Analysis Of Risk for Class Shifting And Determinants of BPJS Kesehatan Membership Using Generalized Ordered Logit-Unconstrained Partial Proportional Odds Model

The main source of funding of BPJS Kesehatan comes from the different premium class in which the participant registered. The medical benefits among classes are equivalent, except inpatient facilities. But when the improvement health degree is not linear with the incurred costs, problem would arise. This study aims to analyze class shifting and determinants of BPJS Kesehatan mem- bership. Around 1.53 percent of participants access higher classes, while 5.62 percent access lower classes. Class III participants with inpatient status severity level 2 and 3, reaching 41% and 43%, respectively. In addition, 60% of non-PBI participants are Class II premium participants; most of them are male, productive age, and workers. This research using Generalized Ordered Log- it-Unconstrained Partial Proportional Odds Model concludes that participants who are married tend to choose higher premium class. Whereas productive age participants and a worker is in the lower premium class. The recommendation is the evaluation of membership based on class premium contributions considering potential participants (productive age and workers) who tend should be conducted in a lower class. Although mutual assistance is the principle of National Health Insurance, specific mechanisms should be established to examine the relation of age and health status to each participant regarding the difference in the registered class, besides their economic factors. Abstrak Pendanaan utama BPJS Kesehatan adalah iuran peserta yang besarnya tergantung dari kelas premi yang didaftarkan peser- ta. Manfaat medis setiap kelas adalah setara kecuali fasilitas ruang inap. Di sisi lain, hal ini dapat menimbulkan permasalahan ketika derajat kesehatan tidak linier dengan biaya yang seharusnya dikeluarkan. Penelitian ini bertujuan untuk melihat per- bedaan antara kelas premi saat peserta mengakses pelayanan kesehatan dengan kelas premi yang didaftarkan. Ditemukan 1,53 persen peserta mengakses kelas lebih tinggi dibanding kelas yang terdaftar, dan 5,62 persen peserta yang mengakses kelas lebih rendah dibanding kelas yang terdaftar. Berdasarkan tingkat keparahan saat menjalani rawat inap, diketahui bah- wa peserta kelas III dengan status rawat inap tingkat keparahan 3 (berat) dan 2 (sedang) masing-masing mencapai 41% dan 43%. Selain itu hampir 60 persen peserta yang membayar iuran sesuai dengan ketentuan yang ditetapkan (non PBI) adalah peserta iuran premi Kelas II yang sebagian besar merupakan peserta laki-laki, berusia produktif, dan berstatus sebagai pekerja. Hasil analisis dengan metode Generalized Ordered Logit-Unconstrained Partial Proportional Odds Model disimpulkan bahwa peserta berstatus kawin cenderung berada pada kelas premi yang lebih tinggi. Sedangkan peserta usia produktif serta peserta dengan status pekerja cenderung berada pada kelas premi yang lebih rendah. Rekomendasi yang diberikan adalah evaluasi kepesertaan berdasarkan iuran premi kelas dapat dilakukan kembali mengingat peserta potensial (usia produktif dan berstatus sebagai pekerja) cenderung berada pada kelas yang lebih rendah. Selain itu meskipun asas gotong royong menjadi prinsip pelaksanaan Program JKN, namun sebaiknya dapat dibuat mekanisme tertentu agar dapat dicermati terkait dengan faktor usia dan derajad kesehatan peserta terhadap perbedaan kelas premi peserta yang didaftarkan tanpa mengabaikan kemampuan ekonomi yang bersangkutan.

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

Objective To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). Design Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. Setting United States. Participants A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. Main outcomes and measures Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. Results 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change −28.0% (95% confidence interval −38.4% to −15.8%); adjusted absolute change −$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (−29.0% (−40.5% to −15.3%); −$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change −4.7 (−7.9 to −1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. Conclusion Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act’s implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.

Impact Of Indonesian Islamic Bank To Build Growth Premium Income Of Shari’a Insurance Company In Indonesia Market

In 2017 the Indonesian Islamic Bank contributes premium income to Shari’a Insurance in Indonesia amounting to 1.8 billion rupiah. There are 5 (five) Islamic Banks in Indonesia that contribute premiums to national Shari’a Insurance. The big five Islamic Banks in Indonesia are; Bank Mandiri Shari’a (BMS), Bank Muamalat Indonesia (BMI), Bank Negara Indonesia Shari’a (BNIS), Bank Rakyat Indonesia Shari’a (BRIS) and Bank Mega Shari’a. With increasing income of the National Shari’a Bank, it is expected to have an increasingly income of Shari’a National. Indonesian Islamic Banks give significant contribution to the growth of Shari’a Insurance premiums in Indonesia. While other Shari’a financial instruments in Indonesia such as Shari’a BPR, Leasing Shari’a are not so large, so they have not provided significant premium contributions to National Shari’a Insurance. If other Islamic Financial Instruments can accelerate market share, then of course it will be able to provide additional premiums that are not small to Shari’a Insurance in Indonesia. This research is expected to be further developed in order to increase the income of Islamic banks in Indonesia while at the same time growing national Shari’a Insurance Premium Income. Keywords : Islamic Bank, Sharia Insurance and Takaful.

Public Subsidies for Employees' Contributions to Employer-Sponsored Insurance

Proposals to provide or subsidize health insurance for low-income families must take account of the fact that many workers have access to employer-sponsored insurance (ESI), but decline it because of required employee premium contributions. This article considers a tax credit for the employee share of ESI in the context of a broader program of income-based health insurance tax credits. Helping uninsured workers pay for available ESI could be more cost-effective than subsidizing their coverage in the nongroup market. The credit would also be available to workers who were already covered, both for equity reasons and to reduce the incentives for employers to drop coverage or for workers to shift to subsidized individual plans. One key issue is how to prevent employers from reducing their current health plan contributions to take advantage of the new funding. Other design questions considered by the article include whether workers should be able to choose between ESI and nongroup coverage, whether minimum benefit standards should apply for employer plans, and how to achieve a fair balance in subsidies for group and nongroup coverage.