Sistem Asuransi Kesehatan
Sistem kesehatan di Jerman menerapkan sistem asuransi
kesehatan sosial, dimana seluruh penduduk di Jerman ini diwajibkan
untuk masuk dalam skema ini.
Sistem asuransi di Jerman ada yang sifatnya wajib yang
disebut dengan G kafau dan asuransi yang sifatnya private (P
kafau). Setiap pasien AOK (salah satu asuransi wajib) mempunyai
kartu peserta yang mencantumkan nama, no peserta, tanda tangan
dan perusahaan asuransi. Ketika peserta AOK ingin berobat,
maka dokter tinggal menggesek kartu peserta (seperti kartu kredit)
dan langsung muncul nomor peserta, nama , tanggal lahir, alamat
dan masa berlaku peserta.
Hal yang menarik adalah peluang terjadinya moral hazard
dari provider, karena provider dapat menuliskan poin yang lebih
tinggi. Sebagai contoh jika pasien dianggap sangat cerewet
sehingga memakan waktu konsultasi yang lama, dokter bisa
menuliskan kode konsultasi yang lebih tinggi, misalnya 3.(kode
maksimum untuk konsultasi bisa 5) dan lembaga asuransi hanya
akan membayar jasa konsultasi ini maksimum 2,3 selebihnya pasien
harus menanggung selisih biaya tersebut, namun iur biaya model
ini hanya bisa diterapkan pada model asuransi private.
Sistem pembayaran PPK berdasarkan sistem poin. Pada
akhir bulan, poin-poin dari masing masing dokter akan direkap
oleh asosiasi dokter spesialis dan kemudian akan dibagikan sesuai
dengan anggaran yang ada. Jika dokter over utilisasi, dokter akan
mendapat poin maksimum melebihi dari perkiraan/perencanaan
awal , maka konsekuensinya uang yang diterima dapat lebih kecil
dan hal ini tentunya akan merugikan dokter itu sendiri karena jasa
akan lebih kecil. Oleh karena itu dokter cenderung untuk memberikan
pelayanan sesuai kebutuhan pasien untuk mengantisipasi
kecukupan biaya.
Dengan model di atas, maka pengendalian biaya pelayanan
dokter pada model G kafau dilakukan oleh asosiasi dokter,
sedangkan model private lebih pada hubungan antara dokter
dengan pasien sendiri. Bagi dokter lebih senang melayani pasien
yang peserta asuransi privat, karena menerima lebih banyak dan
besaran dana yang akan diterima dapat dilihat langsung dari poin
dan sistem informasi serta program yang dipasang di ruang praktek
dokter.
Pada model asuransi G kafau, setiap pasien dikenakan iur
biaya 10 euro untuk pelayanan dokter selama 3 bulan. Sebagai
contoh jika pasien Istiti ingin berkunjung ke dokter obsgyn setelah
dari dokter THT/ lainnya.
Sunday, March 22, 2009
Saturday, March 21, 2009
Policy Context
Policy Context
In 1996, Congress passed welfare reform legislation that restrictedb legal noncitizens’ access to public benefits; undocumented immigrants were already ineligible for most benefits. Immediately after enactment of the law, use of public benefits fell, not just
among legal noncitizen children with noncitizen parents, but also among citizen children in mixed-status families (Zimmermann and Fix 1998). About the same time, Congress expanded health care coverage of low-income children by enacting SCHIP, and many
states extended their state-funded health insurance programs to legal noncitizens (Zimmermann and Tumlin 1999). Between 1999 and 2002, the federal government
made it clear that receipt of health benefits would not jeopardize the naturalization of immigrant family members or their adjustment to legal permanent resident status (Schlosberg and Wong 2002), and several states with large immigrant populations made extensive outreach efforts to these families (Holcomb et al. 2003).
The share of all children under age 18 without health insurance coverage fell
from 12.4 percent to 9.4 percent between 1999 and 2002 (data not shown). This gain was driven by a decline in the uninsurance rate for low-income children, which fell by 5.9 percentage points. The uninsurance rate for children in higherincome families did not change significantly during this period (Kenney, Haley, and Tebay 2003).
Uninsurance fell for both groups of low-income citizen children between 1999 and 2002: the rate dropped 6.0 percentage points for children with citizen parents and 7.1 percentage points for children in mixed-status families (figure 1). Nonetheless, 12.4 percent of children with citizen parents and 21.6 percent of children in mixed-status
families were uninsured in 2002. These coverage gaps are consistent with gaps reported in a recent study based on Current Population Survey data (Ku and Waidman 2003).
Improvements in coverage among low-income citizen children are attributable to expanded public—not employer—coverage. These children gained Medicaid/SCHIP coverage at high rates between 1999 and 2002: public coverage increased by 13.0
percentage points for children with citizen parents and 11.6 percentage points for children in mixed-status families (figure 2).
In 1996, Congress passed welfare reform legislation that restrictedb legal noncitizens’ access to public benefits; undocumented immigrants were already ineligible for most benefits. Immediately after enactment of the law, use of public benefits fell, not just
among legal noncitizen children with noncitizen parents, but also among citizen children in mixed-status families (Zimmermann and Fix 1998). About the same time, Congress expanded health care coverage of low-income children by enacting SCHIP, and many
states extended their state-funded health insurance programs to legal noncitizens (Zimmermann and Tumlin 1999). Between 1999 and 2002, the federal government
made it clear that receipt of health benefits would not jeopardize the naturalization of immigrant family members or their adjustment to legal permanent resident status (Schlosberg and Wong 2002), and several states with large immigrant populations made extensive outreach efforts to these families (Holcomb et al. 2003).
The share of all children under age 18 without health insurance coverage fell
from 12.4 percent to 9.4 percent between 1999 and 2002 (data not shown). This gain was driven by a decline in the uninsurance rate for low-income children, which fell by 5.9 percentage points. The uninsurance rate for children in higherincome families did not change significantly during this period (Kenney, Haley, and Tebay 2003).
Uninsurance fell for both groups of low-income citizen children between 1999 and 2002: the rate dropped 6.0 percentage points for children with citizen parents and 7.1 percentage points for children in mixed-status families (figure 1). Nonetheless, 12.4 percent of children with citizen parents and 21.6 percent of children in mixed-status
families were uninsured in 2002. These coverage gaps are consistent with gaps reported in a recent study based on Current Population Survey data (Ku and Waidman 2003).
Improvements in coverage among low-income citizen children are attributable to expanded public—not employer—coverage. These children gained Medicaid/SCHIP coverage at high rates between 1999 and 2002: public coverage increased by 13.0
percentage points for children with citizen parents and 11.6 percentage points for children in mixed-status families (figure 2).
Friday, March 20, 2009
Health Insurance
Health Insurance
Scientists theorize that depression may be caused by an imbalance of naturally occurring chemicals in the brain and body that affect you emotionally and physically. How serious depression becomes can vary. Depression can cause you to experience the world differently and may deprive you of your hopes and dreams.
Because depression is a medical illness like diabetes and heart disease, it can require treatment and help from a healthcare professional.
Further, even when depression is treated it may recur throughout your life. When symptoms don’t go away completely, the risk for depression coming back increases - but getting well is definitely possible.
Symptoms of depression can be emotional and physical and may chang e throughout your life. Emotional symptoms can include:
• Sadness
• Loss of interest or pleasure in activities you once enjoyed
• Feelings of worthlessness or guilt
• Trouble concentrating or keeping your mind on things
• Thinking a lot about your own death or planning suicide
Physical symptoms can include:
• Decrease or increase in appetite
• Feeling tired nearly all the time
• Significant weight gain or loss
• Sleeping too much or too little
• Slowing of thought processes or body movement
Other physical symptoms that can accompany depression include bodily aches and pains, headaches, backaches, and joint pain (such as in the shoulder). If you experience several of these symptoms every day for a period of at least two weeks, it is recommended that you talk to your healthcare professional.
Public health insurance coverage increased—and rates of uninsurance decreased—between 1999 and 2002 among two groups of low-income, U.S. citizen children: those with parents who are native or naturalized U.S. citizens and those with at least
one immigrant parent who is not a U.S. citizen (referred to as mixed-status families).1 The improvements followed efforts on the part of the states and the federal government to expand coverage of children under Medicaid and the State Childre ’s Health
Insurance Program (SCHIP) and the introduction of policies directed at
improving Medicaid and SCHIP access for immigrant and non-Englishspeaking families. Nonetheless, more than one in five citizen children in lowincome mixed-status families remained uninsured in 2002—a rate 74 percent higher than that of children with citizen parents. This Snapshot uses data from the 1999 and 2002 National Survey of America’s Families (NSAF) to examine the health insurance coverage2 of lowincome
citizen children.3 (In 2002, 72 percent of all children with noncitizen parents were themselves citizens and thus qualified for benefits on the same terms as citizen children with citizen parents.) The Snapshot also looks at differences in health insurance coverage between children whose parents or other caregivers responded to the survey in English and those whose family responded in Spanish. Limited English skills—like lack of citizenship—may prevent parents from applying for public benefits for their children (Holcomb et al. 2003).
Scientists theorize that depression may be caused by an imbalance of naturally occurring chemicals in the brain and body that affect you emotionally and physically. How serious depression becomes can vary. Depression can cause you to experience the world differently and may deprive you of your hopes and dreams.
Because depression is a medical illness like diabetes and heart disease, it can require treatment and help from a healthcare professional.
Further, even when depression is treated it may recur throughout your life. When symptoms don’t go away completely, the risk for depression coming back increases - but getting well is definitely possible.
Symptoms of depression can be emotional and physical and may chang e throughout your life. Emotional symptoms can include:
• Sadness
• Loss of interest or pleasure in activities you once enjoyed
• Feelings of worthlessness or guilt
• Trouble concentrating or keeping your mind on things
• Thinking a lot about your own death or planning suicide
Physical symptoms can include:
• Decrease or increase in appetite
• Feeling tired nearly all the time
• Significant weight gain or loss
• Sleeping too much or too little
• Slowing of thought processes or body movement
Other physical symptoms that can accompany depression include bodily aches and pains, headaches, backaches, and joint pain (such as in the shoulder). If you experience several of these symptoms every day for a period of at least two weeks, it is recommended that you talk to your healthcare professional.
Public health insurance coverage increased—and rates of uninsurance decreased—between 1999 and 2002 among two groups of low-income, U.S. citizen children: those with parents who are native or naturalized U.S. citizens and those with at least
one immigrant parent who is not a U.S. citizen (referred to as mixed-status families).1 The improvements followed efforts on the part of the states and the federal government to expand coverage of children under Medicaid and the State Childre ’s Health
Insurance Program (SCHIP) and the introduction of policies directed at
improving Medicaid and SCHIP access for immigrant and non-Englishspeaking families. Nonetheless, more than one in five citizen children in lowincome mixed-status families remained uninsured in 2002—a rate 74 percent higher than that of children with citizen parents. This Snapshot uses data from the 1999 and 2002 National Survey of America’s Families (NSAF) to examine the health insurance coverage2 of lowincome
citizen children.3 (In 2002, 72 percent of all children with noncitizen parents were themselves citizens and thus qualified for benefits on the same terms as citizen children with citizen parents.) The Snapshot also looks at differences in health insurance coverage between children whose parents or other caregivers responded to the survey in English and those whose family responded in Spanish. Limited English skills—like lack of citizenship—may prevent parents from applying for public benefits for their children (Holcomb et al. 2003).
Thursday, March 19, 2009
Mental problems
Mental problems
People with mental health problems can be divided into three broad groups:
1. At any one time, one-sixth of the working age population of Great Britain
experience symptoms associated with mental ill health such as sleep problems,
fatigue, irritability and worry that do not meet criteria for a diagnosis of a mental
disorder but which can affect a person’s ability to function adequately (Office for
National Statistics, 2001).
2. A further one-sixth of the working age population have symptoms that by
virtue of their nature, severity and duration do meet diagnostic criteria (Office
for National Statistics, 2001). These common mental disorders would be treated
should they come to the attention of a healthcare professional. The commonest
of these disorders are depression, anxiety or a mix of the two.
3. The most recent national survey found that about 0.5% of the population
has a probable psychotic illness (Office for National Statistics, 2001) and the
generally accepted estimate is that between 1% and 2% of the population will
have a severe mental illness, such as schizophrenia, bipolar disorder or severe
depression, which requires more intensive, and often continuing, treatment and
care during their lifetime (Wing, 1994).
Although as a group those with a severe mental illness are more disabled than
those with a common mental disorder, there is no clear cut relationship between
diagnosis and disability at the individual level. A person with an anxiety disorder
can be housebound and require intensive support from a carer whereas a person
with schizophrenia can lead a normal life in all respects other than the subjective
experience of their symptoms.
There was little change between 1993 and 2000 in the proportion of the population of
working age that has mental health problems (Office for National Statistics, 2001).
We will not know whether it has increased since then until the results of
the survey undertaken in 2007 is publish Compared with those who do not have a disorder, people aged 16 to 74 with a common mental disorder are more likely to be women (59%) and to be aged between 35 and 54 (45% compared with 38%). They are also more often disadvantaged socially in that they are more likely to be separated or divorced (14% compared with 7%), to live alone (20% compared with 16%) or as a one parent family (9% compared with 4%), to have no for mal qualification (31% compared with 27%), to come from Social Class V (7% compared with 5%) and to be a tenant of
a local authority or a housing association (26% compared with 15%) (Singleton et
al, 2000). Because of these associations, there are more people with mental health
problems in areas of the country that have high levels of social and economic
deprivation. This is reflected in greatly increased rates of presentation and treatment
of mental disorders in both primary and secondary care in socially deprived areas
and, in particular, in deprived inner city areas (Moser, 2001; Harrison et al., 1995).
In keeping with this, rates of claims for Incapacity Benefits on grounds of mental
and behavioural disorders are highest in urban areas (Oxford Economics, 2007)
People with mental health problems can be divided into three broad groups:
1. At any one time, one-sixth of the working age population of Great Britain
experience symptoms associated with mental ill health such as sleep problems,
fatigue, irritability and worry that do not meet criteria for a diagnosis of a mental
disorder but which can affect a person’s ability to function adequately (Office for
National Statistics, 2001).
2. A further one-sixth of the working age population have symptoms that by
virtue of their nature, severity and duration do meet diagnostic criteria (Office
for National Statistics, 2001). These common mental disorders would be treated
should they come to the attention of a healthcare professional. The commonest
of these disorders are depression, anxiety or a mix of the two.
3. The most recent national survey found that about 0.5% of the population
has a probable psychotic illness (Office for National Statistics, 2001) and the
generally accepted estimate is that between 1% and 2% of the population will
have a severe mental illness, such as schizophrenia, bipolar disorder or severe
depression, which requires more intensive, and often continuing, treatment and
care during their lifetime (Wing, 1994).
Although as a group those with a severe mental illness are more disabled than
those with a common mental disorder, there is no clear cut relationship between
diagnosis and disability at the individual level. A person with an anxiety disorder
can be housebound and require intensive support from a carer whereas a person
with schizophrenia can lead a normal life in all respects other than the subjective
experience of their symptoms.
There was little change between 1993 and 2000 in the proportion of the population of
working age that has mental health problems (Office for National Statistics, 2001).
We will not know whether it has increased since then until the results of
the survey undertaken in 2007 is publish Compared with those who do not have a disorder, people aged 16 to 74 with a common mental disorder are more likely to be women (59%) and to be aged between 35 and 54 (45% compared with 38%). They are also more often disadvantaged socially in that they are more likely to be separated or divorced (14% compared with 7%), to live alone (20% compared with 16%) or as a one parent family (9% compared with 4%), to have no for mal qualification (31% compared with 27%), to come from Social Class V (7% compared with 5%) and to be a tenant of
a local authority or a housing association (26% compared with 15%) (Singleton et
al, 2000). Because of these associations, there are more people with mental health
problems in areas of the country that have high levels of social and economic
deprivation. This is reflected in greatly increased rates of presentation and treatment
of mental disorders in both primary and secondary care in socially deprived areas
and, in particular, in deprived inner city areas (Moser, 2001; Harrison et al., 1995).
In keeping with this, rates of claims for Incapacity Benefits on grounds of mental
and behavioural disorders are highest in urban areas (Oxford Economics, 2007)
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