenable public policy. National health insurance will be designed therefore to serve both the prudent and the profligate, a policy I would regard as equitable.

scholarly journals RELATIONSHIP BETWEEN INCOME LEVEL, PERCEPTION OF HEALTH SERVICES AND CADRES’S ACTIVITY WITH COMPLIANCE WITH PAYMENT OF INDEPENDENT NATIONAL HEALTH ASSURANCE IN KOLAKA DISTRICT

2021 ◽  
Vol 3 (1) ◽  
pp. 115-128
Author(s):  
Jumiati Bandu ◽  
La Ode Kamalia ◽  
Erwin Azizi Jayadipraja
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
Social Insurance ◽  
Patient Perceptions ◽  
P Value ◽  
Related Factor ◽  
Income Levels ◽  
The Social

Background:Every year, the social insurance administration organisation (BPJS Kesehatan) always experiences a very large deficit. The high number of deficits experienced by the social insurance administration organisation (BPJS Kesehatan) is due to the low level of compliance of contribution payments by independent participants. The purpose of this study was to determine the relationship between income levels, patient perceptions of health services and activeness of cadres with compliance with payment of dues to participants in the Independent National Health Insurance, Kolaka District. Methods:This type of research is a quantitative study with a cross sectional study approach. The population in this study were all 1075 independent National Health Insurance participants. The sample size was 89 respondents who were taken by proportional random sampling. The data were obtained using a questionnaire and then analyzed descriptively and inferentially using the Chi Square test. Result:The results showed that there was a relationship between income levels, patient perceptions of health services and the activeness of cadres with compliance with the payment of dues for participants in the independent national health insurance in Kolaka District, where the p-value <?= 0.05. Conclusion:Perception of health services is the most related factor in comparison to the level of income and activity of the cadres. It is hoped that the social insurance administration organisation (BPJS Kesehatan) will carry out strategies in an effort to increase the regularity or compliance of the independent national health insurance participants and increase the number of cadres.

Cases of Dispute and Pending Claims in Hospitals in the Era of National Health Insurance

2022 ◽  
Vol 2 (1) ◽  
pp. 32-38
Author(s):  
Mrs. Yastori
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance System ◽  
Quality Health ◽  
Icd 10 ◽  
Data Collection Technique ◽  
Observation Method

Background: Indonesia began to implement a National Health Insurance System based on the National Social Security System in 2014 with the support of government regulations which states that Indonesia requires every citizen to have access to comprehensive and quality health services so that can continue their life through the National Health Insurance. Pending and dispute claims are problems that often occur in the era of national health insurance that can affect hospital budget allocation and planning policies, increasing the high cost burden for hospitals which will affect the quality of health services provided. The purpose of this study was to determine pending cases and dispute claims in hospitals in the Era of National Health Insurance.Methods: The study used a descriptive method with a qualitative approach. The data collection technique used is the observation method, namely directly to the e-claim file at several hospitals. 15 e-claim files taken in total from April – July 2021.Results: Obtained 13 cases of pending claims and 2 cases of dispute claims. Cases pending claims are caused by not complying with the code with evidence or resources, not in accordance with medical clinical practice guidelines and the rules of the health insurance provider.Conclusions: In coding, it is necessary to match the theory on the ICD-10, update the ICD-10. It is necessary to understand the rules and provisions made by the insurer and the related guidelines and rules. Please be aware of every latest code update.

scholarly journals Szociális ellátások a társadalombiztosítási családtámogatás rendszerében

2019 ◽  
Vol 160 (Supplement 1) ◽  
pp. 43-48
Author(s):  
Ivett Szombati
Keyword(s):  
Health Insurance ◽  
Child Care ◽  
Labour Market ◽  
National Health Insurance ◽  
National Health ◽  
Financial Support ◽  
Family Policy ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
The Social

Introduction and aim: In my study, analysing the data available from the change of the regime to the present day, from among the social services, I examine the changes of the financial support relating to children and its parts which are currently financed from the budget of the National Health Insurance Fund of Hungary, with special emphasis on the Child Care Benefit and the Child Care Allowance and their modifications. Data and methods: Within the framework of our research, we analyze – through data from the National Health Insurance Fund of Hungary, the Hungarian Central Statistical Office, the Organisation for Economic Co-operation and Development (OECD) and the Hungarian State Treasury as well as on the basis of literature review – the social financial support and its changes, within the family policy system. Results: Hungarian family policy is still driven by the attitude of staying at home for three years with the child. The long period spent at home with the children fundamentally affects the adjustment of mothers to the labour market which has a direct effect on the economic productivity. Even though according to the current regulations, mothers are allowed to work full-time besides receiving child care allowance after their child fills 6 months, part-time employment and telework is still in its infancy compared to the Western-European countries. Based on our research, high percentage of families go for the child care benefit directly after the birth of the child thus not participating in the labour market processes. Besides if they do participate, the percentage of employment on minimal wage is still very high which means that in 2016–2017 36% of families with two breadwinners and two children were forced to survive on subsistence income. Conclusion: In the examined period, we found that social and family policy changes unfortunately were not able to react sufficiently to the demographic challenges despite Hungary spending significantly more on family policy than other European and OECD countries. Orv Hetil. 2019; 160(Suppl 1): 43–48.

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