scholarly journals Effectiveness of an Out-of-Pocket Cost Removal Intervention on Health Check Attendance in Japan

2021 ◽  
Vol 18 (11) ◽  
pp. 5612
Author(s):  
Hiroshi Murayama ◽  
Yuta Takahashi ◽  
Setaro Shimada
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Estimating Equation ◽  
Health Check ◽  
National Health Insurance System ◽  
Financial Barriers ◽  
Health Checks ◽  
Kanagawa Prefecture ◽  
Specific Health

Annual health checks are important for identifying individuals at high risk for cardiometabolic diseases. However, there are socioeconomic disparities in health check attendance rates, and an intervention to lower financial barriers could be useful for increasing health check utilization. In this study, we aimed to evaluate the effectiveness of an out-of-pocket cost removal intervention on health check attendance in Japan. Data were obtained on beneficiaries of the National Health Insurance system of Yokohama City, Kanagawa Prefecture, Japan. In 2018, Yokohama started an intervention to remove out-of-pocket costs for specific health checks for all National Health Insurance beneficiaries. We analyzed data from 2015−2018 (131,295 people aged 40–74 years; 377,660 observations). A generalized estimating equation showed that people were more likely to receive specific health checks in 2018 (after the out-of-pocket cost removal intervention started) than in 2017 (immediately before the intervention; odds ratio [95% confidence interval] = 1.167 [1.149–1.185]), after adjusting for age, gender, tax exemption, and residential area. Stratified analyses revealed that the effectiveness of the out-of-pocket cost removal intervention was greater among the older age group and those who did not receive a tax exemption (i.e., those with relatively higher income). The present study showed that the out-of-pocket cost removal intervention could promote specific health check utilization. This indicates that removing financial barriers could motivate people’s behavior regarding health check attendance.

scholarly journals Effectiveness of an out-of-pocket cost removal intervention on health check attendance in Japan

2020 ◽  
Author(s):  
Hiroshi Murayama ◽  
Yuta Takahashi ◽  
Seitaro Shimada
Keyword(s):  
Health Insurance ◽  
High Risk ◽  
National Health Insurance ◽  
National Health ◽  
Health Check ◽  
Outcome Variable ◽  
National Health Insurance System ◽  
Financial Barriers ◽  
Health Checks ◽  
Specific Health

Abstract Background: Annual health checks are important for identifying individuals at high risk for cardiometabolic diseases. In Japan, there is a nationwide program focused on providing specific health checks to screen for such high-risk individuals aged 40–74 years. However, there are socioeconomic disparities in health check attendance rates, and an intervention to lower financial barriers could be useful for increasing health check utilization. Thus, this study aimed to evaluate the effectiveness of an out-of-pocket (OOP) cost removal intervention on health check attendance in Japan.Methods: Data were obtained on beneficiaries of the National Health Insurance system of Yokohama City, Kanagawa Prefecture, Japan. In 2018, Yokohama started an intervention to remove OOP costs for specific health checks for all National Health Insurance beneficiaries. We analyzed data from 2015−2018 (131,295 people aged 40–74 years; 377,660 observations). Specific health check utilization in each year was set as the outcome variable.Results: A generalized estimating equation showed that people were more likely to receive specific health checks in 2018 (after the OOP cost removal intervention started) than in 2017 (immediately before the intervention; odds ratio [95% confidence interval] = 1.167 [1.149–1.185]), after adjusting for age, gender, tax exemption (a proxy variable for annual income), and residential area. Contrastingly, the likelihood of receiving specific health checks in 2015 and 2016 was almost the same as that in 2017 (1.025 [1.008–1.042] in 2015, and 0.959 [0.945–0.974] in 2016). Subgroup analyses revealed that the effectiveness of the OOP cost removal intervention was greater among the older age group and those who did not receive a tax exemption (i.e., those with relatively higher income). Conclusions: The present study showed that the OOP cost removal intervention could promote specific health check utilization. This indicates that financial incentives could motivate people’s behavior regarding health check attendance. However, as the effectiveness differed by age and income level, policymakers should consider the possibility that removing OOP costs widens the disparities in health check access.

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.

scholarly journals Improving Patient Access to New Drugs in South Korea: Evaluation of the National Drug Formulary System

2019 ◽  
Vol 16 (2) ◽  
pp. 288 ◽  
Author(s):  
Seung-Lai Yoo ◽  
Dae-Jung Kim ◽  
Seung-Mi Lee ◽  
Won-Gu Kang ◽  
Sang-Yoon Kim ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
New Drugs ◽  
Patient Access ◽  
National Health Insurance System ◽  
Formulary System ◽  
South Korean ◽  
National Drug ◽  
Improve Patient

This study reviews and evaluates the national drug formulary system used to improve patient access to new drugs by making reimbursement decisions for new drugs as part of the South Korean national health insurance system. The national health insurance utilizes three methods for improving patient access to costly drugs: risk-sharing agreements, designation of essential drugs, and a waiver of cost-effectiveness analysis. Patients want reimbursement for new drugs to be processed quickly to improve their access to these drugs, whereas payers are careful about listing them given the associated financial burden and the uncertainty in cost-effectiveness. However, pharmaceutical companies are advocating for drug prices above certain thresholds to maintain global pricing strategies, cover the costs of drug development, and fund future investments into research and development. The South Korean government is expected to develop policies that will improve patient access to drugs with unmet needs for broadening health insurance coverage. Simultaneously, the designing of post-listing management methods is warranted for effectively managing the financial resources of the national health insurance system.

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