materi prof supasit gov role
Critical Analysis in the
implementation of Ina-CBG
Supasit Pannarunothai
Centre for Health Equity Monitoring Foundation
Government’s Role: Trend & Policy, Third Indonesian Health Economics Association
29 July 2016 Alana Hotel Yogyakarta Indonesia
Government Intervention
•
•
•
•
Financing
Provision
Regulation
Cash transfer
2
What has been done: Financing?
• Financing – level of finance
• Cost containment – global budget (hard
control)
• Financing tool – Ina CBG development
3
What has been done: Regulation?
• Information for regulation
• Regulation mechanisms – audit
4
Counter-assumptions
•
•
•
•
Governments are non-homogeneous
Governments are unstable
Policies are politically determined
Information asymmetry
5
Thailand Case Study
•
•
•
•
•
•
Required budget: Basic & Catastrophic benefit
Source of finance: Beveridge & Bismarck
Compulsory: 3 schemes vs. single fund
DRG tool for allocation of inpatient budget
Information technology for implementation
Organizational arrangements
– Autonomous bodies – conflict of interest
6
Thailand Case Study
• Multiple funds use one single Thai-DRG tool
• Early acceptor: the National Health Security
Office (NHSO) for 75% of population applied
global budget ceiling as stop-loss to funder
• Social Security Office uses adjusted capitation
rate with separate fixed base rate for RW 2+
• Civil Servant Medical Benefit Scheme pays as
the Central office for Healthcare Information
(CHI) advice with 10 fixed base rates plus 2%
for outlier reimbursement scheme (ORS).
7
Thailand Case Study
• Hard control of global budget by NHSO creates
‘disputed deficits’ that need accurate accrual
accounting system at hospital and funder
levels.
• Soft control with ORS of the CSMBS made
possible because of ‘privileged’ funding level
but with sustainable cost control.
• One single National Clearing House for clain
data submission is being implemented to
reduce inequity gap.
8
Reflections on Ina-CBG
•
•
•
•
•
Good data pooling from all hospitals at BPJS
Good hospital cost data from 157 hospitals
Good data on outpatient and inpatient care
90 Different base rates (tariffs)
Critical success factors include:
– Human resource factors to expand to all MDCs
– Data audit: prepayment and post-payment
– Adequate government funding
9
implementation of Ina-CBG
Supasit Pannarunothai
Centre for Health Equity Monitoring Foundation
Government’s Role: Trend & Policy, Third Indonesian Health Economics Association
29 July 2016 Alana Hotel Yogyakarta Indonesia
Government Intervention
•
•
•
•
Financing
Provision
Regulation
Cash transfer
2
What has been done: Financing?
• Financing – level of finance
• Cost containment – global budget (hard
control)
• Financing tool – Ina CBG development
3
What has been done: Regulation?
• Information for regulation
• Regulation mechanisms – audit
4
Counter-assumptions
•
•
•
•
Governments are non-homogeneous
Governments are unstable
Policies are politically determined
Information asymmetry
5
Thailand Case Study
•
•
•
•
•
•
Required budget: Basic & Catastrophic benefit
Source of finance: Beveridge & Bismarck
Compulsory: 3 schemes vs. single fund
DRG tool for allocation of inpatient budget
Information technology for implementation
Organizational arrangements
– Autonomous bodies – conflict of interest
6
Thailand Case Study
• Multiple funds use one single Thai-DRG tool
• Early acceptor: the National Health Security
Office (NHSO) for 75% of population applied
global budget ceiling as stop-loss to funder
• Social Security Office uses adjusted capitation
rate with separate fixed base rate for RW 2+
• Civil Servant Medical Benefit Scheme pays as
the Central office for Healthcare Information
(CHI) advice with 10 fixed base rates plus 2%
for outlier reimbursement scheme (ORS).
7
Thailand Case Study
• Hard control of global budget by NHSO creates
‘disputed deficits’ that need accurate accrual
accounting system at hospital and funder
levels.
• Soft control with ORS of the CSMBS made
possible because of ‘privileged’ funding level
but with sustainable cost control.
• One single National Clearing House for clain
data submission is being implemented to
reduce inequity gap.
8
Reflections on Ina-CBG
•
•
•
•
•
Good data pooling from all hospitals at BPJS
Good hospital cost data from 157 hospitals
Good data on outpatient and inpatient care
90 Different base rates (tariffs)
Critical success factors include:
– Human resource factors to expand to all MDCs
– Data audit: prepayment and post-payment
– Adequate government funding
9