Paying the Doctor: Systems of Remuneration and their Effects, by William A. Glaser. Baltimore: The Johns Hopkins Press, 1970, 323 pp., $10.00

PEDIATRICS ◽  
1971 ◽  
Vol 47 (1) ◽  
pp. 160-163
Author(s):  
Allan M. Butler
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Private Practice ◽  
Payment System ◽  
European Countries ◽  
Medical Services ◽  
Payment Systems

From his personal studies, Glaser analyzes the establishment and summarizes the methods of paying doctors in 16 European countries that have national health insurance programs. Unfortunately, to quote Glaser, "a country's current payment system under its public medical services is usually the arrangement it had before the services were created. . . . Most payment systems in public schemes are simply those inherited from prior practice, since the doctors would be disturbed by changes. Most payment procedures under ‘socialized medicine’ are simply more bureaucratized versions of the methods that were used and often even invented by the doctors under earlier private practice."

scholarly journals Analysis of Partnership of Private Practice Midwife in The National Health Insurance Program in District Bungo Jambi Province

2018 ◽  
Vol 3 (1) ◽  
pp. 23
Author(s):  
Nurlie Azwar ◽  
Prastuti Soewondo
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Private Practice ◽  
Rapid Assessment ◽  
Neonatal Care ◽  
Research Approach ◽  
Family Doctors ◽  
Depth Interview ◽  
The Government

On January 1, 2014, the government began to implement the National Health Insurance (NHI) program to realize social welfare for the whole community. Midwifery and neonatal care in the NHI program involves Puskesmas/family doctors and Private Practice Midwife (PPM) as its network. PPM participation in the NHI program in Bungo District was still lacking, only 12 (54.5%) PPM have cooperated with family doctors from 22 existing PPM. This study aimed to get an overview of PPM participation in the NHI program in Bungo District, Jambi Province. The study used qualitative research approach with Rapid Assessment Prosedur design, purposive sampling, and conducted in-depth interview to 10 PPM, Head of Health Office, MPKP BPJS Health Manager, and Chairman of Bungo Regency Section of Indonesian Midwife Organization (IMO). The study was conducted from January to July 2017. The study found that the knowledge, perceptions and attitude towards NHI program were good, but the perceived toward the claim and predetermined tariff procedures were not so good. PPM motivated to join the NHI program as many patients had become NHI participants. Support from the Government, NHI, and IMO were low, either in the form of socialization, or policies. Therefore, the study suggest an improvement in claims procedures, tariffs, and an increase of socialization from government, NHI and IMO on NHI program related to obstetric and neonatal care.

scholarly journals Data Analysis on Medical Service Utilization and Out-of-pocket Spending among Near-poor National Health Insurance Members in South Korea

2020 ◽  
Author(s):  
sooyeol park
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Low Income ◽  
Study Groups ◽  
Medical Utilization ◽  
Medical Services ◽  
Median Income ◽  
Poor Group ◽  
Poor Population

Abstract Background: The near poor, a low income population which is excluded from the Republic of Korea's Medical Aid (MA) program, experiences insufficient use of medical services and high out-of-pocket (OOP) spending due to insufficient coverage by the country's National Health Insurance (NHI). This study aims to examine medical utilization, OOP spending, and occurrence of catastrophic health expenditures (CHE) among the near poor compared to MA beneficiaries and other NHI members.Methods: A cross-sectional study was conducted drawing upon a nationally representative dataset based on the 2018 Korea Welfare Panel Study (KOWEPS). We classified people into MA beneficiaries, the near-poor population below 50% of the median income threshold, and other NHI members above the 50% median income threshold. Using propensity score matching between MA beneficiaries and the near poor and between the near-poor group and the group of those above the poverty line, this study examined medical utilization, OOP spending, and the occurrence of CHE among the study groups. Results: The findings suggest that MA beneficiaries make greater use of outpatient services compared to the near poor, but other uses of medical services were not significantly different among the study groups. However, OOP spending and occurrence of CHE were significantly higher in the near-poor group compared to the other two groups. Conclusion: We found that the near-poor group was the most vulnerable group in these terms among the Korean population. Health policy needs to take into account the vulnerability of the near-poor population.

scholarly journals National Health Insurance Scheme: Internal and External Barriers in the Use of Reproductive Health Services among Women

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Evi Martha ◽  
Herna Lestari ◽  
Resvi Siti Zulfa ◽  
Yoslien Sopamena
Keyword(s):  
Health Insurance ◽  
Reproductive Health ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
Rapid Assessment ◽  
Medical Services ◽  
Assessment Procedure ◽  
Reproductive Health Services ◽  
Internal Barriers

Lack of familiarity among the community, medical workers, and administrative staff regarding reproductive health services covered by Badan Penyelenggara Jaminan Sosial (BPJS) or the National Health Insurance (NHI) in Indonesia, remained a problem. Therefore, this resulted in sub-optimal use of the medical services, as shown by surveys from the Women's Health Foundation for three consecutive years (2015-2017). This qualitative study was conducted with a Rapid Assessment Procedure design in three cities within Indonesia, namely Padang Pariaman, Manado, and Kupang. Data were collected through IDIs (n = 47 informants) and 6 FGDs (7 persons/group). Participants also consisted of NHI RHS users (mothers and young women), administrative officers at health facilities, medical services providers, and officials related to the NHI assistance. Data were managed using NVivo version 2.0 software, accompanied by thematic analysis. The internal barriers in the use of NHI included inadequate knowledge of RHS covered by NHI, and a culture of shame in informants. External barriers included additional costs for medicines not covered by NHI, the dissatisfaction of health services provided by medical workers, busy work and household activities, with the lack of women's role in decision-making within families, which related to reproductive wellness.

Sign in / Sign up

Export Citation Format

Share Document