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All Journal Journal of Health Technology Assessment in Midwifery Jurnal Kesehatan Masyarakat
Siregar, Dedy Revelino
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Education Health Professions Immunology & microbiology Public Health

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Health insurance service model on the basis of patient-centered care: a scoping review Imron, Moh Ali; Astuti, Andari Wuri; Faidullah, Hilmi Zadah; Wantonoro; Fatimah, Siti; Manurung, Khaterina Kristina; Febriyanti, Maya; Siregar, Dedy Revelino; Baros, Wan Aisyah
Journal of Health Technology Assessment in Midwifery Vol. 7 No. 1 (2024): May
Publisher : Universitas Aisyiyah Yogyakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31101/jhtam.3607

Abstract

Health insurance provides access to every color of the country to get access to health services in the form of promotive, preventive, curative, and rehabilitative efforts at affordable costs. Integrated health services that focus on patient needs (patient-centered care) will increase the active role of families and communities in making decisions related to health services to be provided and are often associated with health financing and insurance used. This Scoping review aims to explore and map the scientific evidence related to the health insurance model in patient-centered care-based health services. This study uses Arkshey & O'Malley Framework and PRISMA-ScR Checklist. In the identification of articles used using PubMed, EBSCO, ProQuest, Wiley Online Library, and Grey supporting literature such as Google Scholar and appropriate databases. The article inclusion criteria used in the search are primary articles in 2012-2022, articles from relevant Gray literature and databases, scientific articles in English and/ or Indonesian, and scientific articles that focus on the health care insurance model and patient-centered care-based health services. While the exclusion criteria used are articles in the form of guidelines, standard operating procedures, opinion papers, reviews, commentaries, research articles that do not use English and Indonesian, and research articles that focus on medicine-centered care are not included in this review. The keywords used are patient-centered care and health insurance. Assessment of Article quality using the Critical Appraisal Skills Program (CASP) and Joanna Bridge Institute Tools (JBI). A total of 6,388 articles were selected and 14 articles were reviewed. Research articles were reviewed from 8 countries with 12 articles using quantitative research design and 2 articles using qualitative research design. From the review article, the author identified 2 main themes, namely the use of health insurance and the application of patient-centered care. Patient satisfaction among Health Insurance users is higher than patients who do not use health insurance because health insurance provides financial protection for health services. The use of health insurance based on patient-centered care is expected to provide positive benefits to health services such as improving patient healing, reducing unnecessary actions/ care, and reducing the length of hospital treatment so that it is expected to reduce the financing made by patients and health insurance used.
Contracts between Referral Health Facilities and Social Health Insurance in Indonesia and England Puspandari, Diah Ayu; Rimawati, Rimawari; Aristianti, Vini; Fadlika, Findri; Septiani, Trisna; Ruby, Mahlil; Wibowo, Mulyo; Febriyanti, Maya; Siregar, Dedy Revelino; Baros, Wan Aisyiah; Manurung, Kathrina
Jurnal Kesehatan Masyarakat Vol. 20 No. 3 (2025)
Publisher : Universitas Negeri Semarang in collaboration with Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI Tingkat Pusat) and Jejaring Nasional Pendidikan Kesehatan (JNPK)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v20i3.21231

Abstract

Purchasers and providers are important in providing quality health services for participants. This is formally regulated through a contractual mechanism to achieve the potential benefits of strategic health purchasing (SHP) and ensure effectiveness, efficiency, and quality. The experience of contracting with providers differs in each country due to underlying determinants. This study aims to identify differences in contracts between referral health facilities and social health insurance in Indonesia and England. A normative legal research approach is used, utilizing secondary data sources such as literature, regulations, and contractual arrangements. Important clauses in the contract, such as rights and obligations, service tariff setting, agreement period, monitoring and evaluation, settlement of expired or disputed claims, mechanisms for providing information, and handling complaints, have been regulated in contracts in both Indonesia and England. Unlike the case in England, incentive payment policies have not been further regulated in Indonesia’s contracts. Additionally, notification and communication procedures for the parties involved have been integrated into the system in England. It is expected that learning from the NHS contracts will provide the potential for developing a more ideal contract implementation, effective monitoring and evaluation, and the delivery of optimal and high-quality health services.
Co-Authors Astuti, Andari Wuri Baros, Wan Aisyah Baros, Wan Aisyiah Fadlika, Findri Faidullah, Hilmi Zadah Febriyanti, Maya Imron, Moh Ali Manurung, Kathrina Manurung, Khaterina Kristina Rimawati, Rimawari Ruby, Mahlil Septiani, Trisna Siti Fatimah Vini Aristianti, Vini Wantonoro Wantonoro, Wantonoro Wibowo, Mulyo