The Nation's Health Insurance aud Health Services Policies

1972 ◽  
Vol 15 (5) ◽  
pp. 713-732
Author(s):  
Eveline M. Burns
Keyword(s):  
Health Insurance ◽  
Health Services

scholarly journals Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil

2017 ◽  
Vol 51 (suppl 1) ◽  
Author(s):  
Deborah Carvalho Malta ◽  
Regina Tomie Ivata Bernal ◽  
Margareth Guimarães Lima ◽  
Silvânia Suely Caribé de Araújo ◽  
Marta Maria Alves da Silva ◽  
...  
Keyword(s):  
Higher Education ◽  
Health Insurance ◽  
Health Services ◽  
Sex Education ◽  
National Health ◽  
Health Survey ◽  
National Health Survey ◽  
Education Level ◽  
Noncommunicable Diseases ◽  
Use Of Health Services

ABSTRACT OBJECTIVE To assess whether sex, education level, and health insurance affect the use of health services among the adult Brazilian population with chronic noncommunicable diseases (NCD). METHODS Data from a cross-sectional survey were analyzed, the National Health Survey (PNS). Frequency of use of services in the population that referred at least one NCD were compared with the frequency from a population that did not report NCD, according to sex, education level, health insurance, and NCD number (1, 2, 3, 4, or more). The prevalence and prevalence ratios were calculated crude and adjusted for sex, age, region, and 95% confidence intervals. RESULTS The presence of a noncommunicable disease was associated with increase in hospitalizations in the last 12 months, in 1.7 times (95%CI 1.53–1.9). Failing to perform usual activities in the last two weeks for health reasons was 3.1 times higher in NCD carriers (95%CI 2.78–3.46); while the prevalence of medical consultation in the last 12 months was 1.26 times higher (95%CI 1.24–1.28). NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. CONCLUSIONS NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level.

BPJS Kesehatan Memberikan Jaminan Kesehatan Terhadap Pasien Atau Masyarakat

2021 ◽  
Vol 7 (2) ◽  
pp. 146-154
Author(s):  
Aidha Puteri Mustikasari
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Social Security ◽  
The State ◽  
Universal Health Care ◽  
Universal Health Insurance ◽  
Universal Health ◽  
Provide Health Insurance

Abstrak. Kepesertaan BPJS Kesehatan pada tahun 2020 tidak akan mencakup 90% penduduk Indonesia, namun rencana Universal Health Care Implementation (UHC) telah direncanakan sejak tahun sebelumnya. Di masa pandemi Covid, sejumlah besar status kepesertaan BPJS Kesehatan  dicabut karena terlambat, padahal masyarakat membutuhkan layanan kesehatan dan asuransi dengan kondisi yang ada. Kajian ini bersifat norma deskriptif , dibahas dalam konteks kepesertaan BPJS kesehatan, dan cukup  menggunakan prinsip asuransi dengan hanya memberikan jaminan kepada peserta, tetapi negara mengikuti kewajiban UUD 1945 yaitu memberikan jaminan kesehatan dan pelayanan kepada warga negara. Untuk mendukung keberadaan jaminan kesehatan universal, Indonesia perlu menerapkan formulir kepesertaan dan  sanksi untuk ketentuan wajib  peserta jaminan sosial yang efektif dan efisien. Abstract. BPJS Health membership in 2020 will not cover 90% of Indonesia's population, but the Universal Health Care Implementation (UHC) plan has been planned since the previous year. During the Covid pandemic, a large number of BPJS Health membership statuses were revoked because they were late, even though people needed health services and insurance with the existing conditions. This study is descriptive in nature, discussed in the context of BPJS health participation, and it is sufficient to use the insurance principle by only providing guarantees to participants, but the state follows the obligations of the 1945 Constitution, namely to provide health insurance and services to citizens. To support the existence of universal health insurance, Indonesia needs to implement an effective and efficient membership form and sanctions for mandatory provisions for social security participants.

scholarly journals Healthcare Access and Utilization among Korean Americans: The Mediating Role of English Use and Proficiency

2016 ◽  
Vol 4 (1) ◽  
pp. 83 ◽  
Author(s):  
Jiang Li ◽  
Annette E. Maxwell ◽  
Beth A. Glenn ◽  
Alison K. Herrmann ◽  
L Cindy Chang ◽  
...  
Keyword(s):  
Health Insurance ◽  
Length Of Stay ◽  
Health Services ◽  
Insurance Coverage ◽  
Korean Americans ◽  
Usual Source Of Care ◽  
Mediating Role ◽  
Usual Source ◽  
The Us ◽  
Source Of Care

The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N= 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect =0.166, SE= 0.07, p<.05; direct effect=0.296, SE= 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.

scholarly journals Analysis of the Effect of Health Insurance on Health Care Utilization in Rwanda

2021 ◽  
Author(s):  
Roger Muremyi ◽  
Dominique Haughton ◽  
François Niragire ◽  
Ignace Kabano
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Care Utilization ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Secondary Data ◽  
Living Condition ◽  
Care Utilization ◽  
Health Coverage

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

The impact of health insurance on health services utilization and health outcomes in Vietnam

2014 ◽  
Vol 9 (4) ◽  
pp. 359-382 ◽  
Author(s):  
G. Emmanuel Guindon
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Health Outcomes ◽  
Health Services Utilization ◽  
Living Standard ◽  
Outpatient Services ◽  
Services Utilization ◽  
The Poor ◽  
Inpatient Services ◽  
The Impact

AbstractIn recent years, a number of low- and middle-income country governments have introduced health insurance schemes. Yet not a great deal is known about the impact of such policy shifts. Vietnam’s recent health insurance experience including a health insurance scheme for the poor in 2003 and a compulsory scheme that provides health insurance to all children under six years of age combined with Vietnam’s commitment to universal coverage calls for research that examines the impact of health insurance. Taking advantage of Vietnam’s unique policy environment, data from the 2002, 2004 and 2006 waves of the Vietnam Household Living Standard Survey and single-difference and difference-in-differences approaches are used to assess whether access to health insurance – for the poor, for children and for students – impacts on health services utilization and health outcomes in Vietnam. For the poor and for students, results suggest health insurance increased the use of inpatient services but not of outpatient services or health outcomes. For young children, results suggest health insurance increased the use of outpatient services (including the use of preventive health services such as vaccination and check-up) but not of inpatient services.

PERLINDUNGAN HUKUM BAGI RSUD DR. MOEWARDI SURAKARTA TERHADAP KETERLAMBATAN PEMBAYARAN KLAIM OLEH BPJS KESEHATAN

2020 ◽  
Vol 8 (1) ◽  
pp. 42
Author(s):  
Asna Zamharira ◽  
Arief Suryono
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Research Method ◽  
Legal Protection ◽  
Secondary Data ◽  
Primary Data ◽  
Cooperation Agreement ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Government

<p>Abstract<br />This articles aims to find out how legal protection for health facilities is towards late payment of claims by BPJS Health. The research method used in writing this law is a normative juridical research method that is research that uses secondary data or literature that is supported by primary data in the field as supporting data. Analysis of data using qualitative analysis. The results of the study revealed that health services in implementing the Health Insurance program between RSUD Dr. Moewardi Surakarta with BPJS Health is based on a collaboration agreement between RSUD Dr. Moewardi Surakarta with BPJS Kesehatan about Advanced Level Referral Health Services for Participants in the Health Insurance Program, one of which is the contents of a cooperation agreement regarding the payment system of claims. The claim system is carried out by referring to the agreement. In the system of claims there were still obstacles that is the delay in the payment of claims by BPJS Kesehatan to the hospital. As a form of legal protection, to resolve the problem of late payment of claims made in accordance with the cooperation agreement and Perpres No. 82 Tahun 2018 concerning Health Insurance. The Government and BPJS Kesehatan are expected to be able to make claims payments in accordance with the terms or agreed cooperation agreements.<br />Keywords: Cooperation agreement; Claim; BPJS Kesehatan; Hospital.</p><p>Abstrak<br />Artikel ini bertujuan untuk mengetahui bagaimana perlindungan hukum bagi fasilitas kesehatan tehadap keterlambatan pembayaran klaim oleh BPJS Kesehatan. Metode penelitian yang digunakan dalam penulisan hukum ini adalah metode penelitian yuridis normatif yaitu penelitian yang menggunakan bahan-bahan hukum sekunder atau kepustakaan yang ditunjang dengan data primer di lapangan sebagai data pendukung. Data diolah dan dianalisis secara kualitatif. Hasil penelitian diketahui bahwa pelayanan kesehatan dalam melaksanakan program Jaminan Kesehatan antara RSUD DR. Moewardi  Surakarta dengan BPJS Kesehatan didasarkan pada perjanjian kejasama antara RSUD Dr. Moewardi Surakarta dengan BPJS Kesehatan tentang Pelayanan Kesehatan Rujukan Tingkat Lanjutan bagi Peserta Program Jaminan Kesehatan yang salah satu isi perjanjiannya mengenai sistem pembayaran klaim. Sistem pembayaran klaim dilakukan dengan berpedoman pada perjanjian kerjasama. Dalam sistem klaim masih ditemui hambatan yaitu terjadinya keterlambatan pembayaran klaim oleh BPJS Kesehatan kepada rumah sakit. Sebagai bentuk perlindungan hukum, untuk penyelesaian permasalahan keterlambatan pembayaran klaim dilakukan sesuai dengan perjanjian kerjasama dan Perpres No. 82 Tahun 2018 tentang Jaminan Kesehatan. Pemerintah dan BPJS Kesehatan diharapkan dapat melaksanan pembayaran klaim sesuai dengan ketentuan atau perjanjian kerjasama yang telah disepakati.<br />Kata Kunci: Perjanjian Kerjasam; Klaim; BPJS Kesehatan; Rumah Sakit.</p>

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.

Utilization of Primary Health Services in Hong Kong

2015 ◽  
pp. 1159-1176
Author(s):  
Raymond K. H. Chan ◽  
Kang Hu
Keyword(s):  
Health Care ◽  
Hong Kong ◽  
Health Insurance ◽  
Health Services ◽  
Private Insurance ◽  
Public Health Services ◽  
Public And Private ◽  
The Public ◽  
Primary Health ◽  
Primary Health Services

This chapter analyzes the issue of primary health care utilization in Hong Kong and introduces the case of Hong Kong where a special division between public and private sectors has developed in the field of primary health services. The chapter argues that in the foreseeable future, it is likely that the division of health care between the public and private sector will be maintained. In recent years, more and more individuals and families have purchased private health insurance so as to gain more options. The idea of universal health insurance was rejected by the public in recent consultations; the current alternative is government-regulated private insurance. Although private primary health services will continue as usual in the near future, public primary health services should be maintained or even expanded. Given the costliness of private services (especially specialist services), it is recommended that more resources should be invested in corresponding public health services.

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