152. Comparison of current health insurance provider criteria for coverage of lumbar discectomy procedures

Medical coverage is budgetary instrument with which individuals are shielded against catastrophic financial weight emerging from unforeseen disease or damage. Having a well working protection system ensures pooling of assets to cover dangers. The medical coverage segment in India is in a beginning stage and a mere 9% of the complete populace is secured under any plan of medical coverage since Health Insurance policies are administrations and henceforth elusive in nature. So there is no prompt shot of acknowledging the services whether fortunate or unfortunate. Indian Insurance Industry has encountered a swelling impact after globalization and the progression of the economy. After the financial advancement, the paradigm changed from focal arranging, direction and control to showcase driven improvement. The level of buying of medical coverage shifts from individual to individual. It relies on numerous variables. The elements can be classified into individual, social, financial, mental and friends related factors. On the off chance that the health insurance business wishes to pull its weight in forming this immense market, it needs to examine the major factors impacting the buy of medical coverage arrangements, With rivalry developing perpetually, insurers need to be in the nonstop procedure of item advancement concoct inventive approaches to contribute toward actualizing the administration's need of offering medical coverage to poor. The current health insurance projects required considerable changes to make them increasingly effective and socially helpful.

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Analisis Beban Biaya Sendiri Pasien Rawat Inap Peserta Askes di RSUD dr. Achmad Diponegoro, Putussibau, Kalimantan Barat

Kesmas National Public Health Journal ◽

10.21109/kesmas.v2i4.260 ◽

2008 ◽

Vol 2 (4) ◽

pp. 166

Author(s):

Johanes Eko Kristiyadi

Keyword(s):

Health Insurance ◽

Length Of Stay ◽

Influence Factor ◽

Hospitalized Patients ◽

Cross Sectional ◽

West Kalimantan ◽

Health Insurance Provider ◽

Level 1 ◽

Out Of Pocket Expenses ◽

Interaction Test

PT. Askes asuradur yang mengelola asuransi wajib pegawai negeri sipil yang dalam peraturannya membolehkan peserta membayar beban biaya sendiri (out of pocket) karena perbedaan antara tarif rumah sakit dengan tarif paket Askes. Penelitian ini bertujuan untuk mengetahui berbagai faktor yang berpengaruh dan model prediksi beban biaya sendiri pasien rawat inap peserta Askes di RSUD dr. Achmad Diponegoro-Putussibau, Kabupaten Kapuas Hulu, Propinsi Kalimantan Barat, tahun 2005. Rancangan penelitian yang digunakan adalah survei dengan sampel sebesar 257 pasien rawat inap tahun 2005. Dfitemukan Rata-rata beban biaya sendiri sebesar Rp. 215.472atau 20,84 % dari rata-rata biaya perawatan sesuai tariff RSUD. Beban minimum dan maksimum adalah Rp. 25.000,- dan Rp. 2.784.000,- dipengaruhi oleh faktor lama hari rawat, penyakit penyulit, obat-obatan, peserta, peserta3(isteri), golongan pegawai, interaksi antara lama hari rawat dengan penyakit penyulit dan interaksi antara penyakit penyulit dengan obat-obatan. Interaksi antara lama hari rawat dengan penyakit penyulit merupakan faktor yang paling mempengaruhinya (nilai ? 0,624). Setelah dilakukan uji asumsi dan uji interaksi, maka diperoleh model prediksi beban biaya sendiri = 5,743 + 0,313*lama hari rawat - 0,785*tidak ada penyakit penyulit + 0,819*obat-obatan (Non DPHO) + 67,397*peserta + 0,179*istri + 1,489*golongan + 0,260*Interaksi penyakit penyulit dengan Obat-obatan + 37,353*Interaksi lama hari rawat dengan penyakit penyulit.Kata Kunci : Biaya sendiri, asuransi kesehatanAbstractPT Askes is the health insurance provider with mandatory membership for public officers in Indonesia. In reality, patient still have to cover some expenses from his or her pocket, due to the differences between hospital fare and the expenses that is covered by Askes. The objective of this research is to find out the determinant factors and the prediction model of out of pocket expenses among hospitalized patients with Askes membership at dr. Achmad Diponegoro Hospital in Putussibau, Kapuas Hulu District, West Kalimantan Province in 2005. This design used in this study is cross-sectional, using 257 samples of hospitalized patients in dr. Achmad Diponegoro Hospital in Putusibau, Kapuas Hulu District, West Kalimantan Province during the year of 2005. The average amount of out of pocket expenses of each patient is Rp 215,472.76 or 20.84 % out of the total expenses in the district hospital. the minimum fare is Rp 25,000.- and the maximum one is Rp 2,784,000.-, depend on the number of days in hospital, type of illness, medications, type of membership (member1=the person with the membership, member3=the spouse), level 1 employee, the interaction between length of stay with type of illness, and the interaction between complicated illness and drugs are the most influence factor ( the ? value are the highest, that is 0,624). The assumption and interaction test, resulted in the model: self expenses = 5,743 + 0,313*length of stay - 0,785*no complicated illness + 0,819*drugs (Non DPHO) + 67,397*member1 + 0,179*member3 + 1,489*employee1 + 0,260*interaction between complicated illness and drugs + 0,260*Interaction between length of stay and complicated illness.Key word : Out of pocket, health insurance

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Holes in the Health Insurance System-Who Lacks Coverage and Why

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2004.tb00148.x ◽

2004 ◽

Vol 32 (3) ◽

pp. 390-396 ◽

Cited By ~ 3

Author(s):

Catherine Hoffman ◽

Diane Rowland ◽

Alicia L. Carbaugh

Keyword(s):

Health Care ◽

Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Health Insurance System ◽

Major Health ◽

Insurance System ◽

Current Health ◽

Private And Public ◽

Care Costs

Lack of health insurance coverage is a large and growing problem for millions of American families. Rising health care costs and economic insecurity continue to threaten the bedrock of the health insurance system - employer-sponsored coverage - while states’ fiscal situations and the escalating federal deficit complicate any efforts at reform. Providing health insurance coverage to the millions of uninsured remains a major health care challenge for the nation and understanding the current health insurance environment, who the uninsured are, and why they are uninsured is critical when considering health care reform. This paper aims to define the problem of the uninsured, providing an overview of the uninsured in America and the roles and limits of private and public insurance. Following this discussion, the paper describes the current health insurance environment and examines the prospects for improving coverage.

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