scholarly journals Sistem Pendukung Keputusan Pemberian Uang Pertanggungan Terhadap Claimer Asuransi Kesehatan Menggunakan Metode SAW

2021 ◽  
Vol 4 (5) ◽  
pp. 363-369
Author(s):  
Dedi Setiawan Halawa ◽  
Fristi Riandari
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Research Problem ◽  
Decision Makers ◽  
Medical Expenses ◽  
Interactive Tools ◽  
Calculation Results ◽  
Health Insurance Claims ◽  
Simple Additive Weighting ◽  
To Receive

DSS can provide interactive tools that allow decision makers to perform various analyzes of the available models. There are several methods used in DSS and one of them is the Simple Additive Weighting (SAW) method. The criteria used in determining the sum insured are length of stay, accidents and medical expenses. The application system can only provide recommendations for the provision of sum assured for health insurance claims at PT. Jasindo Health Care. The formulation of the research problem is to apply the Simple Additive Weighting (SAW) method in determining the award of sum insured to health insurance claimers using the PHP programming language, database, mysql. The calculation results show that Alternative A1 has the highest V value, namely V1 = 100, so alternative A1 is the most entitled to receive the sum insured against health insurance claimers at Jasindo Health Care.

scholarly journals Decomposition of outpatient health care spending by disease - a novel approach using insurance claims data

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Stucki ◽  
Janina Nemitz ◽  
Maria Trottmann ◽  
Simon Wieser
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Claims Data ◽  
Health Care Spending ◽  
Insurance Claims ◽  
Diagnostic Coding ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Health Insurance Claims ◽  
Disease Specific

Abstract Background Decomposing health care spending by disease, type of care, age, and sex can lead to a better understanding of the drivers of health care spending. But the lack of diagnostic coding in outpatient care often precludes a decomposition by disease. Yet, health insurance claims data hold a variety of diagnostic clues that may be used to identify diseases. Methods In this study, we decompose total outpatient care spending in Switzerland by age, sex, service type, and 42 exhaustive and mutually exclusive diseases according to the Global Burden of Disease classification. Using data of a large health insurance provider, we identify diseases based on diagnostic clues. These clues include type of medication, inpatient treatment, physician specialization, and disease specific outpatient treatments and examinations. We determine disease-specific spending by direct (clues-based) and indirect (regression-based) spending assignment. Results Our results suggest a high precision of disease identification for many diseases. Overall, 81% of outpatient spending can be assigned to diseases, mostly based on indirect assignment using regression. Outpatient spending is highest for musculoskeletal disorders (19.2%), followed by mental and substance use disorders (12.0%), sense organ diseases (8.7%) and cardiovascular diseases (8.6%). Neoplasms account for 7.3% of outpatient spending. Conclusions Our study shows the potential of health insurance claims data in identifying diseases when no diagnostic coding is available. These disease-specific spending estimates may inform Swiss health policies in cost containment and priority setting.

Correlates of Receiving Reproductive Health Care Services Among U.S. Men Aged 15 to 44 Years

2011 ◽  
Vol 5 (4) ◽  
pp. 358-366 ◽  
Author(s):  
Marina J. Chabot ◽  
Carrie Lewis ◽  
Heike Thiel de Bocanegra ◽  
Philip Darney
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Reproductive Health ◽  
Health Services ◽  
Hiv Testing ◽  
Birth Control ◽  
Physical Exam ◽  
Reproductive Health Services ◽  
Reproductive Health Care ◽  
To Receive

Men have a significant role in reproductive health decision making and behavior, including family planning and prevention of sexually transmitted diseases (STDs).Yet studies on reproductive health care of men are scarce. The National Survey of Family Growth 2006-2008 provided data that allowed assessment of the predisposing, enabling, and need factors associated with men’s receipt of reproductive health services in the United States. Although more than half (54%) of U.S. men received at least one health care service in the 12 months prior to the survey, far fewer had received birth control counseling/methods, including condoms (12%) and STD/HIV testing/STD treatment (12%). Men with publicly funded health insurance and men who received physical exam were more likely to receive reproductive health services when compared with men with private health insurance and men who did not receive a physical exam. Men who reported religion was somewhat important were significantly more likely to receive birth control counseling/ methods than men who stated religion was very important. The pseudo- R2 (54%), a measure of model fit improvement, suggested that enabling factors accounted for the strongest association with receiving either birth control counseling/ methods or STD/HIV testing/STD treatment.

scholarly journals The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)

2019 ◽  
Vol 26 (11) ◽  
pp. 1305-1313 ◽  
Author(s):  
Maureen A Smith ◽  
Mary S Vaughan-Sarrazin ◽  
Menggang Yu ◽  
Xinyi Wang ◽  
Peter A Nordby ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Case Management ◽  
Health Care Utilization ◽  
Health Systems ◽  
Claims Data ◽  
Care Utilization ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Health Insurance Claims

Abstract Objective Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process. We sought to determine whether the evaluation of programs for high-need high-cost patients required claims data to match cases to comparison patients. Materials and Methods A retrospective cohort study design with multiple measures of before-and-after health care utilization for 1935 case management patients and 3833 matched comparison patients aged 18 years and older from 2011 to 2015. EHR and claims data were extracted from 3 health systems participating in PCORNet. Results Without matching on claims-based health care utilization, the case management programs at 2 of 3 health systems were associated with fewer hospital admissions and emergency visits over the subsequent 12 months. With matching on claims-based health care utilization, case management was no longer associated with admissions and emergency visits at those 2 programs. Discussion The results of a PCORNet-facilitated evaluation of 3 programs for high-need high-cost patients differed substantially depending on whether claims data were available for matching cases to comparison patients. Conclusions Partnering with learning health systems to rapidly evaluate programs for high-need high-cost patients will require that PCORNet facilitates comprehensive and timely access to both electronic health records and health insurance claims data.

scholarly journals Health Expenditure Difference according to Individual Copayment in National Health Insurance System

2021 ◽  
Vol 14 (1) ◽  
pp. 225-232
Author(s):  
Ki C. Kim ◽  
Soon C. Kwon
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
South Korea ◽  
National Health Insurance ◽  
National Health ◽  
Low Ses ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
Medical Expenses ◽  
The Government

Background: South Korea adopt a mandatory national health care system covering all citizens and consisting of the National Health Insurance System (NHIS) and Medical Aid Program (MAP), which cover individuals of non-low and low Socioeconomic Status (SES), respectively. Objective: We investigated and compared the medical expenses per claim in South Korea for SES individuals, to predict health care expenditure and provide fundamental data regarding care for individuals with limited finances. Methods: The inpatient data on NHIS and MAP beneficiaries were derived from the National Health Insurance Statistical Annual Report of South Korea from 2011 to 2015. Medical expenses per claim for the NHIS and MAP were investigated by gender and age, and the ratio of expenses per claim under MAP to that under NHIS was calculated. Results: The ratio from 2011 to 2015 was consistently larger than 1 and increased at an inconsistent rate with each consecutive age group until 30-39 years, and decreased thereafter (Males: 1.09-3.47, Females: 1.07-1.95). Conclusion: The results of this study indicated that higher medical expenditures and longer durations of claim in the low SES group may become obstacles to developing a sustainable health care system. The government should induce social activities of working-age low-SES people to reduce the burden on the government and help them lead a healthy life.

Large Health Savings Accounts: A Step toward Tax Neutrality for Health Care

2008 ◽  
Vol 11 (2) ◽  
Author(s):  
Michael F. Cannon
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Benefits ◽  
Health Care Sector ◽  
Tax Neutrality ◽  
Health Savings Accounts ◽  
Savings Accounts ◽  
Health Related ◽  
The Creation ◽  
To Receive

The creation of tax-free health savings accounts presents a new opportunity to reduce the distortions created by federal tax preferences for health-related expenditures that ultimately could help eliminate those distortions. This paper proposes changes to current law that would allow most workers to receive the full amount that they and their employer spend on their health benefits as a tax-free cash contribution to the worker's health savings account. Restructuring the exclusion for employer-sponsored health benefits in this way would enable more individuals to obtain health insurance that matches their preferences, would increase efficiency in the health care sector, and could reduce inequities created by the exclusion. These changes also offer a means of limiting the currently unlimited tax exclusion for employer-sponsored health benefits that may be more politically feasible than past proposals.

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