OPPORTUNITIES TO INTEGRATE IN BULGARIA THE BEST PRACTICES FROM THE USA MODEL OF PRIVATE ENTERPRENEURSHIP HEALTH INSURANCE SYSTEM

2018 ◽  
Vol 28 (1) ◽  
pp. 183-188
Author(s):  
Yordanka Tasheva
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Private Insurance ◽  
Insurance Companies ◽  
Health Insurance System ◽  
Insurance System ◽  
Medical Care Costs ◽  
The Usa ◽  
The Government ◽  
Bulgarian Population

The USA health insurance system is a model that encourages the entrepreneurship development in all kinds of medical care. The problems in USA and partly in Bulgaria concern the big difference between the actual medical care costs and the payment from the health insurance system. The private insurance companies are different in any USA state. In Bulgaria the private insurance companies must be limited and it is necessary to be integrated a central insurance system for the Bulgarian population. It must be controlled by the government state. In Bulgaria must be only one insurance government company and the population shouldn’t be divided as poor or rich, or employed or unemployed. In the present conditions the private insurance companies cannot be controlled by the Bulgarian government by giving any advices about the investments, saved by the played population health care insurances.

scholarly journals Economic Impact of the Health Insurance System on Slovak Medical Spas and Mineral Spring Spas

2020 ◽  
Vol 12 (8) ◽  
pp. 3384
Author(s):  
Ján Derco ◽  
Piotr Romaniuk ◽  
Michal Cehlár
Keyword(s):  
Health Insurance ◽  
Slovak Republic ◽  
Secondary Data ◽  
Financial Statements ◽  
Insurance Companies ◽  
Health Insurance System ◽  
Insurance System ◽  
Health Insurance Companies ◽  
Spa Treatment ◽  
The Individual

The article deals with the financing of spa undertakings through the health insurance system. The analysis is based on the financial statements of 28 spa undertakings operating in the Slovak Republic, their contracts with the individual health insurance companies and secondary data sources (accommodation statistics of these undertakings, the number of medical stays paid by clients themselves and of those covered by public health insurance, the spa treatment expenditure of the health insurance companies, the percentage of this expenditure out of the total expenditure spent by the health insurance companies on health care). The still significant percentage of revenues from the health insurance companies out of the total revenues of spa undertakings shows the prevalence of the medical nature of spa care. At the same time, it reflects the current tax measures related to the spa industry and shows that the introduction of a recreation allowance might influence the future development of spa care.

scholarly journals Application of preventive medicine resources in the health insurance system

2015 ◽  
Vol 13 (4) ◽  
pp. 600-603
Author(s):  
Karla Regina Dias de Oliveira ◽  
Márcia Mello Costa De Liberal ◽  
Paola Zucchi
Keyword(s):  
Health Insurance ◽  
Human Resources ◽  
Organizational Structure ◽  
Preventive Medicine ◽  
Insurance Companies ◽  
Financial Resources ◽  
Health Insurance System ◽  
Inclusion Criteria ◽  
Insurance System ◽  
Health Insurance Companies

ABSTRACT Objective To identify the financial resources and investments provided for preventive medicine programs by health insurance companies of all kinds. Methods Data were collected from 30 large health insurance companies, with over 100 thousand individuals recorded, and registered at the Agência Nacional de Saúde Suplementar. Results It was possible to identify the percentage of participants of the programs in relation to the total number of beneficiaries of the health insurance companies, the prevention and promotion actions held in preventive medicine programs, the inclusion criteria for the programs, as well as the evaluation of human resources and organizational structure of the preventive medicine programs. Conclusion Most of the respondents (46.7%) invested more than US$ 50,000.00 in preventive medicine program, while 26.7% invested more than US$ 500,000.00. The remaining, about 20%, invested less than US$ 50,000.00, and 3.3% did not report the value applied.

The Effect of Copayments and Income on the Utilization of Medical Care by Subscribers to Japan's National Health Insurance System

1995 ◽  
Vol 25 (2) ◽  
pp. 295-312 ◽  
Author(s):  
Scott A. Kupor ◽  
Yong-Chuan Liu ◽  
Jungwoo Lee ◽  
Aki Yoshikawa
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
National Health Insurance ◽  
National Health ◽  
Capita Income ◽  
Health Insurance System ◽  
Per Capita Income ◽  
National Health Insurance System ◽  
Insurance System ◽  
Per Capita

This study uses cross-sectional data from Japan's 47 prefectures covering subscribers to Japan's National Health Insurance system to analyze the effects of income and copayment levels on the utilization of medical care. Multivariate regression models were run for the years 1984 and 1989, with the utilization ratio (number of health insurance claims per 100 insurance subscribers) for total, inpatient, outpatient, and dental services as the dependent variable. Independent variables included copayment per patient day, deflated per capita income, population density, percentage of subscribers over age 65, number of beds and clinics per 1,000 persons, and number of doctors and dentists per 1,000 persons. The data were then stratified according to per capita income and percentage of insurance subscribers over the age of 65 in each prefecture. The copayment amount exhibited a small, but significant negative effect on the utilization of all medical services. Utilization of outpatient care was most sensitive to the copayment rate. The per capita income stratification models revealed the greatest copayment effect on inpatient care for the lowest income group. The results of the age stratification models support popular notions about the use of hospitals by the elderly as substitutes for elderly care facilities. The effects of copayments and income vary not only among the type of medical care (inpatient, outpatient, and dental) but also among the income and age stratifications of groups in the National Health Insurance system.

scholarly journals INVESTIGATION OF POSSIBLE ORGANIZATIONAL CHANGES TO THE HEALTH INSURANCE SYSTEM IN VIETNAM

2021 ◽  
Author(s):  
Mai Thi DOAN ◽  
Sergey I. DUKHNO
Keyword(s):  
Health Insurance ◽  
Cultural Values ◽  
Population Aging ◽  
The Elderly ◽  
Type Model ◽  
Health Insurance System ◽  
Organizational Changes ◽  
Insurance System ◽  
Asian Society ◽  
The Government

Purpose – to identify the prerequisites for organizational changes of the emerging health insurance system in Vietnam. Research methodology - comparative analysis, statistical analysis, case study. Findings – the obligatory health insurance in Vietnam performs its functions only partially. There is still high level of out-of-pocket spending on medical services. First we identified one of the most important challenges to the health insurance system in Vietnam, namely, the population aging. Secondly, we identified and analyzed and the prerequisites (the pre-existing conditions), which can become the basis for the reorganization of the existing health insurance system without major reforms: (1) the cultural values of Asian society, which allow to build a community-based type model of living for the elderly on the basis of “equal with equal”; (2) technological advances in medicine that extend the healthy life of the elderly, (3) trust in traditional medicine, which allows widen the coverage of the poorest “elderly households”. Practical implications - the results of the study require attention from the government and insurance providers when rethinking of organizing process for mandatory medical insurance. Originality/Value – we have identified the ways of possible organizational changes for the health insurance system, making the most of the existing prerequisites. This can help to get closer to the goal of full coverage with health insurance services while achieving a positive social effect. The identified internal reserves make it possible to imple- ment organizational changes without major reforms of the established health insurance system. No studies have been conducted in this perspective.

scholarly journals IMPLEMENTASI KEBIJAKAN TATAKELOLA PESERTA PROGRAM JAMINAN KESEHATAN NASIONAL DI JATIM

2016 ◽  
Vol 2 (01) ◽  
Author(s):  
M. Ali Imron Rosyadi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Poor People ◽  
Care Seeking ◽  
Health Insurance System ◽  
Insurance System ◽  
Insurance Program ◽  
Health Insurance Program ◽  
The Government

Health insurance system is one of the important components in ensuring theneeds of basic human rights, namely health. Government as theimplementing regulations in the fulfillment of basic rights such as healthhave been doing the development, guidance, and acceleration in organizinghealth care. So that the government is very strategic role in theimplementation of the National Health Insurance program (JKN). But thereis one problem JKN program implementation, namely the weakmanagement of the participants. It affects both services and financing JKNprogram. There have been several studies that analyze these problems,among others, the study of health care seeking behavior of participants ofpublic health insurance, the readiness of stakeholders in the implementationof JKN, and the program participant data JKN invalid and not targeted. Sothat in this research conducted a study which aims to analyze themanagement of participants through the method of interpretation, describe,analyze, and the build a model of the implementation of managementpolicies of insured people, and the synchronization of the health insuranceprogram regional level into the health insurance system nationwidemanaged by BPJS Health in the Province of East Java. The results showedthat participants in the program management JKN is not optimal, andcurrently poor people who can not be accommodated in the management ofContribution Recipient (PBI) has been well managed by the regionalgovernment, through the Regional Health Insurance program. Further theparticipant management implementation model is not effective as a modelof policy implementation of Van Metter and Van Horn due to weakoversight of the bureaucratic system and the human resources involved inthe implementation of the management of the participants. Keywords : Implementation of policy, National Health Insurance (JKN), management of participants.

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