USING CASEMIX SYSTEM FOR HOSPITAL REIMBURSEMENT IN SOCIAL HEALTH INSURANCE PROGRAMME

About the Book

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.

About the Author

Dr Syed Mohamed Aljunid is the Founding Professor and Chair of Department of Health Policy and Management, Faculty of Public Health, Kuwait University. He served for more than 30 years as Professor of Health Economics and Public Health Medicine in Faculty of Medicine National University of Malaysia. He was also appointed as the Founding Senior Research Fellow of United Nations University –International Institute for Global Health. Eka Yoshida Syukri is a pharmacist by training with more than 30 years working experience in the National Referral Hospital in Jakarta, Indonesia where she held a number of management positions. She graduated with a PhD in Community Health from the National University of Malaysia and was directly involved in the implementation of Social Health Insurance Programme in Indonesia for the last 13 years