scholarly journals Day Surgery Development Aspects in Slovakia

2020 ◽  
Vol 31 (2) ◽  
pp. 477
Author(s):  
Beáta Gavurová ◽  
Adela Klepáková ◽  
Ladislava Ivančová
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Pilot Study ◽  
Healthcare System ◽  
Social Groups ◽  
Day Surgery ◽  
Insurance Companies ◽  
Social Sphere ◽  
The Social ◽  
Health Insurance Companies

The day surgery is a highly effective tool for providing health care which has been used in Slovakia only for the last decade. The unified system of payment for inpatient or outpatient (day care) surgeries causes the reduction of health insurance companies´ spending. Incorrectly configured and economically demotivating system of refunding is a cause of lagging behind the European average in utilization of day surgery. Without the evaluation of day surgery it is not possible to link the progress in the social sphere, which leads to the restriction of day surgery availability for some social groups and thus the subsequent stagnation of day surgery in Slovakia. This contribution presents a pilot study conducted in Slovakia and its partial findings focused on the development and trends in the implementation of day surgery in order to increase the efficiency healthcare system.

scholarly journals Development of medical insurance in the Russian Federation. At the crossroads. What's next?

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Igor M. Akulin ◽  
Lubov Yu. Zhiguleva
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health ◽  
Insurance Companies ◽  
Health Insurance System ◽  
National Health Care ◽  
Health Insurance Companies ◽  
Compulsory Health Insurance ◽  
The Russian Federation ◽  
Additional Payment

The RF health care reform is gaining momentum. A thorough consideration should be given to the discussion on the need to exclude health insurance companies from the compulsory health insurance system (CHI). Formation of the National Health Care System of Russia is the main problem of the national health care at this stage of reforms. Additional payment for medical services in the CHI by the general public is not advisable. Changes in the regulatory framework of the CHI system is deemed to be the basis for reforming the system of compulsory and voluntary health insurance in Russia.   

scholarly journals Impacts of an Ageing Population on Social Systems – Selected Issues

2021 ◽  
Vol 1 (2) ◽  
pp. 7-17
Author(s):  
Ladislav Průša
Keyword(s):  
Health Insurance ◽  
Social Services ◽  
Social Systems ◽  
Social Benefit ◽  
Population Ageing ◽  
Insurance Companies ◽  
Ageing Population ◽  
The Czech Republic ◽  
The Social ◽  
Health Insurance Companies

Population ageing impacts on all social systems. The aim of this paper is to characterise the impacts of an ageing population on the social services and healthcare systems in the Czech Republic. These are the systems that will be most affected by the growing number of people of post-productive age. For social services, an estimate of the evolution of the number of beneficiaries of care allowance up to 2030 was drawn up on the basis of an analysis of the evolution in the number of beneficiaries of this social benefit by sex, age and degree of dependency in the years 2007 to 2016; for healthcare, an estimate of health insurance companies’ expected expenditure on healthcare was drawn up on the basis of an analysis of the evolution of spending on healthcare by health insurance companies, broken down by clients’ sex and age. The calculations clearly show that both these systems are unprepared for tackling the consequences of population ageing, so the search should begin now for new solutions that would help ensure that both social services and healthcare continue to be provided to clients to the existing standard in the coming period.

scholarly journals IT-Standards and Standardization Approaches in Healthcare

2008 ◽  
pp. 813-820 ◽  
Author(s):  
Ali Sunyaev ◽  
Jan Marco Leimeister ◽  
Andreas Schweiger ◽  
Helmut Krcmar
Keyword(s):  
Health Insurance ◽  
Information Systems ◽  
Healthcare System ◽  
Integrated Treatment ◽  
Insurance Companies ◽  
The Internet ◽  
Healthcare Information ◽  
Systems Research ◽  
Information Systems Research ◽  
Health Insurance Companies

E-health basically comprises health services and information delivered or enhanced through the Internet and related technologies (Eysenbach, 2001). The future healthcare system and its services, enabling e-health, are based on the communication between all information systems of all participants of an integrated treatment. Connecting the elements of each healthcare system (general practitioners, hospitals, health insurance companies, pharmacies, and so on)—even across national boarders—is an important issue for information systems research in healthcare. Current developments, such as upcoming or already-deployed electronic healthcare chip cards (that are to be used across Europe), show the need for Europe-wide standards and norms (Schweiger, Sunyaev, Leimeister, & Krcmar, 2007). In this article, we first outline the advantages of the standards, and then describe their main characteristics. After the introduction of communication standards, we present their comparison with the aim to support the different functions in the healthcare information systems. Subsequently, we describe the documentation standards, and discuss the goals of existing standardization approaches. Implications conclude the article.

PREVENTIVE HEALTH CARE IN RELATION TO HEALTH INSURANCE SYSTEM IN SLOVAKIA

2019 ◽  
Vol 7 ◽  
Author(s):  
Barbara Pavlíková
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Preventive Care ◽  
Preventive Health Care ◽  
Preventive Health ◽  
Insurance Companies ◽  
Socially Disadvantaged ◽  
Cover Concrete ◽  
Health Insurance Companies ◽  
High Control

Introduction: Preventive measures in a field of health care are cheaper than addressing the consequences of neglected diagnosis and treatment. Aim of this study is to present the Slovak legislation and national plans in the field of preventive health care. This issue is discussed in relation to financing of health care from the health insurance. Methods: This study was conducted by using the method of content analysis of selected legislative and non-legislative documents and statistical reports of the Slovak ministries (finance, health) and of health insurance companies. Results: In Slovakia, universal and selective preventive health care is available for health care payers. Number of people who undergo the preventive examination differs in selected areas and the expenditure on medical treatment and addressing the consequences of neglected prevention are still high. Control plans are vague and do not cover concrete steps leading to achievement of goals presented. Access of marginalized groups of population to the preventive health care is still at very low level. Conclusion: The system of preventive health care measures in Slovakia is relatively well-defined in legislation and supports the provision of preventive care. However, it is not enforced. There are no serious sanctions in case of neglecting patient´s obligations and people are not motivated to undergo preventive examinations. Only sanctions that in some cases work are financial. The detailed research of access of people from socially disadvantaged environment to the preventive care is desirable.

scholarly journals On the slow implementation of pilot projects: Suspected causes from the perspective of statutory health insurance funds / Zur zögerlichen Umsetzung von Modellvorhaben: vermutete Ursachen aus Sicht der gesetzlichen Krankenkassen

2018 ◽  
Vol 5 (1) ◽  
pp. 64-71
Author(s):  
Michael Wessels ◽  
Dorith Geuen
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Statutory Health Insurance ◽  
Insurance Companies ◽  
Care Providers ◽  
Pilot Projects ◽  
Insurance Funds ◽  
Health Insurance Companies ◽  
The Law ◽  
Health Insurance Funds

Abstract Background The system of nursing care in Germany is currently changing. For years, a further development of cooperation in the health care sector has been discussed. And thus a change in the distribution of tasks between health care professions. In 2008, the legislature introduced the introduction of pilot projects for the transfer of medicinal tasks to nurses according to § 63 para. 3c Social Code V. The implementation is very sluggish. The aim of the study was to analyze the reasons for this sluggish implementation from the perspective of the statutory health insurance funds. Methods Quantitative survey of all statutory health insurance funds (n=124) in Germany. Results To ensure supply, 94 % of health insurance companies consider the transfer of medical tasks to non-medical care providers as a sensible approach. Also 96 % consider this to be very important in order to ensure care. Although 96 % of health insurance funds support the implementation of pilot projects, only 8 % are in fact involved in such contracts; 71 % do not plan own pilot projects for the future. In the view of the statutory health insurance funds, legal obstacles (90 %), resistance by medical representatives (84 %), unresolved financing (74 %) and liability issues (70 %) as well as non-applicable regulations in G-BA-directive (79 %) and the law (85 %). Less than half (46 %) of the health insurance companies suspect high costs causing the slow implementation. Discussion The amendments adopted by the legislature in the current reform of the law on care professions can be described as appropriate; in particular the fact that statutory health insurance funds should implement and carry out appropriate pilot projects by 31 December 2020.

scholarly journals Risk Management Indicators in Patients with Lymphoma in Colombia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5852-5852
Author(s):  
Paula Ramírez ◽  
Ana Milena Gil ◽  
Juan Camilo Fuentes ◽  
Claudia Lucia Sossa ◽  
Claudia Marcela Chalela ◽  
...  
Keyword(s):  
Risk Management ◽  
Health Insurance ◽  
Healthcare System ◽  
Insurance Companies ◽  
Health Providers ◽  
Management Indicators ◽  
Health Insurance Companies ◽  
Online Voting ◽  
The Impact ◽  
Consensus Report

Abstract Background: Lymphomas are the sixth most common type of cancer in adults in Colombia. According to Cuenta de Alto Costo data from health insurance companies and health providers, there were 10,928 cases (1,257 new cases reported in 2016) of lymphoma in Colombia in 2017. Consequently, it is crucial to develop an instrument to assess and monitor risk management by insurance companies and providers in adults with diagnosis of Hodgkin and non-Hodgkin lymphoma. This would eventually contribute to reduce the impact of the disease in the patients, their families, and the healthcare system. The aim of this study was to establish evidence-based risk management indicators to measure health insurance companies' and health providers' performance in risk control in patients with lymphoma in Colombia. Methods: A consensus report was conducted adapting the method "The RAND/UCLA Appropriateness Method (RAM)". First, a detailed literature review was performed to synthesize the latest evidence on the topic. Second, a list of indicators was pre-selected. Third, expert panel rated the pre-selected indicators in two rounds. During the first-round, experts answered an online questionnaire to rate each indicator from 1 to 7 using a Likert scale. The ratings were made individually with no interaction among panelists. During the second-round, panelists met and discussed each indicator and the ratings. Then, re-rated each indicator individually. Indicators with a score over 80% were considered consensus. Fourth, a panel meeting was conducted to establish final indicators. And finally, results were shared with all actors involved in the Colombian healthcare system. Results: Twenty-four insurance companies representatives, 2 government representatives, and a public advocate participated. After reviewing the literature and a panel discussion, experts pre-selected a list of 25 management indicators which then were submitted to online voting. Twenty-three indicators achieved a high score and were validated, but since the two remaining indicators only received an intermediate score, all 25 indicators were submitted to a second online voting after discussing the first-round results. During the second-round, 3 indicators that were rated "inappropriately" by the panelists due to lack of relevance or viability, were conclusively excluded. Lastly, 15 final management indicators were approved and classified in five different domains (diagnosis, staging, treatment, opportunity, and results-overall survival, relapse-free survival, and mortality) during the panel meeting. Conclusion: Risk management indicators were established by a consensus report to assess and monitor management of patients with lymphoma by insurance companies and health providers. Since management indicators can be assessed from information reported by insurance companies to Cuenta de Alto Costo group, implementing strategies to improve survival rates and health-related quality of life can have great impact decreasing the burden of the disease in the Colombian healthcare system. Disclosures No relevant conflicts of interest to declare.

scholarly journals The lore about private health insurance and pressure on public hospitals

2002 ◽  
Vol 25 (6) ◽  
pp. 72 ◽  
Author(s):  
David Cromwell
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Private Health Insurance ◽  
Aged Care ◽  
Public Hospitals ◽  
Insurance Companies ◽  
Coalition Government ◽  
Department Of Health ◽  
Health Insurance Companies ◽  
Cash Reserves

Since being elected in 1996,the Coalition government has pursued a raft of policies to increase the proportion of Australians with private health insurance. Against some criteria, these policies have been a success. The proportion of Australians with private health insurance had gradually fallen from around 50%in 1984,to be around 30%in late 1998.With the introduction of a 30%rebate on health insurance, and the introduction of premiums based on a person's age at the time of joining a health fund, coverage rose to 45.9%by September 2000 and has dropped only slightly since (AIHW, 2002). Moreover, the cash reserves of the health insurance companies have improved substantially from the unhealthy levels reported in 1997 (Cormack, 2002). It has also succeeded in giving many more people the ability to make a choice about their health care (Department of Health and Aged Care, 1999).

scholarly journals Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis

2020 ◽  
Vol 57 ◽  
pp. 004695802095462
Author(s):  
Wadi B. Alonazi
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
Insurance Industry ◽  
Rejection Rate ◽  
Healthcare Services ◽  
Macro Level ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Health Insurance Companies ◽  
Micro Level

In the insurance industry, the majority of fraud and abuse cases fall into a limited number of patterns, yet false claims normally lead to negative national, local, and organizational effects. Through monitoring the exploitative and abusive behavior commonly found in healthcare services, this paper aims to analyze initiatives implemented by governmental and related healthcare insurance agencies in Saudi Arabia to reduce moral offenses. To accomplish this objective, major governmental health insurance policy documents were analyzed at the macro-level. At the meso-level, semi-structured interviews were conducted with five health insurance professionals on measures undertaken to prevent such incidents. At the micro-level, the critical factors of fraudulent behaviors were analyzed using a retrospective analysis. Data were retrieved from anti-fraud records of ten leading health insurance companies and the focus was mainly on individuals involved in unethical practices between 2014 and 2019. After a full audit was completed, the results concluded that the Saudi healthcare system is composed of twenty-six cooperative health insurance agencies and over 5,202 health services providers. The official documents contain the details of various moral hazard measures. On annual average, more than 196 fraudulent cases were reported with a claim rejection rate of approximately 15%. The majority of fraud cases were reported in dental services with invalid card usage, followed by obstetrics-gynecology services (47 and 113 cases, respectively). Females tended to make up most deceit cases in obstetrics-gynecology with a high level of abuse (95% confidence interval: −83.398 to −24.202; P < .003 and −28 > 638 to −7.362; P < .005, respectively). This study ultimately identifies basic measures employed at the macro-level to reduce moral hazards. However, such measures are not intended to be coherently implemented at the micro-level, especially by health insurance companies and healthcare providers.

scholarly journals Market Reaction to Health Care Law: An Event Study

2013 ◽  
Vol 3 (1) ◽  
pp. 108 ◽  
Author(s):  
Musab Ababneh ◽  
Alex Tang
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Event Study ◽  
Generic Drug ◽  
Abnormal Returns ◽  
Insurance Companies ◽  
Brand Name ◽  
Negative Effect ◽  
Health Insurance Companies ◽  
Health Care Law

We investigate the effect of the U.S. Supreme Court’s decision to uphold President Obama’s health care reform (Patient Protection and Affordable Care Act), and other reform-related events, on the stocks of impacted firms. More specifically, we use an event study methodology to compute cumulative average abnormal returns (CAARs) for health insurance companies, hospitals, brand-name drug makers, and generic drug makers. Overall, we find that the law has a negative effect on health insurance companies, and on generic drug makers. On the other hand, it has a positive effect on hospitals and on brand-name drug makers.

scholarly journals Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Enno Swart ◽  
Bernt-Peter Robra
Keyword(s):  
Health Insurance ◽  
Emergency Care ◽  
Third Party ◽  
Insurance Companies ◽  
Prehospital Emergency Care ◽  
Health Related ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Health Insurance Companies ◽  
Reported Data

Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

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