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.
Casemix system or Diagnosis-Related Groups (DRGs) has been implemented in UKM-Medical Centre, currently known as Hospital Canselor Tuanku Muhriz UKM, since 2002 with the deployment of a locally developed MY-DRG casemix grouper. Coding of diagnosis and procedures using ICD-10 and ICD9-CM are among the major variables required for optimum implementation of casemix system. The impact of coding errors on hospital revenue and budget has rarely been assessed in countries that implement casemix system for provider's reimbursement. This book reports an outcome of the first study done in Malaysia to quantify the economic losses due to coding errors. A blinded re-coding process was conducted to evaluate the quality of clinical coding of randomly selected patient medical records from four major specialities in the hospital: Medical, Surgical, Paediatrics and Obstetrics & Gynaecology. The rates of overall coding errors were identified, and the different types of coding errors were analysed and reported in detail. The amount of losses in hospital revenue due to coding errors were estimated in the study. Factors that led to the coding errors of diagnoses and procedures were analysed and presented in this book. It is hope that results of this unique research reported in this book would encourage leaders in hospital services to pay serious attention on the problems and embark on intensive and continues training of coders and other clinical staff to effectively reduce the coding errors in the implementation of casemix system.
Casemix system or Diagnosis-Related Groups (DRGs) has been implemented in UKM-Medical Centre, currently known as Hospital Canselor Tuanku Muhriz UKM, since 2002 with the deployment of a locally developed MY-DRG casemix grouper. Coding of diagnosis and procedures using ICD-10 and ICD9-CM are among the major variables required for optimum implementation of casemix system. The impact of coding errors on hospital revenue and budget has rarely been assessed in countries that implement casemix system for provider's reimbursement. This book reports an outcome of the first study done in Malaysia to quantify the economic losses due to coding errors. A blinded re-coding process was conducted to evaluate the quality of clinical coding of randomly selected patient medical records from four major specialities in the hospital: Medical, Surgical, Paediatrics and Obstetrics & Gynaecology. The rates of overall coding errors were identified, and the different types of coding errors were analysed and reported in detail. The amount of losses in hospital revenue due to coding errors were estimated in the study. Factors that led to the coding errors of diagnoses and procedures were analysed and presented in this book. It is hope that results of this unique research reported in this book would encourage leaders in hospital services to pay serious attention on the problems and embark on intensive and continues training of coders and other clinical staff to effectively reduce the coding errors in the implementation of casemix system.
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.
Thank you for visiting our website. Would you like to provide feedback on how we could improve your experience?
This site does not use any third party cookies with one exception — it uses cookies from Google to deliver its services and to analyze traffic.Learn More.