A critical assessment of health care purchasing in Tanzania: a comparison of the mandatory National Health Insurance Fund and voluntary Community Health Fund
This presentation was given at the International Health Economics Association (iHEA) World Congress in Milan, in July 2015. It includes results and policy implications from the RESYST Purchasing Study conducted Tanzania.
Strategic purchasing: a comparative assessment of Civil Servant Medical Benef...resyst
This presentation was given at the International Health Economics Association (iHEA) World Congress in Milan, in July 2015. It includes results and policy implications from the RESYST Purchasing Study conducted in Thailand
The Alliance for Healthcare Transformation provides a wide range of services to help healthcare organizations address the changing healthcare landscape and requirements under the Affordable Care Act. These services include population health assessments and best practices, electronic health records evaluations and clinical systems, patient safety programs, financial and revenue cycle management, monetizing healthcare assets, and international healthcare consulting. The goal is to help providers improve quality of care, health outcomes, and cost efficiency through evidence-based programs and recommendations.
A critical analysis of purchasing arrangements operating under the tax-funded...resyst
The document summarizes the tax-funded health system in South Africa. It describes how tax funds are collected and allocated to provincial departments of health. The provincial departments then allocate funds to public health providers to offer services. It also outlines the actors involved, including the national department of health, provincial treasuries, public and private providers, and citizens. Finally, it discusses challenges in the purchaser-provider and purchaser-citizen relationships and implications for policy around strategic purchasing.
This document summarizes a draft review of literature on paying for health services. The preliminary results suggest that increasing user fees reduces demand for preventive and curative care, especially outpatient care. While fees were intended to generate revenue, studies show they raise little money and disproportionately exclude the poor. The recommendations are that user fees are an inappropriate financing mechanism and should be replaced with pre-paid options to facilitate cross-subsidization for the poor.
Medicare Shared Savings Program--Foundation for a Clinically Integrated NetworkPYA, P.C.
Call them what you will—accountable care organizations, clinically integrated networks, community care organizations—collaborative efforts between independent providers are cropping up to address the challenges created by new payment and delivery models. Already faced with disparities in healthcare not found in urban areas, rural providers must develop new affiliation strategies to overcome these obstacles.
PYA Principal Martie Ross, in partnership with the National Rural Health Association, conducted a Rural Accountable Care Organizations webinar, "Medicare Shared Savings Program--Foundation for a Clinically Integrated Network."
Malawi Mid-Year Review 2014-2015 Health Sector Overviewmohmalawi
The document summarizes the mid-year review of Malawi's health sector for the period of July-December 2014. It outlines key highlights including a continued focus on maternal, neonatal and child health as well as responding to emergencies like floods, cholera outbreaks, and the Ebola threat. It provides details on health sector financing, performance of health systems and service delivery, and reforms being pursued to improve quality and efficiency. Overall resources for the 2014/15 fiscal year were mapped at MK278.8 billion, with the government contributing 92% of the required funding for the health sector pool.
Strategic purchasing: a comparative assessment of Civil Servant Medical Benef...resyst
This presentation was given at the International Health Economics Association (iHEA) World Congress in Milan, in July 2015. It includes results and policy implications from the RESYST Purchasing Study conducted in Thailand
The Alliance for Healthcare Transformation provides a wide range of services to help healthcare organizations address the changing healthcare landscape and requirements under the Affordable Care Act. These services include population health assessments and best practices, electronic health records evaluations and clinical systems, patient safety programs, financial and revenue cycle management, monetizing healthcare assets, and international healthcare consulting. The goal is to help providers improve quality of care, health outcomes, and cost efficiency through evidence-based programs and recommendations.
A critical analysis of purchasing arrangements operating under the tax-funded...resyst
The document summarizes the tax-funded health system in South Africa. It describes how tax funds are collected and allocated to provincial departments of health. The provincial departments then allocate funds to public health providers to offer services. It also outlines the actors involved, including the national department of health, provincial treasuries, public and private providers, and citizens. Finally, it discusses challenges in the purchaser-provider and purchaser-citizen relationships and implications for policy around strategic purchasing.
This document summarizes a draft review of literature on paying for health services. The preliminary results suggest that increasing user fees reduces demand for preventive and curative care, especially outpatient care. While fees were intended to generate revenue, studies show they raise little money and disproportionately exclude the poor. The recommendations are that user fees are an inappropriate financing mechanism and should be replaced with pre-paid options to facilitate cross-subsidization for the poor.
Medicare Shared Savings Program--Foundation for a Clinically Integrated NetworkPYA, P.C.
Call them what you will—accountable care organizations, clinically integrated networks, community care organizations—collaborative efforts between independent providers are cropping up to address the challenges created by new payment and delivery models. Already faced with disparities in healthcare not found in urban areas, rural providers must develop new affiliation strategies to overcome these obstacles.
PYA Principal Martie Ross, in partnership with the National Rural Health Association, conducted a Rural Accountable Care Organizations webinar, "Medicare Shared Savings Program--Foundation for a Clinically Integrated Network."
Malawi Mid-Year Review 2014-2015 Health Sector Overviewmohmalawi
The document summarizes the mid-year review of Malawi's health sector for the period of July-December 2014. It outlines key highlights including a continued focus on maternal, neonatal and child health as well as responding to emergencies like floods, cholera outbreaks, and the Ebola threat. It provides details on health sector financing, performance of health systems and service delivery, and reforms being pursued to improve quality and efficiency. Overall resources for the 2014/15 fiscal year were mapped at MK278.8 billion, with the government contributing 92% of the required funding for the health sector pool.
Central hospitals in Malawi face challenges including inadequate staffing, especially specialists, and poor quality of care. Reforms are proposed to address this, including establishing public trust hospitals with autonomous governance boards. This would give hospitals more control over management and finances while still remaining publicly owned. The objectives are to improve quality, access, and efficiency as well as strengthening support for districts and urban health services. A roadmap outlines steps for implementation over several years.
Is strategic purchasing feasible in publicly funded health systems with integ...resyst
This document summarizes a presentation on whether strategic purchasing is feasible in publicly funded health systems with integrated purchasing and provision. It defines strategic purchasing as continuously searching for the best ways to maximize health system performance by deciding which interventions to purchase, how, and from whom. The presentation explores the principal-agent relationships within these systems, compares ideal strategic purchasing to actual practice, and describes the qualitative research methods used, including document reviews, interviews, and focus group discussions with governments, purchasers, providers, and communities in multiple countries.
presentation is all about ppp in one hand and ppp in health on the other. ppp is not only remain as collaboration for the use of government mobey by the private party but now has legal and administrative aspects as well. however, to make ppp as vibrant and result oriented, mutual trust has to biult between both the parties that would be supplemented by some successful cases of ppp specially in health sector.
This document discusses options for rural hospitals and providers to transition to accountable care models. It outlines the challenges rural providers face in existing Medicare Shared Savings Program (MSSP) ACO models due to their reliance on fee-for-service reimbursement and complex attribution models. As an alternative, the document proposes a Rural Clinically Integrated Network (RCIN) model that would allow independent rural providers to clinically integrate and collectively negotiate with payers while maintaining local decision making. Key functions of a RCIN would include promoting evidence-based medicine, facilitating care coordination across settings, and negotiating and managing value-based payer contracts.
This presentation by the US Federal Trade Commission was made during a workshop on “Regulation and competition in light of digitalisation” held by the OECD in Paris on 31 January 2018. More papers and presentations on the topic can be found out at oe.cd/wrcd.
Myanmar Strategic Purchasing 6: Improving Medical Record KeepingHFG Project
- The document discusses improving medical record keeping as part of a strategic purchasing pilot project in Myanmar involving private general practitioners (GPs).
- It describes the transition from paper to electronic medical records (EMRs) to better collect and exchange patient data. Biometrics are being used for accurate patient identification.
- The pilot introduced a paper-based recording system as an interim step, but it had limitations. An EMR system is now being developed to automate functions like data validation and generate performance reports, while being suitable for small private clinics.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CBHI Initiative in Ethiopia Design, Implementation and ChallengesHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Evaluation of Community-Based Health Insurance Pilot Schemes in Ethiopia: Fin...HFG Project
This report evaluates community-based health insurance (CBHI) pilot schemes in Ethiopia. It finds that the schemes increased utilization of health services and improved financial access. Members reported using services more and facing less financial hardship. The schemes mobilized local resources and received government subsidies. However, enrollment rates were low. The report recommends expanding the schemes while addressing affordability and awareness issues to improve participation rates and financial sustainability during scale-up. It provides guidance to strengthen CBHI and progress toward universal health coverage in Ethiopia.
RSBY is India's health insurance scheme that provides coverage for hospitalization costs to low-income informal sector workers. Over 120 million people are enrolled, with over 5 million hospitalization cases covered to date. While progress has been made in expanding coverage and improving access to care, challenges remain in strengthening implementation systems, ensuring quality of care, preventing fraud, and using the program to build universal healthcare coverage. Next steps include piloting outpatient benefits, expanding coverage to other vulnerable groups, and leveraging the smart card platform to deliver other social services to the poor.
Di McIntyre's presentation at the Department of Science and Technology (DST) international seminar on a National Health Insurance (NHI) from 6 – 7 December 2012 at the CSIR Conference Centre, Pretoria.
This document summarizes the results of an assessment of Mongolia's provider payment systems conducted to inform reforms. It finds that Mongolia currently uses 3 main payment methods - line item budgets, DRG-based payments for hospitals, and fee-for-service. The assessment examined each system's design, incentives, and stakeholders' perceptions. It identified strengths and weaknesses compared to international standards and how each system impacts health policy goals. The assessment concludes with a roadmap to refine Mongolia's systems to better support universal health coverage.
In this July 26, 2012 webinar, CMS Innovation Center staff provided an overview of the State Innovation Models Initiative.
More information can be found at: http://innovations.cms.gov/initiatives/state-innovations/index.html.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this August 15, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Testing award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses components of the revenue cycle in healthcare, including pre-claims submission, claims processing, accounts receivable, claims reconciliation, and collections. It describes the charge description master which houses billing information for healthcare services and supplies. Effective revenue cycle management is important for a provider's financial stability. The revenue cycle involves coordination between many departments to accurately capture and bill for services provided to patients.
MACRA and the Merit-Based Incentive Payment System (MIPS)PYA, P.C.
This document provides an overview of the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA). MIPS replaces previous quality reporting programs and includes four components that determine a Composite Performance Score: Quality, Resource Use, Clinical Practice Improvement Activities, and Advancing Care Information. Scores will determine payment adjustments beginning in 2019, with the potential for bonuses or penalties up to 9% by 2022 based on performance compared to benchmarks and thresholds. The document reviews the scoring methodology and reporting requirements for each MIPS component.
East Midlands corporate governance network, February 2017, NottinghamBrowne Jacobson LLP
This seminar covered the new Integrated Support and Assurance Process, a background into the General Data Protection Regulation requirements coming into force on 1 April 2018, and the implications of Brexit on the NHS.
Health technology and innovation for UHC by Dr Beatrice Murage, Savannaachapkenya
This document discusses challenges and opportunities around achieving universal healthcare coverage in Africa. It notes that over 150 million people globally face financial hardship from health expenses each year. While government and out-of-pocket payments still dominate healthcare financing, countries are undergoing economic and political changes that could impact healthcare. National health insurance programs like Kenya's NHIF cover millions but face challenges in expanding coverage and controlling costs. Adopting health technologies could help address inefficiencies in claims processing and resource allocation to move closer to universal coverage.
Tracking implementation and (un)intended consequences of peripheral health fa...resyst
The document discusses the Health Sector Services Fund (HSSF) in Kenya, which provides direct financing to peripheral health facilities to improve quality of care and sustainability. It outlines the implementation of HSSF, including challenges around delays in funding, inadequate funding levels, and complex reporting requirements. The document also examines knowledge gaps and next steps for HSSF as Kenya's health system undergoes devolution and the introduction of new financing mechanisms.
Business opportunities in private hospital sector in indiaBusiness Finland
The document summarizes business opportunities in India's private hospital sector. It notes that the healthcare industry in India is growing rapidly at 20% annually and is expected to reach $100 billion by 2015. The private sector accounts for 65% of hospital beds and 80% of healthcare spending, and is growing at 24.1% annually. Opportunities exist for foreign companies in areas like medical equipment, diagnostic devices, health IT, and green building technologies. The largest private hospital chains in India are outlined. Fast growing specialty areas include oncology, orthopedics, and cardiology.
This document provides an overview of health insurance. It defines health insurance as insurance that covers medical and surgical expenses. It explains why health insurance is needed to protect against high, unexpected medical costs and make quality treatment affordable. It then describes different types of health insurance plans including HMOs, PPOs, and high-deductible plans. The document provides steps for obtaining health insurance, filing claims, and surrendering a policy. It also outlines advantages and disadvantages of health insurance as well as tips to avoid health insurance scams.
Explaining the Health Insurance Marketplace October 2013Shawn Daughenbaugh
Basic information about the healthcare.gov marketplace. What is it, how is it affecting Wisconsin, and what is to come?
Presented in October of 2013, there is a lot we did not know and still do not.
Central hospitals in Malawi face challenges including inadequate staffing, especially specialists, and poor quality of care. Reforms are proposed to address this, including establishing public trust hospitals with autonomous governance boards. This would give hospitals more control over management and finances while still remaining publicly owned. The objectives are to improve quality, access, and efficiency as well as strengthening support for districts and urban health services. A roadmap outlines steps for implementation over several years.
Is strategic purchasing feasible in publicly funded health systems with integ...resyst
This document summarizes a presentation on whether strategic purchasing is feasible in publicly funded health systems with integrated purchasing and provision. It defines strategic purchasing as continuously searching for the best ways to maximize health system performance by deciding which interventions to purchase, how, and from whom. The presentation explores the principal-agent relationships within these systems, compares ideal strategic purchasing to actual practice, and describes the qualitative research methods used, including document reviews, interviews, and focus group discussions with governments, purchasers, providers, and communities in multiple countries.
presentation is all about ppp in one hand and ppp in health on the other. ppp is not only remain as collaboration for the use of government mobey by the private party but now has legal and administrative aspects as well. however, to make ppp as vibrant and result oriented, mutual trust has to biult between both the parties that would be supplemented by some successful cases of ppp specially in health sector.
This document discusses options for rural hospitals and providers to transition to accountable care models. It outlines the challenges rural providers face in existing Medicare Shared Savings Program (MSSP) ACO models due to their reliance on fee-for-service reimbursement and complex attribution models. As an alternative, the document proposes a Rural Clinically Integrated Network (RCIN) model that would allow independent rural providers to clinically integrate and collectively negotiate with payers while maintaining local decision making. Key functions of a RCIN would include promoting evidence-based medicine, facilitating care coordination across settings, and negotiating and managing value-based payer contracts.
This presentation by the US Federal Trade Commission was made during a workshop on “Regulation and competition in light of digitalisation” held by the OECD in Paris on 31 January 2018. More papers and presentations on the topic can be found out at oe.cd/wrcd.
Myanmar Strategic Purchasing 6: Improving Medical Record KeepingHFG Project
- The document discusses improving medical record keeping as part of a strategic purchasing pilot project in Myanmar involving private general practitioners (GPs).
- It describes the transition from paper to electronic medical records (EMRs) to better collect and exchange patient data. Biometrics are being used for accurate patient identification.
- The pilot introduced a paper-based recording system as an interim step, but it had limitations. An EMR system is now being developed to automate functions like data validation and generate performance reports, while being suitable for small private clinics.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
CBHI Initiative in Ethiopia Design, Implementation and ChallengesHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Evaluation of Community-Based Health Insurance Pilot Schemes in Ethiopia: Fin...HFG Project
This report evaluates community-based health insurance (CBHI) pilot schemes in Ethiopia. It finds that the schemes increased utilization of health services and improved financial access. Members reported using services more and facing less financial hardship. The schemes mobilized local resources and received government subsidies. However, enrollment rates were low. The report recommends expanding the schemes while addressing affordability and awareness issues to improve participation rates and financial sustainability during scale-up. It provides guidance to strengthen CBHI and progress toward universal health coverage in Ethiopia.
RSBY is India's health insurance scheme that provides coverage for hospitalization costs to low-income informal sector workers. Over 120 million people are enrolled, with over 5 million hospitalization cases covered to date. While progress has been made in expanding coverage and improving access to care, challenges remain in strengthening implementation systems, ensuring quality of care, preventing fraud, and using the program to build universal healthcare coverage. Next steps include piloting outpatient benefits, expanding coverage to other vulnerable groups, and leveraging the smart card platform to deliver other social services to the poor.
Di McIntyre's presentation at the Department of Science and Technology (DST) international seminar on a National Health Insurance (NHI) from 6 – 7 December 2012 at the CSIR Conference Centre, Pretoria.
This document summarizes the results of an assessment of Mongolia's provider payment systems conducted to inform reforms. It finds that Mongolia currently uses 3 main payment methods - line item budgets, DRG-based payments for hospitals, and fee-for-service. The assessment examined each system's design, incentives, and stakeholders' perceptions. It identified strengths and weaknesses compared to international standards and how each system impacts health policy goals. The assessment concludes with a roadmap to refine Mongolia's systems to better support universal health coverage.
In this July 26, 2012 webinar, CMS Innovation Center staff provided an overview of the State Innovation Models Initiative.
More information can be found at: http://innovations.cms.gov/initiatives/state-innovations/index.html.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this August 15, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Testing award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses components of the revenue cycle in healthcare, including pre-claims submission, claims processing, accounts receivable, claims reconciliation, and collections. It describes the charge description master which houses billing information for healthcare services and supplies. Effective revenue cycle management is important for a provider's financial stability. The revenue cycle involves coordination between many departments to accurately capture and bill for services provided to patients.
MACRA and the Merit-Based Incentive Payment System (MIPS)PYA, P.C.
This document provides an overview of the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA). MIPS replaces previous quality reporting programs and includes four components that determine a Composite Performance Score: Quality, Resource Use, Clinical Practice Improvement Activities, and Advancing Care Information. Scores will determine payment adjustments beginning in 2019, with the potential for bonuses or penalties up to 9% by 2022 based on performance compared to benchmarks and thresholds. The document reviews the scoring methodology and reporting requirements for each MIPS component.
East Midlands corporate governance network, February 2017, NottinghamBrowne Jacobson LLP
This seminar covered the new Integrated Support and Assurance Process, a background into the General Data Protection Regulation requirements coming into force on 1 April 2018, and the implications of Brexit on the NHS.
Health technology and innovation for UHC by Dr Beatrice Murage, Savannaachapkenya
This document discusses challenges and opportunities around achieving universal healthcare coverage in Africa. It notes that over 150 million people globally face financial hardship from health expenses each year. While government and out-of-pocket payments still dominate healthcare financing, countries are undergoing economic and political changes that could impact healthcare. National health insurance programs like Kenya's NHIF cover millions but face challenges in expanding coverage and controlling costs. Adopting health technologies could help address inefficiencies in claims processing and resource allocation to move closer to universal coverage.
Tracking implementation and (un)intended consequences of peripheral health fa...resyst
The document discusses the Health Sector Services Fund (HSSF) in Kenya, which provides direct financing to peripheral health facilities to improve quality of care and sustainability. It outlines the implementation of HSSF, including challenges around delays in funding, inadequate funding levels, and complex reporting requirements. The document also examines knowledge gaps and next steps for HSSF as Kenya's health system undergoes devolution and the introduction of new financing mechanisms.
Business opportunities in private hospital sector in indiaBusiness Finland
The document summarizes business opportunities in India's private hospital sector. It notes that the healthcare industry in India is growing rapidly at 20% annually and is expected to reach $100 billion by 2015. The private sector accounts for 65% of hospital beds and 80% of healthcare spending, and is growing at 24.1% annually. Opportunities exist for foreign companies in areas like medical equipment, diagnostic devices, health IT, and green building technologies. The largest private hospital chains in India are outlined. Fast growing specialty areas include oncology, orthopedics, and cardiology.
This document provides an overview of health insurance. It defines health insurance as insurance that covers medical and surgical expenses. It explains why health insurance is needed to protect against high, unexpected medical costs and make quality treatment affordable. It then describes different types of health insurance plans including HMOs, PPOs, and high-deductible plans. The document provides steps for obtaining health insurance, filing claims, and surrendering a policy. It also outlines advantages and disadvantages of health insurance as well as tips to avoid health insurance scams.
Explaining the Health Insurance Marketplace October 2013Shawn Daughenbaugh
Basic information about the healthcare.gov marketplace. What is it, how is it affecting Wisconsin, and what is to come?
Presented in October of 2013, there is a lot we did not know and still do not.
This session is part of the Clean Energy Regulators Initiative Webinar Programme.
Theme 9 - Energy Access
Module 5: Analysis of Electricity Tariffs in Africa
This session has several purposes:
Review electricity tariff structures in Africa;
Assess tariffs in terms of long-term financial viability for the electricity sector and ability to attract capital;
Offer suggestions to evolve to a healthier and more attractive tariff structure.
Countries analyzed: Kenya, Cape Verde, Ghana, Tanzania, and Senegal.
Overall findings:
Strong growth in electricity demand
Network losses very high
Financial performance distribution utilities low
Loss reduction important
Tariffs should be set at economic levels but incorporate reasonable level of losses, while utilities should work on significant reduction of losses. Regulatory policies should incentivize such improvements.
Comparative study of ulip plan and mutual fund of reliance industries marketi...Rohit Ranjan
Unit Linked Insurance Plans (ULIPs) allow policyholders to invest their premiums in a fund that invests in stocks and bonds, with the value of the policy based on the performance of the selected fund. ULIPs provide transparency into where premiums are invested and how returns are calculated, but also carry investment risk unlike traditional policies. IRDA regulations provide guidance around terms, premiums, charges and other features intended to increase transparency and protections for ULIP customers.
This document provides an overview of health insurance, including definitions of key terms, models of health expenditure, and examples of health insurance systems in different countries. It discusses the history of health insurance beginning in Germany in 1883 and adoption in other countries. It also outlines the traditional model of health insurance focusing on insurers/employers and proposes a more flexible model to serve different populations. Private health insurance is described as having an important role to play in overall healthcare systems by enhancing access and increasing service capacity.
financial analysis of icici prudential life insuranceamit soni
This document provides a financial analysis of ICICI Prudential Life Insurance company. It includes an overview of the company and its products, sources of finance such as equity shares and debt, comparative financial statements from 2007-2008 showing increases in reserves and current assets. Financial ratios are calculated including current ratio, profitability ratio, debt ratio and return ratio. Findings note more charges taken from customers and lack of profit until 2008. Recommendations include caring more about fund management and providing lower charges to customers.
ICICI Prudential Life Insurance is a joint venture between ICICI Bank and Prudential Plc established in 2000. It offers various individual and group insurance plans like term plans, wealth plans, child plans, health plans, retirement plans, ULIPs and group plans. The plans cater to different demographics and socio-economic segments across India with the goal of providing financial protection and saving/investment solutions. The summary highlights the company details and provides an overview of the types of insurance products and plans offered to different customer segments.
The analysis was done by Masters in Business Management candidates referring to the TIC documents and related Investment literature in Tanzania environment.
Insurance involves the equitable transfer of risk, where an insurer agrees to compensate an insured for a potential loss in exchange for a premium payment. The key parties are the insurer (the company), the insured (the policyholder), and the premium (the amount charged). Insurance is governed by acts and involves a contract between the insurer and insured regarding a specific insurable risk, with defined terms and conditions. For a risk to be insurable, it must be measurable, accidental in nature, and not catastrophic. Common types of insurance include life, property, liability, and guarantee policies.
Chapter 01 concepts and principles of insuranceiipmff2
The document defines insurance as a social device where individuals transfer risk to an insurer who pools losses to make statistical predictions and provide payments from premium contributions. Legally, it is a contract where an insurer provides security to an insured against specified events in exchange for a premium proportionate to the risk. Key elements are risk transfer from insured to insurer, insurance as a business to meet costs and make profit, and an insurance contract as a legally enforceable agreement. Fundamental principles include utmost good faith, indemnity, subrogation, contribution, and proximate cause. There are various types of insurance and governing laws regulate the insurance sector in India.
This document discusses risk and risk management. It defines risk as uncertainty about potential losses and categorizes risks as objective or subjective. It also discusses concepts like chance of loss, perils, hazards, and different types of risks like fundamental risk, particular risk, and enterprise risk. The objectives and steps of the risk management process are also outlined, including identifying exposures, analyzing frequency and severity of losses, selecting risk control or financing techniques, and implementing and monitoring the risk management program.
The document discusses project risk management and outlines six processes for managing risk: risk management planning, risk identification, qualitative risk analysis, quantitative risk analysis, risk response planning, and risk monitoring and control. It provides details on tools and techniques used in each process, such as documentation reviews, information gathering, probability and impact matrices, and quantitative risk analysis modeling. The overall goal of risk management is to increase the probability of positive events and decrease the probability of negative events on a project.
The document provides an overview of various life insurance products and concepts in India. It discusses key terms like insurance, life insurance, types of life insurance policies including whole life, term, and endowment plans. It also covers principles of insurance like insurable interest, utmost good faith, and indemnity. Finally, it summarizes popular individual and group insurance products offered by major Indian and global life insurance companies.
The document provides an overview of life insurance basics, including defining life insurance as an agreement where the insurer promises to pay a sum to a beneficiary upon the policy owner's death in exchange for premium payments. It discusses the different types of life insurance policies including term, whole life, universal life and variable life, and how they differ in terms of coverage duration, premium structure, and cash value growth. The document also reviews important considerations for determining coverage needs and affordability, as well as how to name beneficiaries under a policy.
This document provides an overview of fire insurance. It discusses key principles of insurance like utmost good faith, indemnity, and insurable interest. It also describes different types of fire insurance policies like valued policies, floating policies, declaration policies, and adjustable policies. The document outlines the scope of fire insurance and covers losses from fire and other perils. It also discusses the rights of insurers like salvage, subrogation, and contribution. Specific policy and average policy are also summarized.
The document discusses risk management frameworks and processes. It provides:
1) An overview of risk management, including highlighting risks at the project, program, and portfolio levels.
2) A risk management framework involving establishing context, risk identification, analysis, evaluation, and treatment.
3) Details of risk governance, including risk management plans, risk registers, governance documents, and ongoing and discrete risk activities.
The document discusses the history and types of life insurance in India. It notes that life insurance can be traced back to ancient texts and the first insurance companies were established in the late 19th century. It then summarizes different types of life insurance policies including term insurance, endowment plans, whole life plans, and unit linked insurance plans. The document also briefly outlines how life insurance claims are processed.
Similar to A critical assessment of health care purchasing in Tanzania: a comparison of the mandatory National Health Insurance Fund and voluntary Community Health Fund
Building the sustainable response to TB and HIV/AIDS in Ukraine: from Scenari...Elena Nechosina
Presentation at the Regional stock taking meeting on the implementation of the Investment Approach in EECA: Moving from analysis to action and investing for sustainable impact (23-25 February 2016, Vienna, Austria)
The Zimbabwe Network for Health (ZimHealth) is a non-profit organization founded by Zimbabweans in Switzerland to raise funds and support for Zimbabwe's public health services. It was established in 2005 in response to poor conditions at Harare Hospital. ZimHealth aims to inform Europeans about Zimbabwe's health needs, raise funds, and distribute resources equitably across Zimbabwe. It is run by an elected Executive Committee and seeks to partner with Zimbabwe's health facilities. Over five years, ZimHealth plans to refurbish several primary clinics and provincial hospitals at an estimated total cost of over 1 million Swiss francs.
Social health insurance implementation function governanceNajibullah Safi
The document discusses governance in social health insurance. It defines governance and outlines key governance functions for social health insurance, including setting rules for coverage, benefits, financing and provider networks. It also provides examples of governance structures in Germany, Indonesia and Bangladesh, comparing features such as the role of government, regulatory frameworks, and organizational setups. The document emphasizes that there is no single best system and that countries develop their governance structures over time based on their unique situations and priorities.
Is strategic purchasing a feasible mechanism in the publicly funded health sy...resyst
This document summarizes a study on the feasibility of strategic purchasing in Nigeria's publicly funded health system. It finds that while policy frameworks guide strategic purchasing, bureaucratic delays limit timely funding releases. Monitoring of budget performance focuses on matching spending to plans rather than health impacts. Purchaser-provider relationships employ some tools to enhance quality and efficiency, but human resource and funding challenges constrain service delivery. Purchaser-citizen engagement is limited by lack of communication channels and incentives for community committees. The study concludes that strategic purchasing requires stronger enforcement of provider performance incentives, empowering citizens, and mutual accountability between purchasers and communities.
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A critical assessment of health care purchasing in Tanzania: a comparison of the mandatory National Health Insurance Fund and voluntary Community Health Fund
1. A critical assessment of health care purchasing
in Tanzania: a comparison of the mandatory
National Health Insurance Fund (NHIF) and
voluntary Community Health Fund (CHF)
Dr. Gemini Mtei,
Ifakara Health Institute
iHEA, Milan; Wednesday 15 July, 2015
2. Overview of the key purchasing actors
Government through general taxation-controlled by MOF
- Pay salaries to public facility staff
- Investment and procurement of drugs and medical supplies
- Budget based
Community Health Insurance (CHF) -Voluntary insurance for informal
sector managed by local governments
• - Funds used to purchase drugs, supplies, facility maintenance, etc
• -Budget based-not used to reimburse providers for service given to CHF members
• - Members access at public primary care facilities only except in few districts that
have included hospital care
National Health Insurance Fund (NHIF) - Mandatory insurance
for government employees, voluntary for others
- Comprehensive benefit package – outpatient & inpatient
- All public facilities automatically accredited and selected private facilities
- Fee for service reimbursement
3. Is there strategic purchasing under NHIF & CHF?
Yes & No!
•What is purchased?- Limited package for CHF members,
comprehensive for NHIF (Wider choice) -Both NHIF and CHF have weak
systems for member engagement
•Where services are purchased?-Primary facilities only under CHF-
service agreements for referral care to CHF members in few districts -broad
choice of providers under NHIF, with automatic accreditation for all public
providers under NHIF
•How purchased? - Budget based under CHF; Fee for service under NHIF;
NHIF makes loans to facilities for equipment & supplies
4. Findings - Citizen-purchaser relationship (1)
Both NHIF and CHF have mechanisms in place to identify
members’ needs.
NHIF normally use media, Researchers, field visits, client service day and
actuarial reports
CHF relies on health facility committees and village meetings to identify needs
‘‘We have a forum; it is two years of implementation conducted. We go and visit CHF members
whereby we call for a meeting with the citizens; we explain about CHF, we give citizens opportunity to
ask us questions so it is that formality. Last year we conducted in ten wards, we were conducting
meetings with the citizens to discuss about health insurance scheme. (IDI, CHF Coordinator, rural
district)
“…….Here at the headquarter we have that arrangement of doing research using journalist every year.
We use journalists, we send them to the regions without our presence, they go there interview
members and observe how our members receive service at the facilities, they document challenges
facing members and needs. They record and prepare documentaries that we sit and discuss and decide
what to change and what not….. But also internally we have research department which conduct
research to collect members’ and providers’ views; the research department is also in-charge of the
journalist study…… (IDI, NHIF National level)
5. Findings - Citizen-purchaser relationship (2)
• Opinions from members showed some doubts in terms of
effectiveness of available mechanisms to identify needs and
ensure members participation
“To be honest we never see CHF implementers rather of being emphases by providers
to join CHF, for example in the village meeting, the representative take a role of
persuading people to join CHF ”(FGD -CHF member -rural district)
“….They talk on Tv and Radio but we want them to come to us members, face to
face…they can do seminars that are more relevant I think not the radio….they
sensitize the advantage of insurance but we as members we don’t see those
benefit….(FGD, NHIF members, Urban District)
6. Findings - Provider-purchaser relationship (1)
• There is no split between purchaser and provider roles under
CHF
• Local government authority manages both CHF and public facilities that provide
services for CHF members
• CHF members can only access services from public providers who
frequently run short of drugs and other essential supplies
• “The challenge is that for example we have shortage of drugs so I can’t say we are
treating this patient according to the appropriate standard, we really have a
shortage of drugs, the government is trying and we purchase a certain amount of
drugs by using cost sharing but due to the big number of patients most of the times
we have shortage of drugs” (FGD-health providers rural district)
7. Findings - Provider-purchaser relationship (2)
• Providers are not reimbursed for services provided to CHF members BUT
CHF revenues are budgeted for purchasing drugs and other medical
supplies for the whole facility
• NHIF is mandated to contract all public providers while certain criteria
(e.g. certification & agreement to price guide) are used to contract
selected private providers
• “….in principle all these public facilities are supposed to provide services to our members by default, we have
also accredited private facilities but they have to follow our procedure, we receive applications, but in some
areas it is our initiative due to suggestions that we received from the community in our visits and meetings…”
(IDI, National Level)
• “…….they assesses the space of the facility, numbers of doctors, and the capacity in terms of how many services
the facility is able to provide, how much are they able to manage. Do they have all the important diagnostic or
the basic equipment, even to test malaria? (IDI, District Manager, Urban District)
• NHIF reimburses all facilities through a fee for service
8. Findings - Provider-purchaser relationship (2)
• To address the challenge of drug shortage, especially in public facilities
NHIF has accredited pharmacies and drug dispensing shops
• “……due to the shortages of the drugs in the facilities, we said that if they miss drugs, they will fill the form
and will get drugs from the pharmacy. But also we have accredited those called accredited drugs dispensing
outlets especially in the village areas. There are members like teachers and others they can get services from
there. Those are the key players that we deal with them. Currently we have about 56000 accredited
pharmacies. ADDOs are common in rural areas, so they serve our people such as the teachers’’ (IDI, National
Level)
• In some places, especially in rural areas, special arrangements have been put in place
to provide services that would otherwise not been provided at dispensaries but a
higher level of care
• “…..our procedure is that services should be provided according to the guidelines of the particular facility,
with regard to the level. That health facility guideline indicates the service to be provided. We talked with
people from the ministry they said that for dispensary it is not allowed to admit patients basing on the
guideline. However, we have facilities that are very remote and used as hospital to some members, so what
we normally do is to set a special agreement with the government to allows that facility to provide some
services. Because if we don’t agreed it means if you provide those services, we will not reimburse you, you
see. So if we agree with the ministry, we can allow the facility to admit patient so we will pay……(IDI,
National Level)
9. Findings - Government-purchaser
relationship (1)
• The use of CHF and NHIF funds is guided by the government rules and
regulations including the finance and procurement acts
• CHF operations are governed by the council health service board and
health facility committees
• “…when it reaches at a time of taking the money, signatory is required that is the medical officer in charge of
the respective health facility and two representatives from the committee board of a respective health
facility, money cannot be withdrawn until two representatives authorize” (IDI_CHF coordinator rural district)
• Government purchasing procedures also require internal and external
auditing of funds utilization
• “The government has purchasing procedures and have to be followed also there are purchasing expertise in
each sector, municipal but also there are internal auditors, external auditors their task is to oversee whether
we are going exactly with the purchasing plan and I trust that is a law and law has its punishment for those
who commit mistakes. I am not expert in purchasing laws but I know there is purchasing law which work
parallel with punishments and there is auditing system which aims at checking as to whether purchasing is
being followed up in all government sectors or not…(health panning officer)
10. • Both CHF & NHIF are supposed to provide operational reports to
the members and for auditing purpose
• ‘‘When the auditor comes he/she must see the procurement reports so he/she will go to the procurement
unit if he/she finds there is something he/she will come to the department and that is why they do auditing,
they do auditing from the reports you can’t do auditing if there is no any report of any kind of purchases and
that is why after every one quarter the report on purchases is submitted and discussed by the financial
committee, all the purchases which were made’’ [IDI, CHF manager).
• The social security regulatory authority is responsible for regulating
both NHIF and CHF. In addition, the Central Bank of Tanzania regulates
NHIF investments
• “…..SSRA is the one who controls us. On Monday they will come for inspection. So they are the ones who
regulate. But for the issues of investments, The Bank of Tanzania (BOT) is the regulator. Off course the SSRA
collaborates with BOT. There are BOT guidelines which support us in the issues of investment….” (IDI, NHIF
National manager)
Findings - Government-purchaser
relationship (2)
11. Key conclusions
• Some efforts have been put in place to exercise strategic
purchasing, more so under NHIF than CHF
• However challenges still exist:
• Channels that are currently been used to identify members’ needs
have not been effective for either NHIF or CHF
• Selection of providers is not strategic - purchasers don’t have power
to select better performing providers except when selecting private
providers under NHIF
• There is no separation of purchaser and provider roles under CHF;
the Act might undermine efficiency in the operation of this scheme
12. Recommendations
• It is important to establish a clear separation between purchaser
and provider functions under CHF - among options would be to
merge the two or have separate entity independent of district
management
• Communication mechanisms between members and purchasers
need to be improving by adopting a more active engagement, for
example through face to face meetings and mobile phone
communications
• The regulator of social security schemes needs to increase
engagement with all parts, members, providers and purchasers
in order to guarantee mutual accountability
15. www.wpro.who.int/asia_pacific_observatory
http://resyst.lshtm.ac.uk
@RESYSTresearch
The research is a collaboration between RESYST and the Asia
Pacific Observatory on Health Systems and Policies.
RESYST is funded by UK aid from the UK Department
for International Development (DFID). However, the
views expressed do not necessarily reflect the
Department’s official policies.
More information: http://resyst.lshtm.ac.uk/research-projects/
multi-country-purchasing-study