Using Casemix System For Hospital Reimbursement In Social Health Insurance Programme
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| Author | : Syed Aljunid |
| Publisher | : Partridge Publishing Singapore |
| Total Pages | : 114 |
| Release | : 2020-11-26 |
| Genre | : Health & Fitness |
| ISBN | : 1543761720 |
Social Health Insurance (SHI) is one of the vehicles in achieving Universal Health Coverage. However, in many low- and middle-income countries, implementation of SHI failed to provide efficient and effective coverage due to poor provider payment method. Indonesia has introduced social health insurance in 2014. With the population of more than 270 million, Indonesia is the biggest country in the world that implemented SHI with casemix system (INA-CBG) as the prospective provider payment method. In this book, we presented an outcome of a study implemented in the largest hospital in Jakarta, Indonesia that compared the impact of using casemix system as provider payment method with fee-for-service. A total 32,227 outpatients and 8,270 inpatients medical records were reviewed and included in the study. In addition, a survey was also conducted among billing administrators to assess the cost of the billing process and their perceptions on the two reimbursement methods. The total hospital charges, length of stay of inpatients, rate of unnecessary admissions and cost of billing process were among the indicators of efficiency compared in the study between the two provider payment methods. The book provides comprehensive evidence to confirm the advantages of casemix system as an efficient provider payment method in SHI programme.
| Author | : Caryn Bredenkamp |
| Publisher | : World Bank Publications |
| Total Pages | : 69 |
| Release | : 2019-12-19 |
| Genre | : Medical |
| ISBN | : 1464815216 |
This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.
| Author | : OECD |
| Publisher | : OECD Publishing |
| Total Pages | : 138 |
| Release | : 2015-11-02 |
| Genre | : |
| ISBN | : 9290617322 |
The report focuses on a review of the implementation experience of case-based and DRG mechanisms in the Asia and Pacific region, drawing particularly on research in Australia, Japan, New Zealand, the Republic of Korea, Singapore and Thailand.
| Author | : Evelyn Hovenga |
| Publisher | : Academic Press |
| Total Pages | : 500 |
| Release | : 2020-03-13 |
| Genre | : Science |
| ISBN | : 0128169788 |
Measuring Capacity to Care Using Nursing Data presents evidence-based solutions regarding the adoption of safe staffing principles and the optimum use of operational data to enable health service delivery strategies that result in improved patient and organizational outcomes. Readers will learn how to make better use of informatics to collect, share, link and process data collected operationally for the purpose of providing real-time information to decision- makers. The book discusses topics such as dynamic health care environments, health care operational inefficiencies and costly events, how to measure nursing care demand, nursing models of care, data quality and governance, and big data. The content of the book is a valuable source for graduate students in informatics, nurses, nursing managers and several members involved in health care who are interested in learning more about the beneficial use of informatics for improving their services. Presents and discusses evidences from real-world case studies from multiple countries Provides detailed insights of health system complexity in order to improve decision- making Demonstrates the link between nursing data and its use for efficient and effective healthcare service management Discusses several limitations currently experienced and their impact on health service delivery
| Author | : Reinhard Busse |
| Publisher | : McGraw-Hill Education (UK) |
| Total Pages | : 490 |
| Release | : 2011-11-16 |
| Genre | : Medical |
| ISBN | : 0335245587 |
Diagnosis Related Group (DRG) systems were introduced in Europe to increase the transparency of services provided by hospitals and to incentivise greater efficiency in the use of resources invested in acute hospitals. In many countries, these systems were also designed to contribute to improving – or at least protecting – the quality of care. After more than a decade of experience with using DRGs in Europe, this book considers whether the extensive use of DRGs has contributed towards achieving these objectives. Written by authors with extensive experience of these systems, this book is a product of the EuroDRG project and constitutes an important resource for health policy-makers and researchers from Europe and beyond. The book is intended to contribute to the emergence of a ‘common language’ that will facilitate communication between researchers and policy-makers interested in improving the functioning and resourcing of the acute hospital sector. The book includes: A clearly structured introduction to the main ‘building blocks’ of DRG systems An overview of key issues related to DRGs including their impact on efficiency, quality, unintended effects and technological innovation in health care 12 country chapters - Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Portugal, Spain and Sweden Clearly structured and detailed information about the most important DRG system characteristics in each of these countries Useful insights for countries and regions in Europe and beyond interested in introducing, extending and/ or optimising DRG systems within the hospital sector
| Author | : Prof Dr Syed Mohamed Aljunid |
| Publisher | : Partridge Publishing Singapore |
| Total Pages | : 147 |
| Release | : 2022-11-20 |
| Genre | : Business & Economics |
| ISBN | : 154377198X |
The Government of Aceh Province in Indonesia has established the Social Health Insurance (SHI) called Jaminan Kesehatan Aceh (JKA) in 2006 that provide health coverage to all 4.6 million population of the province. Fee-for-service was initially used as the provider payment method in the programme until 2013. In 2014, in line with the National Health Insurance of Indonesia (Jaminan Kesehatan Nasional JKN), INA-CBG (Indonesia Case-Based Group) casemix system was adopted by JKA to replace the Fee-for-Service method. This book presents outcome of the evaluation done using a combination of qualitative and quantitative methods on the implementation of JKA programme. The quantitative study was conducted to assess income of three selected hospitals (Type B, C and D) reimbursed using INA-CBG groups covering more than 17,000 cases. Quantitative data analysis revealed that overall, the hospitals received 32.4% higher income when reimbursed with casemix system (INA-CBG) as compared to fee-for-service. Type D hospital is the biggest gainer with 81.0% increase in income. In conclusion, the use of Casemix (INA-CBG) as a prospective payment method has benefitted the hospitals a lot. It is hope that additional resources gained through this programme will allow the hospitals to provide optimum care to the population.
| Author | : OECD |
| Publisher | : OECD Publishing |
| Total Pages | : 447 |
| Release | : 2019-10-17 |
| Genre | : |
| ISBN | : 9264805907 |
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
| Author | : Michael R. Reich |
| Publisher | : Routledge |
| Total Pages | : 346 |
| Release | : 2016-10-21 |
| Genre | : Business & Economics |
| ISBN | : 1351861719 |
Governing Health Systems: For Nations and Communities Around the World examines the complex relationships between governance and performance in community and national health systems. Each chapter provides an in-depth case study, using both qualitative and quantitative methods, on health systems in many countries, including Uganda, Ghana, India, Zambia, Japan, Nigeria, Indonesia, Brazil, Palestine, and South Korea. The chapters were written by former Takemi Fellows, who were mid-career research fellows at the Harvard T.H. Chan School of Public Health, and their colleagues. This case study approach yields important findings as well as contextual insights about the challenges and accomplishments in addressing governance issues in national and community health systems around the world. Health policymakers around the world are struggling to address the multiple challenges of governing health systems. These challenges also represent important themes for the research mission of the Takemi Program in International Health at the Harvard T.H. Chan School of Public Health. This book is based on the program’s thirtieth anniversary symposium held in October 2013 at Harvard. The studies presented in this book—deep examinations of illustrative examples of health system governance for communities and nations—contribute to our knowledge about global health and assist policymakers in dealing with the complex practical problems of health systems. In short, this book addresses central questions about governing health systems—and why governance matters.
| Author | : William A. Haseltine |
| Publisher | : Brookings Institution Press |
| Total Pages | : 198 |
| Release | : 2013 |
| Genre | : Business & Economics |
| ISBN | : 0815724160 |
"Today Singapore ranks sixth in the world in healthcare outcomes well ahead of many developed countries, including the United States. The results are all the more significant as Singapore spends less on healthcare than any other high-income country, both as measured by fraction of the Gross Domestic Product spent on health and by costs per person. Singapore achieves these results at less than one-fourth the cost of healthcare in the United States and about half that of Western European countries. Government leaders, presidents and prime ministers, finance ministers and ministers of health, policymakers in congress and parliament, public health officials responsible for healthcare systems planning, finance and operations, as well as those working on healthcare issues in universities and think-tanks should know how this system works to achieve affordable excellence."--Publisher's website.
| Author | : Huihui Wang |
| Publisher | : World Bank Publications |
| Total Pages | : 101 |
| Release | : 2017-08-14 |
| Genre | : Business & Economics |
| ISBN | : 1464811180 |
Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.
