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Using Casemix System For Hospital Reimbursement In Social Health Insurance Programme
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Book Synopsis Using Casemix System for Hospital Reimbursement in Social Health Insurance Programme by : Syed Aljunid
Download or read book Using Casemix System for Hospital Reimbursement in Social Health Insurance Programme written by Syed Aljunid and published by Partridge Publishing Singapore. This book was released on 2020-11-26 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Book Synopsis Implementation of Casemix System as Prospective Provider Payment Method in Social Health Insurance: a Case Study of Acheh Provincial Health Insurance by : Prof Dr Syed Mohamed Aljunid
Download or read book Implementation of Casemix System as Prospective Provider Payment Method in Social Health Insurance: a Case Study of Acheh Provincial Health Insurance written by Prof Dr Syed Mohamed Aljunid and published by Partridge Publishing Singapore. This book was released on 2022-11-20 with total page 147 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Book Synopsis Transition to Diagnosis-Related Group (DRG) Payments for Health by : Caryn Bredenkamp
Download or read book Transition to Diagnosis-Related Group (DRG) Payments for Health written by Caryn Bredenkamp and published by World Bank Publications. This book was released on 2019-12-19 with total page 69 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Book Synopsis Development of Pharmacy Service Weights in the Implementation of Casemix System for Provider Payment by : Dr Syed M. Aljunid
Download or read book Development of Pharmacy Service Weights in the Implementation of Casemix System for Provider Payment written by Dr Syed M. Aljunid and published by Partridge Publishing Singapore. This book was released on 2017-09-19 with total page 104 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book outlines the use of the casemix system as a provider payment tool in the health system with special focus on cost of pharmacy services of in-patient care. Casemix system, which is traditionally called Diagnosis Related Groups or DRG in more advanced economies, is now being implemented in many developing countries that plan to or have embarked on social health insurance programs as a source of the health funding. Extensive research has been carried out by the authors involving 13,673 patients that were prescribed with 111,794 items of drugs and admitted to one of the premier teaching hospital in Malaysia. Data from this research was vigorously analysed to impute the pharmacy service weights of all relevant casemix groups. This book provides the best reference for pharmacy service weights that can be used as a guide for effective implementation of the casemix system in any country in the world that plans to use the system.
Book Synopsis Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions by : OECD
Download or read book Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions written by OECD and published by OECD Publishing. This book was released on 2015-11-02 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Book Synopsis Measuring Capacity to Care Using Nursing Data by : Evelyn Hovenga
Download or read book Measuring Capacity to Care Using Nursing Data written by Evelyn Hovenga and published by Academic Press. This book was released on 2020-03-13 with total page 500 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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
Book Synopsis EBOOK: Diagnosis-Related Groups in Europe: Moving towards transparency, efficiency and quality in hospitals by : Reinhard Busse
Download or read book EBOOK: Diagnosis-Related Groups in Europe: Moving towards transparency, efficiency and quality in hospitals written by Reinhard Busse and published by McGraw-Hill Education (UK). This book was released on 2011-11-16 with total page 490 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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
Book Synopsis Health Care Finance and the Mechanics of Insurance and Reimbursement by : Michael K. Harrington
Download or read book Health Care Finance and the Mechanics of Insurance and Reimbursement written by Michael K. Harrington and published by Jones & Bartlett Publishers. This book was released on 2015-02-27 with total page 370 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book addresses the methods and process for reimbursement, including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing. With up-to-date coverage of the Affordable Care Act, this text will prepare health administration and health information management students with the necessary tools to successfully transition from the classroom to the health care facility. Some of the topics covered include: claims processing; the Affordable Care Act; Medicare Prospective Payment System (Inpatient); Medicare Outpatient Prospective Payment Systems (Non-Inpatient); coding for the non-HIM professional; revenue cycle management; healthcare fraud and abuse; electronic health records and meaningful use; government incentive programs; recovery audit contractors student & instructor resources. --
Book Synopsis Diagnosis Related Group Case-mix Reimbursement in New Jersey by :
Download or read book Diagnosis Related Group Case-mix Reimbursement in New Jersey written by and published by . This book was released on 1987 with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies by : OECD
Download or read book Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies written by OECD and published by OECD Publishing. This book was released on 2019-10-17 with total page 447 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Book Synopsis Case Mix by : Francis H. Roger France
Download or read book Case Mix written by Francis H. Roger France and published by . This book was released on 2001 with total page 200 pages. Available in PDF, EPUB and Kindle. Book excerpt: The case mix concept has been introduced in the USA more than twenty years ago in order to measure hospital productivity and to promote quality of care. The DRGs were selected by HCFA in 1983 as the case mix classification system for the MEDICARE prospective payment system (PPS). Many other countries have adopted the case mix concept after long periods of testing and accepting, but with large variations in data collection, information standards, grouping tools, financing methods and quality of care developments all over the world. Each country has developed a local clinical and political culture about case mix tools. The present book is intended to update the case mix situation, country by country.
Book Synopsis Health Insurance Handbook by : Hong Wang
Download or read book Health Insurance Handbook written by Hong Wang and published by World Bank Publications. This book was released on 2012-01-18 with total page 141 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well to provide financial risk protection.
Book Synopsis Affordable Excellence by : William A. Haseltine
Download or read book Affordable Excellence written by William A. Haseltine and published by Brookings Institution Press. This book was released on 2013 with total page 198 pages. Available in PDF, EPUB and Kindle. Book excerpt: "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.
Book Synopsis Modern Methods of Clinical Investigation by : Institute of Medicine
Download or read book Modern Methods of Clinical Investigation written by Institute of Medicine and published by National Academies Press. This book was released on 1990-02-01 with total page 241 pages. Available in PDF, EPUB and Kindle. Book excerpt: The very rapid pace of advances in biomedical research promises us a wide range of new drugs, medical devices, and clinical procedures. The extent to which these discoveries will benefit the public, however, depends in large part on the methods we choose for developing and testing them. Modern Methods of Clinical Investigation focuses on strategies for clinical evaluation and their role in uncovering the actual benefits and risks of medical innovation. Essays explore differences in our current systems for evaluating drugs, medical devices, and clinical procedures; health insurance databases as a tool for assessing treatment outcomes; the role of the medical profession, the Food and Drug Administration, and industry in stimulating the use of evaluative methods; and more. This book will be of special interest to policymakers, regulators, executives in the medical industry, clinical researchers, and physicians.
Book Synopsis Governing Health Systems by : Michael R. Reich
Download or read book Governing Health Systems written by Michael R. Reich and published by Routledge. This book was released on 2016-10-21 with total page 346 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Book Synopsis Health System Efficiency by : Jonathan Cylus
Download or read book Health System Efficiency written by Jonathan Cylus and published by Health Policy. This book was released on 2016-12-15 with total page 264 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this book the authors explore the state of the art on efficiency measurement in health systems and international experts offer insights into the pitfalls and potential associated with various measurement techniques. The authors show that: - The core idea of efficiency is easy to understand in principle - maximizing valued outputs relative to inputs, but is often difficult to make operational in real-life situations - There have been numerous advances in data collection and availability, as well as innovative methodological approaches that give valuable insights into how efficiently health care is delivered - Our simple analytical framework can facilitate the development and interpretation of efficiency indicators.
Book Synopsis Diagnosis Related Groups (DRGs) and the Medicare Program by :
Download or read book Diagnosis Related Groups (DRGs) and the Medicare Program written by and published by . This book was released on 1983 with total page 100 pages. Available in PDF, EPUB and Kindle. Book excerpt:
