Demand-side Interventions to Control Moral Hazard in Health Systems, Beneficial or Detrimental: A Systematic Review Study

Rostamkalaee, Zohreh Koohi; Jafari, Mehdi; Gorji, Hasan Abolghasem

doi:10.47176/mjiri.36.69

Cited by 4 publications

(1 citation statement)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moral hazard sekali lagi bukan merupakan perspektif tunggal berdasarkan pasien jaminan kesehatan (demand side) akan tetapi berdasarkan pihak rumah sakit (supply side). Seringkali moral hazard membahas pada demand side sehingga seolah pihak penyelenggara dalam hal ini memiliki kebenaran yang absolut (Rostamkalaee et al, 2022). Penelitian ini didasarkan pada pandangan tersebut sehingga mengambil sisi supply side yaitu moral hazard dari pihak rumah sakit dalam memberikan jaminan kesehatan BPJS.…”

Section: Pendahuluanunclassified

Diskursus Moral Hazard Sebagai Eksistensi Humanitarian Supply Chain Management Jaminan Kesehatan Di Kota Surabaya

Jannah

Muliatie

Aminatuzzuhro

2022

JAE

View full text Add to dashboard Cite

Penelitian ini menganalisis diskursus moral hazard dari penyelenggara negara dalam upaya meningkatkan humanitarian supply chain jaminan kesehatan di Kota Surabaya. Metode penelitian ini merupakan penelitian kualitatif yang menginterpretasikan moral hazard melalui perangkat teori moralitas Immanuel Khan. Metode ini dianggap tepat dengan penggunaan data primer dan sekunder yang ada. Data primer didapatkan berdasarkan observasi secara langsung, indepth interview, dan focus group discussion. Lebih lanjut data sekunder didapatkan dari literatur masa lampau, studi, buku, penelitian, dan dokumen penting lainnya. Fokus penelitian ini adalah moral hazard dan humanitarian supply chain. Kesimpulan penelitian menunjukkan moralitas hubungan manusia dengan manusia lain memiliki kelebihan dan keunggulan pda moralnya. Morallah yang menunjukkan hakikat umat manusia. Kant mengemukakan pendapat bahwa manusia tidak boleh diterapkan sebagai salah satu tujuan. Dalam hal percepatan penanganan di bidang kesehatan efisiensi dan efektivitas dari pengobatan maupun pelayanan sangatlah penting mengingat urgensi dari permasalahan kesehatan yang tinggi. Terbukti dengan penggunaan teknologi dalam negeri yang masih minim meskipun kita tidak menutup mata bahwa ada beberapa teknologi yang digunakan akan tetapi tingkat efektifitasnya masih rendah. Kemajuan teknologi di bidang kesehatan menjadi salah satu tantangan Indonesia kedepan utamanya sebagai peningkatan layanan kesehatan dan stabilitas supply chain.

show abstract

Section: Pendahuluanunclassified

Diskursus Moral Hazard Sebagai Eksistensi Humanitarian Supply Chain Management Jaminan Kesehatan Di Kota Surabaya

Jannah

Muliatie

Aminatuzzuhro

2022

JAE

View full text Add to dashboard Cite

show abstract

The Effect of Digital Supervision of China Basic Medical Insurance on Out-of-pocket Expenditure: Evidence from Quasi-natural Experiment

Wang,

Song,

et al. 2024

INQUIRY

View full text Add to dashboard Cite

Scientific research has shown that the sustainability of public health insurance is crucial for governments to effectively manage the risks associated with populations aging. In response, the Chinese government has initiated efforts to ensure the long-term viability of its medical insurance funds. This study utilizes data from 24 484 respondents in the 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), treating the digital supervision of medical insurance funds as a quasi-natural experiment. The study employs a difference-in-differences (DID) model to evaluate the policy effects and uses heterogeneity analysis to explore variations in impact. The objective is to assess the effectiveness of digital supervision and understand how it achieves its policy goals. The findings indicate that digital supervision of medical insurance funds has a significant positive impact on residents’ out-of-pocket medical expenditure. Heterogeneity analysis reveals that the policy’s effect is particularly strong in urban samples, especially among younger and elderly urban residents, while showing no significant impact on rural populations. This suggests that the policy has a greater influence on groups with higher moral hazard. By implementing digital supervision of medical insurance funds, the Chinese government has ensured the sustainability of these funds, laying a foundation for mitigating the risks associated with population aging. Additionally, the policy has contributed to promoting healthcare equity and reducing the waste of medical resources.

show abstract

K-means clustering of outpatient prescription claims for health insureds in Iran

et al. 2023

View full text Add to dashboard Cite

Objective The segmentation of consumers based on their behavior and needs is the most crucial action of the health insurance organization. This study's objective is to cluster Iranian health insureds according to their demographics and data on outpatient prescriptions. Setting The population in this study corresponded to the research sample. The Health Insurance Organization's outpatient claims were registered consecutively in 2016, 2017, 2018, and 2019 were clustered. Design The k-means clustering algorithm was used to cross-sectionally and retrospectively analyze secondary data from outpatient prescription claims for secondary care using Python 3.10. Participants The current analysis transformed 21 776 350 outpatient prescription claims from health insured into 193 552 insureds. Results Insureds using IQR were split into three classes: low, middle, and high risk. Based on the silhouette coefficient, the insureds of all classes were divided into three clusters. In all data for a period of four years, the first through third clusters, there were 21 799, 7170, and 19 419 insureds in the low-risk class. Middle-risk class had 48 348,23 321, 25 107 insureds, and 14 037, 28 504, 5847 insured in the high-risk class were included. For the first cluster of low-risk insureds: the total average cost of prescriptions paid by the insurance for the insureds was $211, the average age was 26 years, the average franchise was 88.5US$, the average number of medications and prescriptions were 409 and 62, the total average costs of prescriptions Outpatient was 302.5 US$, the total average number of medications for acute and chronic disease was 178 and 215, respectively. The majority of insureds were men, and those who were part of the householder's family. Conclusions By segmenting insurance customers, insurers can set insurance premium rates, controlling the risk of loss, which improves their capacity to compete in the insurance market.

show abstract

Demand-side Interventions to Control Moral Hazard in Health Systems, Beneficial or Detrimental: A Systematic Review Study

Cited by 4 publications

References 60 publications

Diskursus Moral Hazard Sebagai Eksistensi Humanitarian Supply Chain Management Jaminan Kesehatan Di Kota Surabaya

Diskursus Moral Hazard Sebagai Eksistensi Humanitarian Supply Chain Management Jaminan Kesehatan Di Kota Surabaya

The Effect of Digital Supervision of China Basic Medical Insurance on Out-of-pocket Expenditure: Evidence from Quasi-natural Experiment

K-means clustering of outpatient prescription claims for health insureds in Iran

Contact Info

Product

Resources

About