Penerapan Prinsip Kesetaraan dalam Pemberian Hak Bagi Peserta BPJS Kesehatan Berdasarkan Peraturan Presiden Nomor 82 Tahun 2018 tentang Jaminan Kesehatan

This normative legal research is relevant to answering the legal issue of health insurance policies. The application of the principle in various policies of social health insurance services or between one policy and another in Indonesia is appropriate. These policies are Law Number 40 of 2004 concerning the National Social Security System, Law Number 24 of 2011 concerning the Social Security Administering Body, Government Regulation Number 76 of 2015 concerning Amendments to Government Regulation Number 101 of 2012 concerning Recipients of Health Insurance Contribution Assistance , Presidential Regulation Number 82 of 2018 concerning Health Insurance, and Regulation of the Social Security Administering Body Number 1 of 2014 concerning the Implementation of Health Insurance. However, in Presidential Regulation Number 82 of 2018 concerning Health Insurance, there is a sense of injustice for the community due to differences in health services that cannot be covered by BPJS Health, such as health services due to criminal acts of persecution, sexual violence, victims of terrorism and criminal acts of trafficking in accordance with statutory regulations.This normative legal research is relevant to answering the legal issue of health insurance policies. The application of the principle in various policies of social health insurance services or between one policy and another in Indonesia is appropriate. These policies are Law Number 40 of 2004 concerning the National Social Security System, Law Number 24 of 2011 concerning the Social Security Administering Body, Government Regulation Number 76 of 2015 concerning Amendments to Government Regulation Number 101 of 2012 concerning Recipients of Health Insurance Contribution Assistance , Presidential Regulation Number 82 of 2018 concerning Health Insurance, and Regulation of the Social Security Administering Body Number 1 of 2014 concerning the Implementation of Health Insurance. However, in Presidential Regulation Number 82 of 2018 concerning Health Insurance, there is a sense of injustice for the community due to differences in health services that cannot be covered by BPJS Health, such as health services due to criminal acts of persecution, sexual violence, victims of terrorism and criminal acts of trafficking in accordance with statutory regulations

Customer-Centric Approach For Financial And Economic Surveys Of Private Security Companies

The subjects of the study are private security companies. Its object is the leading role of the customer-centric approach for financial and economic justification of the successful functioning and development of private security companies. The research hypothesis is that an objective assessment of the financial and economic aspects and the motivation of individuals and legal entities to purchase protection and security services under the conditions of post-epidemic recovery of the economy can be carried out by means of customer satisfaction and service pricing justification surveys. The aim of this article is to present the results of a customer satisfaction survey and the assessment of the financial and economic aspects as well as the motivation of individuals and legal entities to purchase protection and security services under the conditions of post-epidemic recovery of the economy. Structurally, the article includes three main sections: the first section focuses on the circulation of cash flows of private security companies; the second section presents selected elements of the conducted survey; and the third present an analysis of the survey among private security companies where the protection and security services compete and at the same time complement property insurance services. The survey results (based on a multi-crtieria Likert scale) confirm the validity of the "value for money" concept as an important factor for the pricing of private protection and security services. The survey questionnaire successfully compares the services of non-life insurance companies and the services of protection and security companies. The prevailing opinion is in favour of using the services of spe-cialized companies over taking out insurance policies, with 61% of respondents expressing the opinion that hiring a specialized protection and security company is a more effective way to ensure property protection to taking out equivalent insurance with a general insurance company

Customer-Centric Approach For Financial And Economic Surveys Of Private Security Companies

The subjects of the study are private security companies. Its object is the leading role of the customer-centric approach for financial and economic justification of the successful functioning and development of private security companies. The research hypothesis is that an objective assessment of the financial and economic aspects and the motivation of individuals and legal entities to purchase protection and security services under the conditions of post-epidemic recovery of the economy can be carried out by means of customer satisfaction and service pricing justification surveys. The aim of this article is to present the results of a customer satisfaction survey and the assessment of the financial and economic aspects as well as the motivation of individuals and legal entities to purchase protection and security services under the conditions of post-epidemic recovery of the economy. Structurally, the article includes three main sections: the first section focuses on the circulation of cash flows of private security companies; the second section presents selected elements of the conducted survey; and the third present an analysis of the survey among private security companies where the protection and security services compete and at the same time complement property insurance services. The survey results (based on a multi-crtieria Likert scale) confirm the validity of the "value for money" concept as an important factor for the pricing of private protection and security services. The survey questionnaire successfully compares the services of non-life insurance companies and the services of protection and security companies. The prevailing opinion is in favour of using the services of spe-cialized companies over taking out insurance policies, with 61% of respondents expressing the opinion that hiring a specialized protection and security company is a more effective way to ensure property protection to taking out equivalent insurance with a general insurance company

Design of the Worker Profiling and Reemployment Services System and Evaluation in Michigan

The Unemployment Compensation Amendments of 1993, Public Law 103-152, require each state employment security agency to implement a Worker Profiling and Reemployment Services (WPRS) system. WPRS systems are intended to identify unemployment insurance beneficiaries who are most likely to exhaust their regular benefits, and refer them quickly to reemployment services to speed the transition to new employment. This brief paper was prepared for a national colloquium on WPRS held June 11-14, 1996 in Atlanta. The paper summarizes work done by the W.E. Upjohn Institute for Employment Research for the State of Michigan to design and implement a UI profiling model, and to design an evaluation of the WPRS system effectiveness.unemployment, insurance, reemployment, Eberts, O'Leary

The Political Economy of the Disability Insurance. Theory and Evidence of Gubernatorial Learning from Social Security Administration Monitoring

The dramatic rise in the disability insurance (DI) roles in the last 20 years has been the subject of much controversy in both popular and academic circles. While, the relationship between DI and labor force participation has been the subject of a growing literature, the mechanism of this transition from employment to DI remains unclear. We hypothesize that one mechanism is the state-level administration of the program which creates a classic principal-agent problem. This paper analyzes the impact of continuing conflict of interests for Disability Determination Services agencies—between Social Security Administration standards and state gubernatorial political interests — interacted with the increased demand for disability insurance as an alternative for low-skilled works during the period of 1982 to 2000. We find evidence that multi-term governors allow a greater fraction of applicants than do first term governors. We then develop a model that illustrates how these differences can be due to the type of monitoring conducted by the Social Security Administration. We provide additional evidence supporting this hypothesis in the form of sub-group analysis by economic and political constraints. Overall, we find evidence that the monitoring system is counter-productive and encourages over-use of the disability insurance program to serve political ends.Disability insurance; principal-agent; social security administration; monitoring

Women's Health Coverage Since the ACA: Improvements for Most, But Insurer Exclusions Put Many at Risk

Since enactment of the Affordable Care Act (ACA), many more women have health insurance than before the law, in part because it prohibits insurer practices that discriminate against women. However, gaps in women's health coverage persist. Insurers often exclude health services that women are likely to need, leaving women vulnerable to higher costs and denied claims that threaten their economic security and physical health.Goal: To uncover the types and incidence of insurer exclusions that may disproportionately affect women's coverage. Method: The authors examined qualified health plans from 109 insurers across 16 states for 2014, 2015, or both years.Key findings and conclusions: Six types of services are frequently excluded from insurance coverage: treatment of conditions resulting from noncovered services, maintenance therapy, genetic testing, fetal reduction surgery, treatment of selfinflicted conditions, and preventive services not covered by law. Policy change recommendations include prohibiting variations within states' "essential health benefits" benchmark plans and requiring transparency and simplified language in plan documents

Factors Causing Delayed Claims At The Hospital In Collaboration With Health Social Security Agency Branch Office Of Tasikmalaya

The Government's efforts to reduce the cost of health services and improve the health of the Indonesian people have been carried out by the National Health Insurance Program by the Health Social Security Agency (BPJS), Health Social Security Agency is the Health Social Security Administering Body which is a legal entity formed to administer the health insurance program. social services that work closely with health facilities to help Indonesian people to obtain basic health services. The hospital is an advanced level health facility that serves National Health Insurance participants on condition that they have collaborated with Health Social Security Agency to be able to organize the National Health Insurance program. Based on previous studies, there are still pending claims in various hospitals throughout Indonesia, thus disrupting hospital cashflow. Research Objectives: To find out the factors causing pending claims for BPJS health in hospitals in collaboration with Health Social Security Agency (BPJS) branch office of Tasikmalaya. Research Methods: The type of research used is descriptive with a qualitative approach Research Results: from the results of the study it is known that the contributing factors include billing and payment of chronic drug claims, claims that are not in accordance with the provisions of the treatment episode, billing claims with diagnostic codes and procedures that not in accordance with the 2010 ICD-10 and ICD-9 CM coding rules, other coding rules and guidelines for the management of claims problem solutions, traffic accident claims that are not in accordance with the provisions and are billed in a fragmented manner. Conclusion: Currently, in general, BPJS claims at advanced health facilities in collaboration with Health Social Security Agency (BPJS) branch office of Tasikmalaya are going well, there are still several causes of pending claims that can be improved, suggestions need to be done. Analysis of the level of knowledge of HR in the Hospital Casemix section, there is a need for an application to assist in the settlement of claims in terms of warnings or blocking of regulatory rules as well as evaluating the utilization review of each hospital on the services provided.Keywords: Health insurance administration body, Pending, Clai

Ticket to Work and Self-Sufficiency Program: Overview and Current Issues

[Excerpt] Title I of the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170) established the Ticket to Work and Self-Sufficiency program (hereafter referred to as the Ticket to Work or Ticket program), which is administered by the Social Security Administration (SSA). The purpose of this program is to enhance work incentives for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries. The legislation created a “ticket” system to expand choices in the numbers and types of providers that SSDI and SSI beneficiaries may choose to assist them in receiving employment services. The legislation also expanded Medicare and Medicaid coverage for individuals with a disability who are working or could work. Most notably, the Ticket to Work program created a market for public and private providers of support services known as employment networks (ENs) to which Social Security disability beneficiaries can voluntarily assign their tickets in exchange for a range of employment support services. The goal of the Ticket program is to reduce dependence on disability benefits and help Social Security disability beneficiaries enter or reenter the workforce. ENs would then be eligible to receive payments from SSA based on ticket holders achieving employment “milestones” or outcomes. This report provides an overview of how the Ticket to Work program operates and addresses several issues related to the Ticket program. First, it provides a brief background on the SSDI and SSI programs and a legislative history on how the Ticket program evolved. Second, this report provides an in-depth explanation on the various components and regulations of the Ticket to Work program in its current form and prior to major regulatory changes in July 2008. Third, it examines other work incentive programs created by Ticket to Work legislation and concludes with a discussion on the issues surrounding implementation of the Ticket program

Health insurance as a strategy for access: streamlined facts of the colombian health care reform

The Colombian reform to the health system (Law 100 of 1993) established, as strategy to facilitate the access, the universality of a health insurance that is acquired by means of the quotation in the contributive regime or by means of the gratuitous affiliation to the subsidized regime, in order to cover all the population with a unique plan of benefits that includes services in all levels of complexity. In this paper we intend to cover the main streamlined facts of the reform as far as coverage and access of the insurance, by means of logit models, the determinants of the enrollment and the access are considered, using data from the Living Standards Surveys of 1997 and 2003. It stands out that the coverage rose from 20% of the population in 1993 to 60% in 2003, although it seems very difficult to reach the universality; the structure and evolution of the coverage show that both regimes complement each other, while the contributive one has greater presence in the cities and among the population with formal employment, the subsidized one has greater weight among the rural population and in those with low levels of income; on the other hand, the insurance has advantages for the subsidized population, with a greater probability for use of the services, although the plan offers less benefits than the contributive one there are some barriers for the access.health insurance, access, enrollment affiliation, social security, Colombia

The Employment Security Program (With Special Reference to Tennessee Unemployment Insurance)

Employment security was one of the major programs for which provision was made in the Social Security Act of 1935. Under its terms a tax program was instituted which encouraged the states to enact unemployment insurance laws and expand their employment services. The Act imposed a federal tax on the payrolls of subject employers against which such employers were permitted to offset the major part of the taxes which they paid under state unemployment insurance laws. Since employers in states which did not enact appropriate insurance laws were liable for the full federal tax, the states acted speedily to set up unemployment insurance programs. Within less than two years after the passage of the Social Security Act, unemployment insurance laws had been enacted by all 51 jurisdictions, including the 48 states, the District of Columbia, Alaska and Hawaii. It is the purpose of this study to examine briefly the federal role in this program, then to analyze in some detail the state phase with emphasis upon the organizational patterns, legal requirements, administrative procedures and precedents related to unemployment insurance operations