scholarly journals STRATEGY IMPLEMENTATION OF NATIONAL HEALTH INSURANCE USING BALANCED SCORECARD METHOD: A CASE STUDY IN AN – NISA HOSPITAL IN TANGERANG

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Luh Putu Sinthya Ulandari
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Balanced Scorecard ◽  
Business Models ◽  
Clinical Pathways ◽  
Low Cost ◽  
Successful Implementation ◽  
Target Market ◽  
Depth Interview

One of the private hospital successful implementation the National Health Insurance with cost efficiency without neglecting the quality of service is An-Nisa Hospital. This study aimed to finding out the strategy of An-Nisa Hospital in the implementation of the National Health Insurance with Balanced Scorecard. The research was conducted in May 2018 using qualitative approach. Data was collected through in-depth interview to 7 informants from hospital and 2 informants from BPJS Kesehatan. The subjects were selected purposively and the data was analyzed using thematic analysis. The results show that there are several strategies that have been developed and implemented, including: adding types of services, increasing the capacity of inpatients and polyclinics, increasing doctor practice slots, completing medical equipment, applying the principle of low cost and increasing working capital, choosing JKN patients as target market, develop 5 values propotition, complaint management, develop standard operating procedures, develop drug formulary and clinical pathways, carry out operational and audit controls, build business models, form casemix teams and claim management, develop training, giving reward and good salaries, build a competitive work environments, and pay attention to employee career paths. Through this strategy, An-Nisa Hospital is able to implement the JKN Program well and still record a surplus without sacrificing service quality

scholarly journals Analysis of Partnership of Private Practice Midwife in The National Health Insurance Program in District Bungo Jambi Province

2018 ◽  
Vol 3 (1) ◽  
pp. 23
Author(s):  
Nurlie Azwar ◽  
Prastuti Soewondo
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Private Practice ◽  
Rapid Assessment ◽  
Neonatal Care ◽  
Research Approach ◽  
Family Doctors ◽  
Depth Interview ◽  
The Government

On January 1, 2014, the government began to implement the National Health Insurance (NHI) program to realize social welfare for the whole community. Midwifery and neonatal care in the NHI program involves Puskesmas/family doctors and Private Practice Midwife (PPM) as its network. PPM participation in the NHI program in Bungo District was still lacking, only 12 (54.5%) PPM have cooperated with family doctors from 22 existing PPM. This study aimed to get an overview of PPM participation in the NHI program in Bungo District, Jambi Province. The study used qualitative research approach with Rapid Assessment Prosedur design, purposive sampling, and conducted in-depth interview to 10 PPM, Head of Health Office, MPKP BPJS Health Manager, and Chairman of Bungo Regency Section of Indonesian Midwife Organization (IMO). The study was conducted from January to July 2017. The study found that the knowledge, perceptions and attitude towards NHI program were good, but the perceived toward the claim and predetermined tariff procedures were not so good. PPM motivated to join the NHI program as many patients had become NHI participants. Support from the Government, NHI, and IMO were low, either in the form of socialization, or policies. Therefore, the study suggest an improvement in claims procedures, tariffs, and an increase of socialization from government, NHI and IMO on NHI program related to obstetric and neonatal care.

scholarly journals Health insurance literacy: discussion and reaction of Facebook users’ towards the National Health Insurance in Indonesia

2020 ◽  
Author(s):  
Tika Indiraswari ◽  
Stefanus Supriyanto ◽  
Ernawaty ◽  
Nuzulul Kusuma Putri
Keyword(s):  
Social Media ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Prescription Drugs ◽  
Low Cost ◽  
Scientific Information ◽  
Care Utilization ◽  
Health Coverage ◽  
Discussion Forums

Universal Health Coverage always persevered as a pro poor policy in many countries, characterized by a major impact on higher out-of-pocket healthcare costs, with low-cost alternative prescription drugs and capitation payments made to physicians, in order to reduce inequity. These concerns have been discussed widely on social media, including Facebook, but social media are consistently neglected as a source of scientific information. The purpose of this study, therefore, is to analyze the thought process or feelings of individuals about the policies, also focusing on the possible reactions. Hence, a systematic review in the form of discussion forums on the Facebook page of the National Health Insurance Agency, Indonesia was conducted from 2015 to 2016, with regards to the implementation of National Health Insurance, within a year and half after the policy was launched. In addition, the contents of 148 discussions were deductively analyzed, and the findings showed the pragmatic disposition of most Facebook users towards health care utilization, the costs of Insurance, and the possible benefits of payment. Furthermore, the debate conducted in social media related with the policy and its practice issues ought to be countered through appropriate modification.

scholarly journals Studi Kasus : Kesiapan Rumah Sakit An – Nisa Tangerang Dalam Implementasi Program Jaminan Kesehatan Nasional

2019 ◽  
Vol 47 (4) ◽  
Author(s):  
Luh Putu Sinthya Ulandari
Keyword(s):  
Health Insurance ◽  
Human Resources ◽  
National Health Insurance ◽  
National Health ◽  
Thematic Analysis ◽  
Clinical Pathways ◽  
Qualitative Approach ◽  
Hospital Data ◽  
Private Hospitals ◽  
Depth Interviews

Abstract Health facilities play an important role in achieving the goals of National Health Insurance (JKN), to providing health services to all Indonesian people. The study aimed to determine the readiness of An - Nisa Hospital as one of the private hospitals in Tangerang in the implementation of the JKN. This research was conducted in March 2018 using a qualitative approach through in-depth interviews and documentation study. The sample was determined purposively, consisting of 7 internal informants from An - Nisa Hospital. Data were analyzed using thematic analysis. Various preparations have been made by An - Nisa Hospital before the hospital joined the BPJS Kesehatan provider, starting from casemix training, coding, costing, preparing clinical pathways, and learning about an information technology systems used in the JKN era. The addition of human resources, facilities and infrastructure was also carried out to support the implementation of JKN. An - Nisa Hospital formed a casemix team whose task was to compile claim documents and collect claims to BPJS Kesehatan. This study concludes that An - Nisa Hospital had prepared themselves before joining the BPJS Kesehatan provider, and the hospital is fully committed to successful the JKN Program. Keywords: preparation, implementation, national health insurance Abstrak Fasilitas kesehatan memegang peranan penting dalam tercapainya tujuan Jaminan Kesehatan Nasional (JKN) yaitu dalam memberikan pelayanan kesehatan kepada seluruh masyarakat Indonesia. Tujuan dari penelitian ini adalah untuk mengetahui kesiapan dari RS An – Nisa sebagai salah satu rumah sakit swasta di Tangerang dalam implementasi Program JKN. Penelitian dilakukan pada Maret 2018 dengan pendekatan kualitatif. Data dikumpulkan dengan wawancara mendalam dan studi dokumen. Sampel ditentukan secara purposive, yang terdiri dari 7 informan pihak internal RS An – Nisa. Data dianalisis secara deskriptif kualitatif. Berbagai persiapan telah dilakukan oleh RS An – Nisa sebelum mereka bergabung menjadi provider BPJS Kesehatan, mulai dari mengikuti pelatihan casemix, coding, costing, penyusunan clinical pathway, serta menikuti pembelajaran tentang sistem informasi teknologi yang digunakan di era JKN. Penambahan SDM, fasilitas sarana dan prasarana pun dilakukan guna mendukung penyelenggaraan JKN. RS An – Nisa membentuk sebuah tim casemix yang bertugas untuk menyusun dokumen klaim dan melakukan penagihan klaim kepada BPJS Kesehatan. Penelitian ini menyimpulkan bahwa RS An – Nisa telah mempersiapkan diri secara totalitas sebelum bergabung menjadi provider BPJS Kesehatan, serta berkomitmen penuh dalam menyukseskan program JKN. Kata kunci: Persiapan, implementasi, jaminan kesehatan nasional

scholarly journals Knowledge, Attitude and Perception of the National Health Insurance Amongst Health Workers in Ugu District, Kwa-Zulu Natal, South Africa in 2017

2020 ◽  
Vol 13 (1) ◽  
pp. 763-770
Author(s):  
Nagammal Govender ◽  
Ozayr Mahomed
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Care Workers ◽  
Health Workers ◽  
Successful Implementation ◽  
Detailed Knowledge ◽  
Care Workers

Background: South Africa aims to progress towards universal health coverage by implementing the National Health Insurance (NHI). The perception and actions of health care workers influence the successful implementation of any intervention. Aim: The aim of the study was to establish the knowledge, attitude and perception of National Health Insurance amongst health care workers in Ugu in 2017 Methods: A descriptive cross-sectional study using self -administered questionnaires were used to gather information from 380 conveniently selected respondents between October 2017 and December 2017 across all health facilities in Ugu Health District. To establish associations between demographic factors and knowledge, attitude and perception on NHI, Chi- Square (X2) test and multivariate logistic regression were analysed. Results: Most respondents were aware of National Health Insurance (96.84%). However, only 33% had detailed knowledge of the objectives of National Health Insurance. There was a significant relationship between age less than 45 years and more than 10 years of experience on knowledge of National Health Insurance. The overall perception of National Health Insurance was good (61.92%), despite 60% of respondents believing that there was no proper communication regarding National Health Insurance by the government. Healthcare workers who live in the urban residential area had a better perception of National Health Insurance. The attitude towards NHI was positive, as 77.84% of respondents were willing to comply with the requirements of National Health Insurance. Conclusion: A targeted approach for communicating information about the National Health Insurance and an increased investment could improve its credibility and effective application.

scholarly journals Balanced Score Card and Service Delivery at National Health Insurance Fund in Mombasa County, Kenya

2019 ◽  
Vol 3 (VI) ◽  
pp. 251-270
Author(s):  
Mohamed Said Intiswar ◽  
James Maina Rugami
Keyword(s):  
Health Insurance ◽  
Service Delivery ◽  
National Health Insurance ◽  
National Health ◽  
Balanced Scorecard ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
National Health Insurance Fund ◽  
The Balanced Scorecard ◽  
The Public

The Public sector plays a critical role in the effective delivery of public services that are essential to the functioning of a state economy. The service delivery in the public sector has been noted to be ineffective due to self-interest service from the public sector officers, unlike the private sector, where focus is primarily on shareholder value. The study examined the effect of the balanced scorecard and service delivery at the national health insurance fund in Mombasa County, Kenya. The specific objectives of the study were to determine the effect of the financial perspective of the balanced scorecard, the effect of customer perspective of the balanced scorecard, the internal business perspective of balanced and examine the effect of innovation and learning perspective of balanced scorecard on service delivery at national health insurance fund in Mombasa County. The study is anchored on Balanced score card model and agency theory. The study adopted a descriptive survey research design that depicts the attributes of a specific circumstance, occasion, or case.  The targeted population of the study was 158 and the respondents were senior managers, middle level managers, lower level managers and the support staff working at national health insurance fund in Mombasa County. The study finds that the balanced scorecard improves systems of the cost structure, the organization creates more revenue opportunities, net shareholder value is maintained and the asset is well utilized. Additionally, it can be concluded that most employees are delighted with the financial evaluation process by use of the balanced scorecard. The study found a positive relationship between the balanced scorecard components namely customer focus, financial perspective, customer perspective, internal business perspective, innovation, learning aspect and service delivery. The study concluded that customer focus to enhance the service delivery could be through implementing customer satisfaction measures, implementing customer service charter, maintaining product functionality, maintaining customer relationship management and maintaining customer loyalty. The study recommended that the need for NHIF to achieve the balanced scorecard to be able to track financial results while simultaneously monitoring progress through building the capabilities and as well acquiring the intangible assets they would need future growth. Also, the study recommended the organization to consider the issue cost minimization strategy to enhance the service delivery to the customers. In addition to that, there is a need to have a permanent solution to steady funds to be able to meet its obligations. The study further recommended that the organization to embrace the balanced scorecard and will help improve communication between the management and customers thus improve on the quality service hence satisfy the needs of the customers.

scholarly journals Factors affecting independent participants of Indonesia’s National Health Insurance in paying premium compliance: a qualitative study

2020 ◽  
Author(s):  
Deni Kurniadi Sunjaya ◽  
Dewi Marhaeni Diah Herawati ◽  
Adiatma YM Siregar
Keyword(s):  
Health Insurance ◽  
Qualitative Study ◽  
National Health Insurance ◽  
National Health ◽  
Institutional Environment ◽  
Insurance Premium ◽  
Financing System ◽  
Factors Affecting ◽  
Depth Interview

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.

SERVICE QUALITY OF NURSE IN THE SCOPE OF NATIONAL HEALTH INSURANCE IN BATU CITY

2018 ◽  
Vol 2 (1) ◽  
pp. 133
Author(s):  
Sih Ageng Lumadi ◽  
Pipin Shintya Wulandari
Keyword(s):  
Health Insurance ◽  
Service Quality ◽  
National Health Insurance ◽  
National Health ◽  
Second Grade ◽  
Health Provider ◽  
Concept Of Health ◽  
Depth Interview ◽  
Nursing Quality

Introduction. The Program of Indonesian Government in 2014 is to apply health insurance based program which known as National Health Insurance (NHI). The concept of this program is all of Indonesian will have health insurance based on Gotong Royong principal. The concept of health provider will be totally changes in health provider, referral system and financing. This study aimed to known the phenomena of nursing quality assurance under NHI which held in the first and the second grade of health provider in Batu, East Java. Method. Qualitative study with in depth interview was used to explore the phenomena. 18 participants were participating in this study taken based on the inclusion criteria were taken by purposive sampling. There were five theme which were nurse responsiveness, assurance of health provider, tangible, empathy and reliability. Result. The satisfaction of patients receive care in Batu BPJS still not achieved optimally. Discussion. It is suggests for the next researcher to explore the factors which barrier the nurse to give the optimal serveto national health insurance patient.Keywords: Service Quality, Nursing, NHI

PP011 Covering New Medical Devices With Low Cost-Effectiveness Evidence

2017 ◽  
Vol 33 (S1) ◽  
pp. 71-72
Author(s):  
Su-Jin Cho ◽  
Jung Ae Ko ◽  
Lee Yo Seb ◽  
Eun Ji Yun ◽  
Rang Kyoung Ha
Keyword(s):  
Health Insurance ◽  
Cost Effectiveness ◽  
Medical Device ◽  
National Health Insurance ◽  
National Health ◽  
Medical Devices ◽  
Low Cost ◽  
Financial Burden ◽  
New Technology ◽  
Clinical Effectiveness

INTRODUCTION:The Korea National Health Insurance (K-NHI) has covered medical devices with low cost-effectiveness evidence by what is known as the Selective Benefit (SB) since December of 2013 as a type of conditional coverage. Most medical devices in the SB category are new technology and have higher levels of clinical effectiveness and/or functions than those in the benefit category, but they are characterized as being expensive. We compare the K-NHI medical device coverage system to those in Japan and Taiwan so as to be more informed about how to cover and set prices for new medical devices.METHODS:We searched for materials related to medical device coverage or the reimbursement systems of three countries (Korea, Japan, and Taiwan). National health insurance laws, policy reports, and the websites of the Ministries of Health of the respective countries, for instance, were also reviewed.RESULTS:The NHI systems of Korea, Japan, and Taiwan have several similarities with regard to their medical device benefit lists. They reimburse listed medical devices separately although they cover them basically by including procedures or a diagnosis-related group (DRG) fee. The K-NHI reimburses for medical devices with low cost-effectiveness using the actual market medical price, similar to other medical devices in the benefit category. However, there are no detailed rules regarding how to set prices for these devices. Every listed medical device is covered at the notified price in Japan, but the prices of new medical devices with improved functions can add 1 -100 percent of the price to the notified price. The prices of devices related to new medical procedures are determined by cost-accounting methods. The NHI service in Taiwan compensates for medical devices which are alternates but clinically improved types through a balance billing method.CONCLUSIONS:The NHI systems in Japan and Taiwan set prices with regard to reimbursements for new medical devices separately, specifically for devices which are advanced clinically or functionally but expensive. The K-NHI must consider establishing a pricing or reimbursement system for new medical devices through the discussion with stakeholders for reasonable reimbursements and decreasing the financial burden on the K-NHI.

scholarly journals Estimating the effectiveness of national health insurance in covering catastrophic health expenditure: Evidence from South Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255677
Author(s):  
Hyunwoo Jung ◽  
Junhyup Lee
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Low Cost ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Catastrophic Health Expenditure ◽  
Cost Burden ◽  
Out Of Pocket Payments

The catastrophic health expenditure (CHE) indicator has been used to measure the medical cost burden of households. Many countries have institutionalized their health insurance systems to reduce out-of-pocket payments, the main contributor to the financial burden. However, there is no method to estimate how the insurance coverage reduces the CHE. This study proposes an approach to evaluate the effectiveness of insurance in reducing the CHE impacts in terms of incidence and gap, which are based on a modified calculation method of CHE. Additionally, we apply these methods to data from the Korea Health Panel Survey (2011–2016). The results are as follows. First, under the setting of a threshold of 10%, the CHE incidence rate was 19.26% when the Korean national health insurance benefits reduced the CHE’s incidence for 15.17% of the population in 2017. Second, the results of the concentration index of CHE showed that the intensity approach of CHE is better than the incidence approach. Third, the new approach we applied revealed that health insurance reduces the burden of CHE to some degree, although it was not an efficient way to reduce CHE. In conclusion, this study provides new policy approaches to save the finances of national health insurance and reduce the intensity of CHE at the same time by raising the low-cost burden of medical services and lowering that of high cost. Moreover, we suggest that policymakers should focus on income level of the households rather than specific diseases.

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