scholarly journals ASURANSI KESEHATAN BERDASARKAN UNDANG-UNDANG NOMOR 3 TAHUN 1992

2009 ◽  
Vol 9 (3) ◽  
Author(s):  
Arief Suryono
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Services ◽  
Service Provider ◽  
Social Insurance ◽  
Health Care Insurance ◽  
Health Service Provider ◽  
The Social ◽  
The Law ◽  
Employment Guarantee

Health insurance according to the Law No. 3/1992 obout the social employment guarantee which consist of responsiver and the addressee and health service provider is the health social insurance which is aimed to give the health care guarantee toward the addressee that is enterprenaur and worker.  The law relationship which is consisted between: Responssiver-Addressee is the insurance relationship; Responssiver-Health services provider is the user of health service belong to the health service provider toward to the addressee; Health services provider-Addressee is gives the health service to the addresse is patient.  The responsibility of the responssiver toward the addressee is to give the health care insurance to the addressee gives the health service provider for the importance of the addressee. Kata Kunci:  Asuransi Kesehatan

scholarly journals The Albanian Social Security System and the Institutions of Social Protection in Albania

2015 ◽  
Vol 3 (2) ◽  
pp. 18
Author(s):  
Laureta Mano ◽  
Mirela Selita
Keyword(s):  
Health Care ◽  
Health Services ◽  
Social Security ◽  
Social Services ◽  
Social Insurance ◽  
Social Protection ◽  
Disabled Persons ◽  
Health Care Insurance ◽  
The Social ◽  
The Right

The social security system in Albania consists of social assistance and social services, health services and health care insurance and social insurance schemes. In the social objectives of the constitution are declared that the State within the constitutional competencies and the probable means as well as in the fulfillment of private initiatives and responsibilities, aims to higher possible standards of health, physical and mental; social care and services of elderly, orphan and invalids; medical rehabilitation, special education and integration in the community, of disabled persons. The Constitution foreseen that everyone has the right of social insurance when retired or in case of incapacity of work under a certain system established by a law. Everyone, when is unemployed for any reasons independent on individual will and when there is no living means, has the right of need under the conditions foreseen by law. Social insurance is a scheme protecting by benefits persons in respect of temporary incapacity due to sickness, maternity, old-age, disability and loss of breadwinner, employment accidents/occupational diseases, unemployment. Social Services are benefits in kind for disabled persons or vulnerable persons. Social Assistances are cash benefits given to families in need, that means families with lower incomes comparable with minimum standard of living or families without incomes. Health services consist of public health, primary health care, hospitalization services nurse's service, dental and pharmaceutical net. The Institutions of Social Protection in Albania are Social Insurance Institute, National Social Services and Health Care Insurance Fund.

The Classification and Statistical Manual of Mental Health Concerns: A Proposed Practical Scientific Alternative to the DSM and ICD

2017 ◽  
Vol 58 (1) ◽  
pp. 93-114 ◽  
Author(s):  
Jeffrey Rubin
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Disorders ◽  
Health Service ◽  
Health Services ◽  
Service Provider ◽  
Health Service Provider ◽  
Statistical Manual ◽  
Health Concerns ◽  
Mental Health Concerns

The Classification and Statistical Manual of Mental Health Concerns ( CSM) is a proposed alternative to the Diagnostic and Statistical Manual of Mental Disorders ( DSM) and International Classification of Diseases ( ICD). In contrast to the DSM/ ICD overarching concept of “mental disorders,” the CSM’s overarching concept is “mental health concerns.” A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of these topics: behavior, emotion, mood, meaning of life, death, dying, managing chronic pain, addiction, work, relationships, education, eating, cognition, sleep, and challenging life situations. The CSM begins from the perspective of the person seeking services and that is what would be classified in its manual. In addition to classifying mental health concerns, the CSM would describe a collaborative approach between the person expressing the concern and the mental health service provider for creating a psychological formulation narrative that eschews the DSM/ ICD pathologizing jargon. Compared with the DSM/ ICD approach, the use of the CSM potentially would be less stigmatizing, as well as more practical. Moreover, it would be more consistent with principles of science, eliminate the monopoly of the DSM/ ICD mental disorder approach for accessing mental health services, provide a new choice to both mental health service users and providers, challenge old ideas, stimulate fresh perspectives, and open new avenues of research.

scholarly journals The Functionalization of Law and Criminal Procedures to Confront Health Care Fraud in Hospitals

2021 ◽  
Vol 8 (3) ◽  
pp. 332-355
Author(s):  
Musa Pane ◽  
Diah Pudjiastuti
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Services ◽  
Legal System ◽  
Descriptive Study ◽  
Literature Study ◽  
Proper Place ◽  
Health Care Fraud ◽  
Service Institution ◽  
The Law

Fraud is a systematic crime that has a very broad impact. It can happen in any fields, including in hospitals. Fraud is a form of corruption. Hospital is a health service institution. Corruption in hospitals has the potential to lead to ineffective health services for people. The phenomenon of health care fraud in hospital is an indication the law does not function in accordance with the objective. This study aims to determine the functionalization of law and sentence for fraudulent acts as a form of corruption in hospitals based on justice values. This study is a descriptive study with normative juridical method that employed statutory and conceptual approaches. The data were collected through a literature study. It was subsequently analyzed qualitatively. This study is of the position to view that prosecution of criminal acts of corruption requires functionalization of law. The functionalization of law must be interpreted as positioning everything in its proper place. It is the synergy of the legal system, which consists of formulative, judicial, and executive policies. The criminal procedures can apply the punishment system for perpetrators of fraudulent acts in hospitals that includes extended alternative punishment.

PELAYANAN KESEHATAN DI ERA JAMINAN KESEHATAN NASIONAL SEBAGAI PROGRAM BADAN PENYELENGGARA JAMINAN SOSIAL KESEHATAN

2019 ◽  
Vol 25 (1) ◽  
pp. 80 ◽  
Author(s):  
Prima Maharani Putri ◽  
Patria Bayu Murdi
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Social Security ◽  
Service Provider ◽  
Social Security System ◽  
Security System ◽  
Service Program ◽  
Health Service Provider ◽  
The Social ◽  
Principle Of Justice

 AbstractThe principle of justice, certainty and usefulness in BPJS services has not been felt by all parties, especially the Health Service Provider (PPK) as BPJS provider and also the BPJS who has no clear position and authority due to Law No. 40 of 2004 concerning the Social Security System National and Law No. 24 of 2011 concerning the Social Security Organizing Agency which collided with the Presidential Regulation on Health Insurance. Although the benefits of BPJS services have been felt mainly by BPJS Beneficiaries (PBI) participants, there are injustices and legal uncertainties and the possibility of triggering fraud in various parties, especially the PPK with the INA-CBGs system at the JKJ health service program. Abstrak Prinsip keadilan, kepastian dan kegunaan dalam layanan BPJS belum dirasakan oleh semua pihak, terutama Penyedia Layanan Kesehatan (PPK) sebagai penyedia BPJS dan juga BPJS yang tidak memiliki posisi dan wewenang yang jelas karena UU No. 40 tahun 2004 tentang Sistem Jaminan Sosial Nasional dan Undang-Undang Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial yang bertabrakan dengan Peraturan Presiden tentang Asuransi Kesehatan. Meskipun manfaat layanan BPJS telah dirasakan terutama oleh peserta Penerima BPJS (PBI), ada ketidakadilan dan ketidakpastian hukum dan kemungkinan memicu penipuan di berbagai pihak, terutama PPK dengan sistem INA-CBGs di program layanan kesehatan JKJ.

Telepsychiatry for the Rohingya refugees (Preprint)

2018 ◽  
Author(s):  
Tanjir Rashid Soron
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Service ◽  
Health Service ◽  
Mental Health Care ◽  
Social Networking Sites ◽  
Health Workers ◽  
Mobile Apps ◽  
The Social ◽  
Health Need

UNSTRUCTURED Though health and shelter are two basic human rights, millions of refugees around the world are deprived of these basic needs. Moreover, the mental health need is one of least priority issues for the refugees. Bangladesh a developing country in the Southeast Asia where the health system is fragile and the sudden influx of thousands of Rohingya put the system in a more critical situation. It is beyond the capacity of the country to provide the minimum mental health care using existing resource. However, the refuges need immediate and extensive mental health care as the trauma, torture and being uprooted from homeland makes them vulnerable for various mental. Telepsychiatry (using technology for mental health service) opened a new window to provide mental health service for them. Mobile phone opened several options to reach to the refugees, screen them with mobile apps, connect them with self-help apps and system, track their symptoms, provide distance intervention and train the frontline health workers about the primary psychological supports. The social networking sites give the opportunity to connect the refugees with experts, create peer support group and provide interventions. Bangladesh can explore and can use the telepsychiatry to provide mental health service to the rohingya people.

Kuntoutukseen osallistuminen ja eri osajärjestelmien ristikkäiskäyttö

Kuntoutus ◽  
2020 ◽  
Vol 43 (4) ◽  
pp. 6-20
Author(s):  
Hanna Rinne ◽  
Jenni Blomgren
Keyword(s):  
Health Care ◽  
Occupational Health ◽  
Social Insurance ◽  
Pension System ◽  
Rehabilitation Services ◽  
Occupational Health Care ◽  
The Public ◽  
Social Insurance Institution ◽  
The Social ◽  
The City

Tieto kuntoutuksen kentän kokonaisuudesta ja erilaisten kuntoutuspalveluiden käytöstä samoilla ihmisillä on varsin hajanaista ja puutteellista. Tutkimuksen tavoitteena on selvittää kuntoutukseen osallistumisen yleisyyttä ja päällekkäisyyttä eri osajärjestelmissä Oulun asukkailla vuonna 2018 laajalla rekisteriaineistolla (N = 192 844). Tutkimuksessa tarkastellaan julkisen sosiaali- ja terveyspalvelujärjestelmän kuntoutusta, Kelan kuntoutusta, työeläkekuntoutusta, työterveyshuollon fysioterapiaa ja Kelan korvaamaa yksityistä fysioterapiaa. Vuonna 2018 oululaisista 18 prosenttia sai vähintään yhden tutkitun osajärjestelmän kuntoutusta (N = 34 061). Yleisintä oli julkisen sosiaali- ja terveyspalvelujärjestelmän kuntoutus, harvinaisinta työeläkekuntoutus. Naiset osallistuivat kuntoutukseen miehiä yleisemmin. Kuntoutukseen osallistuminen oli miehillä yleisintä 65 vuotta täyttäneillä, naisilla 45–64-vuotiailla. Harvinaisinta se oli 16–24-vuotiailla miehillä ja alle 16-vuotiailla naisilla. Suurin osa (90 %) kuntoutukseen osallistuneista oli osallistunut vain yhden osajärjestelmän kuntoutukseen. Useamman osajärjestelmän kuntoutukseen osallistuminen oli naisilla miehiä yleisempää. Ikäryhmistä se oli yleisintä 45–64-vuotiailla ja harvinaisinta alle 16-vuotiailla. Vähintään kahden osajärjestelmän kuntoutukseen osallistuneet olivat keskimäärin vanhempia kuin vain yhden osajärjestelmän kuntoutukseen osallistuneet ja myös naisten osuus oli heillä suurempi. Rekisteritietoja kuntoutuksesta on hankala koota kattavasti, sillä järjestelmä on hyvin hajanainen ja toimijoita ja rekisterinpitäjiä on lukuisia. Myös kuntoutuksen määrittely aineistoista osoittautui vaikeaksi. Yhtenäiset tietojärjestelmät kuntoutuksesta palvelisivat paitsi tutkijoita, myös kuntoutujia. Abstract Prevalence and overlap of participation in rehabilitation in different subsystems – a register-based study among residents of the city of Oulu, Finland, in 2018 Knowledge of the whole spectrum of rehabilitation and of the use of different rehabilitation services by the same individuals is quite fragmented and incomplete. The aim of this study is to examine the prevalence and overlap of participation in rehabilitation in different subsystems among residents of the city of Oulu, Finland, in 2018 using extensive register-based data (N=192,844). The study examines rehabilitation organized by the public social and health care system, by the Social Insurance Institution of Finland, by the earnings-related pension system, as well as physiotherapy in occupational health care and private physiotherapy reimbursed by the Social Insurance Institution of Finland. In 2018, 18 per cent of the residents of Oulu received rehabilitation of at least one of the examined subsystems (N=34,061). Receiving rehabilitation of public social and health care was the most common; the rarest was rehabilitation within the earnings-related pension system. Women participated in rehabilitation more often than men. Using rehabilitation services was most common in men aged 65 and over, and in women aged 45–64. It was least common in men aged 16–24 years and in women under 16 years of age. The majority (90%) of those who participated in rehabilitation had participated in rehabilitation of only one subsystem. Participation in rehabilitation of several subsystems was more common in women than in men. It was most common in those aged 45–64 years and least common in those under 16 years of age. Those who received rehabilitation of at least two subsystems were, on average, older than those who received rehabilitation of only one subsystem, and more often women. It is difficult to compile comprehensive register data on rehabilitation, as the system is very fragmented and there are many organizers and registrars. Defining rehabilitation from the data also proved difficult. Unified information systems on rehabilitation would serve not only researchers but also rehabilitees. Keywords: rehabilitation, register-based research, Finland

scholarly journals A Value-Based Steering Model for Healthcare

2021 ◽  
Vol 1 ◽  
Author(s):  
Laura J. Pitkänen ◽  
Riikka-Leena Leskelä ◽  
Helena Tolkki ◽  
Paulus Torkki
Keyword(s):  
Health Service ◽  
Health Services ◽  
Healthcare System ◽  
Public Service ◽  
Service Provider ◽  
Service System ◽  
Design Science ◽  
Service Needs ◽  
Science Study ◽  
A Value

This article aims to answer how a commissioning body can steer health services based on value in an environment where the commissioner is responsible for the health services of a population with varying health service needs. In this design science study, we constructed a value-based steering model consisting of three parts: (1) the principles of steering; (2) the steering process; and (3) Value Steering Canvas, a concrete tool for steering. The study is based on Finland, a tax-funded healthcare system, where healthcare is a public service. The results can be applied in any system where there is a commissioner and a service provider, whether they are two separate organizations or not. We conclude that steering can be done based on value. The commissioning body can start using value-based steering without changes in legislation or in the present service system. Further research is needed to test the model in practice.

scholarly journals Kualitas Pelayanan Pasien BPJS di Rumah Sakit

2019 ◽  
Vol 7 (1) ◽  
pp. 13-24
Author(s):  
Raina Dwi Miswara ◽  
Samodra Wibawa
Keyword(s):  
Health Services ◽  
Social Insurance ◽  
Public Services ◽  
Basic Needs ◽  
Medical Personnel ◽  
Public Trust ◽  
Queuing System ◽  
The Social ◽  
The Government

Public services have become an important issue in Indonesia for more than a decade. One of them is health services, which is one of the basic needs whose provision must be held by the government as mandated in Article 28 H of the Constitution. For this reason, the Social Insurance Administration Organization (Badan Penyelenggara Jaminan Sosial, BPJS) was established on 1 January 2014. Are services to patients covered by BPJS satisfiying enough? This paper answers this question through literature studies and observations, comparing four hospitals in Java and two outside Java. It was found that there were still many problems in this service, and the most prominent was the queuing system that was unsatisfactory and too few staff and medical personnel and rooms compared to the increasing number of BPJS patients. In order to maintain public trust, the government needs to resolve this problem immediately

scholarly journals Converging perspectives of providers and student users on extending a patient portal into a university-based mental health service: A qualitative study

2020 ◽  
Author(s):  
N Gasteiger ◽  
Theresa Fleming ◽  
K Day
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Qualitative Study ◽  
Health Services ◽  
Mental Health Care ◽  
Patient Portal ◽  
Patient Portals

© 2020 The Authors Background: Patient portals have the potential to increase access to mental health services. However, a lack of research is available to guide practices on extending patient portals into mental health services. This study explored stakeholder (student service users' and health providers') expectations and perceptions of extending patient portals into a New Zealand university-based mental health service. Materials and methods: This qualitative study explored the perspectives of 17 students and staff members at a university-based health and counselling service on an Internet-based patient portal through a software demonstration, two focus groups and 13 interviews. Data were analyzed thematically. Results: Staff and students perceived the patient portal as useful, easy to use and expected it to help make mental health care more accessible. Staff were most concerned with the portal's ability to support their triage processes and that it might enable students to ‘counselor hop’ (see multiple counselors). Staff recommended extension into services that do not require triage. Most students expected the portal to enhance patient-counselor contact and rapport, through continuity of care. Students were concerned with appointment waiting times, the stigmatization of poor mental health and their capacity to seek help. They considered the portal might assist with this. Students recommended extension into all services, including urgent appointments. After viewing findings from initial student and staff groups, staff concluded that extending a patient portal into their counseling services should be prioritized. Conclusion: This research suggests that there is value in extending patient portals into mental health care, especially into low-risk services. Future research should explore opportunities to support triage and appointment-making processes for mental health services, via patient portals.

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