scholarly journals Medico-economic impact of enhanced rehabilitation after surgery: an exhaustive, nation-wide claims study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frédéric Bizard ◽  
Thierry Boudemaghe ◽  
Laurent Delaunay ◽  
Lucas Léger ◽  
Karem Slim
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Cost Reduction ◽  
Average Length ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Social ◽  
The Mean ◽  
Medico Economic ◽  
The Cost

Abstract Background Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program. Methods Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates. Results The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of € 1060 (CI 95% 995 to 1125) per patient and a total of €65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to € 1.6 million, breaking into a € 2.2 million increase partially compensated by cost savings of € 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to € 1.8 million (CI 95% 1.7 million to 2.0 million). Conclusions Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS.

scholarly journals Semi-supercentenarians in the United States

2020 ◽  
pp. 191-201
Author(s):  
Bert Kestenbaum
Keyword(s):  
United States ◽  
Health Insurance ◽  
Social Security ◽  
The United States ◽  
Online Resources ◽  
National Death Index ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Social

AbstractThis chapter discusses in detail the procedure followed to identify a 1-in-10 sample of persons born between 1870 and 1899 who resided in the United States at the time of their death at ages 105–109 for men and 108 or 109 for women. We tabulate the characteristics of these “semi-supercentenarians” and offer some observations about the level of their mortality. The procedure for identifying semi-supercentenarians consists of (1) casting a net to find candidates and then (2) determining for which candidates can both date of birth and date of death be validated. The net used to find candidates in the United States is different from the nets typically used in other counties: in the United States we use the file of enrollments in the federal government’s Medicare health insurance program. Some of the information needed for the verification step comes from another administrative file – the Social Security Administration’s file of applications for a new or replacement social security card. Verification of the date of death is accomplished by querying the National Death Index. Dates of birth are verified by using online resources to access the records of several censuses conducted many decades earlier.

Effect of Health Insurance Program in Social Security in Kailali District, Nepal

2020 ◽  
Vol 4 (3) ◽  
pp. 01-05
Author(s):  
Saraswati Kumari Joshi ◽  
Durga Kumari Joshi ◽  
Sita Kumari Joshi ◽  
Nisha Adhikari ◽  
Shristi Joshi ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Insurance Program ◽  
Health Insurance Program

scholarly journals RECONSTRUCTION NATIONAL SOCIAL SATISFACTION SYSTEM FOR HEALTH FIELD IN THE AUTONOMY REGION WITH VALUE OF WELFARE

2018 ◽  
Vol 1 (1) ◽  
pp. 101
Author(s):  
Gunarto Gunarto
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Government Regulation ◽  
Health Sector ◽  
Social Security System ◽  
Security System ◽  
Research Approach ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Government

Objectives to be achieved in this research To understand and analyze the National Social Security System Construction of Health Sector in the current positive law, to understand and analyze the weaknesses of the National Social Security System in the Field of Health today and to analyze and reconstruct the National Social Security System for Health Based on the value of welfare Research is expected to have both theoretical and practical uses that researchers use is socio legal research, this research approach is chosen to see how far the effectiveness of law in the prosperity of the community especially in health insurance coverage, here the law is not only seen in terms of its effectiveness but Also related to non-legal factors such as institutions related to the welfare of the community. The Legal System of the Health Insurance Program with the participation of BPJS is still very weak both in terms of the legal substance component, in providing equitable welfare in obtaining health services through the Health Insurance Program with. Strengthening Components of Legal Substances by changing Article 39 Paragraphs (1), (3) and (4) of Presidential Regulation No. 12 of 2013, Strengthening Legal Structure Components by Strengthening FKTP I on the regulation of Government Regulation, Strengthening Legal Culture Component by developing Culture of community law through continuous education to the community so that the community, the Government is not responsible for providing funds for Beneficiaries of Contribution (PBI).

scholarly journals Perlindungan Hukum dan Pemenuhan Hak Pekerja pada Program Jaminan Kesehatan Nasional

2020 ◽  
Vol 15 (1) ◽  
pp. 83-92
Author(s):  
Tedi Sudrajat
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
Analysis Method ◽  
Advanced Level ◽  
Social Security Program ◽  
Informal Workers ◽  
Protection Scheme ◽  
Service Guarantees ◽  
Insurance Program ◽  
The Social

Badan Penyelenggara Jaminan Sosial (BPJS) berlaku pada tahun 2014, namun sampai saat ini masih banyak pemberi kerja dan pekerja yang kurang paham dengan program yang diselenggarakan BPJS Kesehatan, dan penerapannya masih belum dikategorikan optimal. Hal yang menarik dianalisis adalah Pertama, bentuk perlindungan pekerja dalam program Jaminan Kesehatan Nasional (JKN) dan Kedua, persoalan dalam penerapannya. Tulisan ini menggunakan jenis penelitian Yuridis Normatif dengan pendekatan perundang-undangan dan pendekatan analisis serta dianalisis secara normatif kualitatif. Dalam tulisan ini diketahui terdapat perubahan dari program Jaminan Sosial Tenaga Kerja (Jamsostek) ke BPJS kesehatan yang berimplikasi penerapan jaminan dan pelayanan kesehatan bagi pekerja. BPJS membuat prosedur yang dapat meningkatkan keterjangkauan peserta pekerja terhadap pelayanan kesehatan secara berjenjang dari fasilitas pelayanan Kesehatan (fasyankes) tingkat pertama ke  tingkat lanjut. Terlepas dari hal tersebut, terdapat beberapa persoalan hukum dalam penerapan program JKN meliputi persoalan dari aspek kepesertaan, penggunaan kartu kesehatan dan jaminan pelayanan kesehatan. Social Security Administrative Bodies (referred as BPJS) established in 2014, but until now there are still many employers and workers who are not aware of the programs held by BPJS Kesehatan, moreover the implementation was still not optimal. The problems studied were first, the form of worker protection in the National Health Insurance program and second, legal issues in its implementation. This manuscript used Normative Juridical research with statute approach, analytical approach and qualitative analysis method. In this manuscript, it known that there is a change from the Workers’ Social Security program to BPJS Kesehatan which has implications for the implementation of health insurance and services for workers. After the enactment of the BPJS Law, there are protection scheme for health insurance for both formal and informal workers. In addition, the BPJS provides a mechanism that can increase the affordability of workers to tiered health services from the first level to the advanced level. Meanwhile, there are several obstacles in the implementation of the Social Security program which include constraints on the aspects of participation, use of health cards and health service guarantees.

scholarly journals Disposition factors in the implementation of the National Health Insurance Program-Healthy Indonesia Card in Makassar City

2021 ◽  
Vol 2 (1) ◽  
pp. 45-54
Author(s):  
Askariani Sahur ◽  
Muh. Akmal Ibrahim ◽  
Thahir Haning ◽  
Hamsinah Hamsinah
Keyword(s):  
Health Insurance ◽  
Social Security ◽  
National Health Insurance ◽  
National Health ◽  
Work Experience ◽  
Supervisory Board ◽  
Social Security Administration ◽  
National Health Insurance Program ◽  
Insurance Program ◽  
Health Insurance Program

This study aims to analyze the disposition factors in the implementation of the National Health Insurance Program-Healthy Indonesia Card in Makassar City. This research uses qualitative methods. This research focuses on disposition factors in the implementation of health insurance service delivery policies at the Guarantee Administration with a phenomenological approach. Sources of data were collected through direct observation and in-depth interviews. The results showed that the disposition in the implementation of the National Health Insurance Program-Healthy Indonesia Card at the Makassar City Social Security Administration is through the appointment of employees in the Social Security Administering Bodies (BPJS) organizational structure at the level. Specific requirements (minimum S1, minimum 5 years work experience as supervisor for the Supervisory Board and directors for the Board of Directors) are considered qualified to hold the position. The selection of branch leaders is imposed by an internal selection system of BPJS Kesehatan. Incentives received by the leadership and employees for determining the amount of salary based on the provisions of the central level and adjusted to the region. The amount of salary / incentive for Makassar City BPJS Health employees is determined according to the lowest Makassar City Minimum Wage, the rest is based on position level. It can be understood that the performance of the Makassar City Healthcare BPJS has not provided the satisfaction of JKK KIS users because there are still complaints from prospective participants who are still taking care of membership, even though it is admittedly the process of validating data originating from the kelurahan, people still consider it slow.

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