Health Financing and Referral System - Coggle Diagram
Health Financing and Referral System
The World Health Organization (WHO) states that the ideal budget allocation for health is at least 6% of the state budget (APBN). Meanwhile in developed countries, the budget allocation for health reaches 6%-15%. In Indonesia the budget for the Ministry of Health is less than 5% of the state budget.
In the world of insurance there are 6 basic principles that must be met
Utmost good faith
Definition of Health Financing
costs are the amount of funds that must be provided to organize and or utilize various health efforts needed by individuals, families, groups and communities.
Sources of funding for health costs differ in several countries
Cost assistance from within and outside the country.
Combined government and community budgets.
the health costs can be divided into two types
Medical service fee
Cost of public health services
managed care is a system in which health services are implemented in an integrated manner with the health financing system, which has 5 (five) elements as follows:
Provision of health services by certain providers (select providers).
There are special criteria for determining the provider.
Have a quality control program and utilization management.
Emphasis on promotive and preventive efforts.
There are financial incentives for participants who carry out service according to procedure.
Law of Large Numbers
Insurance requires a large number of participants, so that risk can be distributed evenly and widely and effectively reduced.
This principle is a legal consequence of large numbers, the more participants, the greater the risk that can be reduced. According to analysts in the United States, the number of members of 50,000 per Health Maintenance Organization (HMO), is considered profitable.
The health service referral system
in stages according to medical needs, namely: Starting from the first level of health services by first level health facilities
If further services by specialists are required, the patient may be referred to a second-level health facility.
FINANCING SYSTEM MODEL
Direct Payments by Patients