National Health Insurance Proposals: Their Effect on Family Planning and Other Preventive Health Services

1974 ◽  
Vol 6 (2) ◽  
pp. 111
Author(s):  
Donald Fisher
Keyword(s):  
Health Insurance ◽  
Family Planning ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
Preventive Health Services ◽  
Preventive Health

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.

Why Some Countries Have National Health Insurance, others Have National Health Services, and the United States Has Neither

1989 ◽  
Vol 19 (3) ◽  
pp. 383-404 ◽  
Author(s):  
Vicente Navarro
Keyword(s):  
United States ◽  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
Labor Movement ◽  
Health Sector ◽  
Developed Countries ◽  
The United States ◽  
Social Force

This article presents a discussion of why some capitalist developed countries have national health insurance schemes, others have national health services, and the United States has neither. The first section provides a critical analysis of some of the major answers given to these questions by authors belonging to the schools of thought defined as “public choice,” “power group pluralism,” and “postindustrial convergence.” The second section puts forward an alternative explanation rooted in a historical analysis of the correlation of class forces in each country. The different forms of funding and organization of health services, structured according to the corporate model or to the liberal-welfare market capitalism model, have appeared historically in societies with different correlations of class forces. In all these societies the major social force behind the establishment of a national health program has been the labor movement (and its political instruments-the socialist parties) in its pursuit of the welfare state. In the final section the developments in the health sector after World War II are explained. It is postulated that the growth of public expenditures in the health sector and the growth of universalism and coverage of health benefits that have occurred during this period are related to the strength of the labor movement in these countries.

The Impacts of Subsidized Health Insurance on Employees’ Use of Preventive Health Services

2007 ◽  
Vol 30 (1) ◽  
pp. 22-34
Author(s):  
Linda S. Kahn ◽  
Laurene Tumiel-Berhalter ◽  
Renee Cadzow ◽  
Robert Watkins ◽  
Kathleen M. Leonard ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Preventive Health Services ◽  
Preventive Health
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