The Implementation of Fraud Prevention on the National Health Insurance at Salewangan Maros Hospital, Indonesia: A Qualitative Study

Abstract Background: There are currently 14% independent participants in Indonesia's National Health Insurance (INHI) from the overall (199 millions) participants. However, around 43.8% of them do not comply in paying the insurance premium. The purpose of the study is to explore factors that influence delinquent payment of contributions. Methods : The research design was qualitative study with phenomenology approach and constructivism paradigm. Data collected by in-depth interview and using theoretical sampling approach. We recruited 16 respondents of unpaid worker participants who arrear and who obey to pay the premiums from 4 difference cities/ districts. Triangulation was done trough 15 respondents from various stakeholders. We constructed substantive theory from data trough coding, cathegorizing and pattern matching. Results: Compliance of paying insurance premium is affected by the intention to pay for contribution. Meanwhile, the intention to pay is influenced by the understanding of INHI program, financial ability, self attitude, operational system and service quality. These constructs consist of 5 to 8 indicators. To improve payment contribution of independent participants, INHI program has to pay attention for factors originating internally from the participants themselves and also externally: social and institutional environment support and the quality of health care and financing system. Conclusions: INHI program need to improve a proper socialization, mechanisms for collecting beneficiary contributions, and strengthening the healthcare system, both for services and the implementation of the financing system.

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Accrediting private providers with National Health Insurance to better serve low-income populations in Kenya and Ghana: a qualitative study

International Journal for Equity in Health ◽

10.1186/s12939-018-0893-y ◽

2018 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Lauren Suchman

Keyword(s):

Health Insurance ◽

Qualitative Study ◽

National Health Insurance ◽

National Health ◽

Low Income ◽

Private Providers

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Management of chronic non-communicable diseases in Ghana: a qualitative study using the chronic care model

BMC Public Health ◽

10.1186/s12889-021-11170-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hubert Amu ◽

Eugene Kofuor Maafo Darteh ◽

Elvis Enowbeyang Tarkang ◽

Akwasi Kumi-Kyereme

Keyword(s):

Health Insurance ◽

Qualitative Study ◽

National Health Insurance ◽

National Health ◽

Health Professionals ◽

Chronic Care ◽

Management Practices ◽

Communicable Diseases ◽

Effective Management ◽

Non Communicable Diseases

Abstract Background While the burden and mortality from chronic non-communicable diseases (CNCDs) have reached epidemic proportions in sub-Saharan Africa (SSA), decision-makers and individuals still consider CNCDs to be infrequent and, therefore, do not pay the needed attention to their management. We, therefore, explored the practices and challenges associated with the management of CNCDs by patients and health professionals. Methods This was a qualitative study among 82 CNCD patients and 30 health professionals. Face-to-face in-depth interviews were used in collecting data from the participants. Data collected were analysed using thematic analysis. Results Experiences of health professionals regarding CNCD management practices involved general assessments such as education of patients, and specific practices based on type and stage of CNCDs presented. Patients’ experiences mainly centred on self-management practices which comprised self-restrictions, exercise, and the use of anthropometric equipment to monitor health status at home. Inadequate logistics, work-related stress due to heavy workload, poor utility supply, and financial incapability of patients to afford the cost of managing their conditions were challenges that militated against the effective management of CNCDs. Conclusions A myriad of challenges inhibits the effective management of CNCDs. To accelerate progress towards meeting the Sustainable Development Goal 3 on reducing premature mortality from CNCDs, the Ghana Health Service and management of the respective hospitals should ensure improved utility supply, adequate staff motivation, and regular in-service training. A chronic care management policy should also be implemented in addition to the review of the country’s National Health Insurance Scheme (NHIS) by the Ministry of Health and the National Health Insurance Authority to cover the management of all CNCDs.

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