Comparison of Various Models of Health Insurance

Comparison of Various Models of Health Insurance

Paint: The concept of insurance in health financing has evolved through various approaches of the social (social health insurance) and commercial (commercial health insurance). Developing both Dantara Health Insurance is regulated in a World Bank report (1993) recommended to be implemented as a substitute for the principle Commercial / Private Helath Insurance

In Indonesia, the development of social health insurance (Health Insurance / JK) is regulated in Law No. 40 of 2004 on the Social Security System (Forecast) which is one of the program with Accident Compensation Insurance Program (JKK), Security Hari Tua (JHT), Security Death ( JKM) and the Pension Guarantee (JP). JK program held nationally, based on the principle of social insurance and equity. The goal is to provide benefits kesehatran maintenance and protection in meeting the basic needs of health
The principle of social insurance programs in the Forecast includes JK mandatory participation and non-discriminatory for a formal group, based on percentage revenue contribution to be a burden shared between the giver and the recipient's work to some extent, so that there is mutual between rich and poor, high-risk hospital - low, old and young with the benefits of the same medical service (the principle of equity), and accessible services nationally (portability), is comprehensive, with healthcare benefits promotive, preventive, curative and rehabilitative, including drugs and medical consumable materials. Management is carried out with prudence, nonprofit, transparency and accountability high. Fund of funds mandate program is used as much as possible for the interests of participants.

Specialty programs in the Navigation JK is that the Organizing Board must develop a system of health care, service quality control systems and healthcare payment systems to improve efficiency of health insurance. Organization of health insurance to apply the principles of managed healthcare concept, such as application of the concept of family physicians, the concept of reference, the concept of territory and the prospective payment (Prospective Payment System) as capitation, rates, packages, and DRG's (Diagnosis Related Groups). Drug services provided in accordance with the list and the highest price of medicines, medical materials and consumables specified.