Asuransi Komersial Adalah – 4 Definitions of the Agreement between the two or more parties with which the guarantor is associated with the insured in order to ensure a bonus of the insured from the losses, damage or loss of expected profit or legal responsibility of the third party, which may suffer from the insured event, or gives payment on the basis death or life of a person who is in the army. (Law No. 2 /1992)
5 Risk management, in which a person or group of people (called the owner of politics / participants) transfers a risk that is faced with the payment of bonuses (contributions / contributions) insurance. The risk of an asuradur’s name is used / benefit
Asuransi Komersial Adalah
6 Risk of loss in the form of materials or in the form of loss of production capabilities from the disease. The appearance of deviations from expectations, and then causes losses
Asuransi Allianz Dan 6 Produk Kesehatan Unggulannya
The selection of the PPK with FFS payments zone high -quality participants High fraud and high abuse requires a contract with PPK, PPK participants, the lack of capitalization is required to consider the use of capitalization
The measurability of losses (measurement) is repaired in the seminar => you can see that the loss is more insurance (the number of the most famous should be large) as many participants as possible, as far as possible, many participants
Property insurance: the object belongs (car, gold, house, etc.) insurance against accidents: ensure a loss in the form of legal liability after passing through the CO JULICS: Judicial doctor:
Criteria for requests for social search in insurance premiums through mutual cooperation in relation to justice / control of capital, and not the risk associated with Muda-Mudu, rich voluntary risks associated with state / private payment are not profit / for a small profit
Aswata Oto A+
Criteria for commercial searches are looking for a commercial nature of consumer satisfaction with universal coverage of increased bonuses that meet small needs in response to the basic requirements, it is impossible -> the existence of groups that cannot pay fast bonuses are not available / expensive
Aitses Social Traise, without choosing a beach choice), contributes to a simple and cheap administrative economic growth allows universities of a doctor / policeman all the population (universal coverage) of the needs of a person or a folk growth group in the highest satisfaction products are very diverse, giving consumers a choice without a universal coating
Commercial menu in search of social search for the selection of Bapel less creative uniform services many medical institutions that do not like relatively small financial pools for product management, impossible opportunities are not effective.
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Traditional AITSES Care participants can freely choose a PPK payment using the FFS system, since inflation of the costs of healthcare service providers cannot be controlled
Asuransi Di Jerman Oleh
FFS PPK payment for excessive services to reduce the desired provision of services used for FFS Tarip to ensure excessive provision of services to provide excessive services if they experience too many services
PPK is paid in advance for a person (participant) per month (for example, in a commercial circulation in RP. 3000, PMPM) The total payment depends on the number of participants who choose as PPK tk.I. The main calculation of the capital: a) covering carts that should give ppk b) assumptions
21 Capitalization Capitalization will pass well if: a) the use of the pelvis is relatively large B. The average cost is a relatively small question: which is more likely to be paid capitalization using PT. Pie?
22 catabilization as: install services to provide the supplier. Example: testing, probability conference. Example: 20% (0, 2) determines the average cost. Example: RP.15000 / Service calculate the capacity value: P X cost: 0, 2 x RP.15000: RP. 3000
Cara Bijak Sewaktu Membeli Asuransi
It includes all services that arose in MIS hospitals: in the United States – a private room 1, 100 – a private room of 1000 US dollars.
No. 518 / Menkes / Per / VI / 2008 On Health Care Tariffs for PT Seeks (Perso) of participants and family members at the Public Health Center and the State Hospital
Article 9 of the sick leave expanded levels are determined on the basis of the service rate on the day of medical care and open prices. Advanced levels in the hospital mentioned in paragraph (1) include tariffs for services and services. Tariffs for plants mentioned in paragraphs (2) is the cost of using hospital institutions and institutions, standard means of legal protection, housing and equipment used in the context of observation, diagnosis, treatment, medical rehabilitation and / or other medical services. Tariffs for services mentioned in paragraph (2) include the costs of service providers, diagnosis, treatment, consulting, visits, medical rehabilitation, other medical services and / or service services.
No. Hospital class Carrift class per day (RP) 1. Classes A&B and class II 2. C.
Asuransi Sosial Pengertian
Health Service Supplier (PPK): Type of Hospital: Content’s instance, consists of hospital packages, diagnostic support, medical actions and medicinal services. 1) Package services include: testing and consultations with specialized doctors; Care and accommodation in the medical room; Testing and behavior of specialized doctors; Laboratory package (package IIA); Providing standard drugs and equipment during treatment 2) a radiagist test package (package IIB), a package of ECC) and diagnostic support of an external package 3) consists of: a) a package of medical actions (package III) b) Operating medical measures C) not operational medical measures Measures 4) Medicine services are drugs that correspond to the list and upper ceilings of the prices for medicines (DPHO). 5) Providing sent letters
Only in class A and B without tariff action (RP) 1 Ambalesectomy Abdominotor 2 completed functional neuro -percutateur Paraverteb / Visceral Block 6 Full functional complex of eotaxia 8 complicated functional neuroofyan stereotaxi.
Services included in the Pack II A (PI IIA) Tariff Service package (RP) Piria 33,000 BR. Type of service I. Blood: II. Urine 1 Eosinophilic types 2 erythrocyte bilirubin 3 hematocrite Glucose 4th type 4 hemoglobin Cray 6 Calculation of ketone leukocytes Clot III. Feeces 15 platelets of bacteria 16 versions / her / her / Cher.
Diagnostic groups (DRG) MATES (DRG) are a classification scheme that provides a clinically significant method from the point of view of the number and type of patients who received treatment in the hospital, by resources necessary for the owner. (Fetter, 1991)
Sarana Advokasi & Edukasi
33 Payment of hospital assistance based on DRG is the treatment method in diagnostic hospitals that is not based on the use of medical and medium services provided to the patient in the context of the healing of the disease.
Gold Standard Hospital Hospital Payment of a hospital based on the diagnosis of diseases of the disease SK Menkes No.. 989 / Menkes / SK / IX / 2007 Date 3. September 2007: Group
Class 3 Class 2 Class 1 VIP VVIP 011101 IP Cranitomy 9, 1 011102 IP Cranotomy with MCC 14, 5 044181 IM Astma I Bronchiolit 5, 0 044182 7, 5 044183 8, 5 044183 8, 0
Reduction of administrative expenses for hospitals that improve hospital services
Perbedaan Asuransi Sosial Dan Komersial
His statement requires the dominant third -party payer.
Financial incentives for hospitals for effective management of resources in hospital services. To maintain expenses below the DRG rate, the hospital should try to reduce control of the bad and use
The hospital will treat only patients who really impose a simple operation that will be performed outside the Nujiv hospital, provided as a recovery of a house spent outside the hospital, where patients and families are more responsible for the recovery process
Organization of a clinical trace in order to reduce the training day for Doctor of Socialization of DRG and the influence of the primary diagnosis and secondary diagnosis of an educational encoder
Badan Penyelengara Jaminan Sosial (bpjs) Kesehatan
Outlier (los and component costs compared to standard costs) Monit and high cost) Monitoring the doctor’s behavior to develop the best CASEMIX Center MZ group (Co.) Install “Special Health or“ Outstanding RS services ”for DRGs, which always make a profit for hospitals .
43 insurance strategies to strengthen information systems, special for training data on the requirements of the requirements Fraud detection has become more complicated (upcoding) detection Readmisiih detection / link using a review
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Commercial insurance created by private financial institutions with all customers who can buy their products,
