Suchergebnisse

Die vorliegende Master Thesis beschäftigt sich mit dem Thema "grenzüberschreitende Gesundheitsdienstleistungen innerhalb der Europäischen Union", wobei der Hauptfokus auf der Patientenmobilitätsrichtlinie liegt. Möchte ein Versicherter eines Mitgliedstaates in einem anderen Mitgliedstaat eine Gesundheitsdienstleistung in Anspruch nehmen, so stellen sich ihm primär folgende Fragen: 1. Welches Recht gelangt zur Anwendung? 2. Wie muss er/sie vorgehen, um Kostenersatz zu erlangen? Vorrangiges Ziel dieser Arbeit ist es, diese Fragen zu klären und einen für Patienten und Versicherte verständlichen Überblick zu geben. Die Arbeit schafft eine gute Abgrenzung der geltenden Regelungssysteme, untersucht die Auswirkungen des EU-Gesundheitsrechts auf das österreichische Recht und erklärt das Verfahren gegenüber den österreichischen Krankenversicherungsträgern. Als Quelle diente unter anderem ein Experteninterview mit dem stellvertretenden Leiter der Leistungsabteilung der Tiroler Gebietskrankenkasse. Final beschäftigt sich die Arbeit mit der Frage nach dem aktuellen Stellenwert der grenzüberschreitenden Patientenmobilität. Diese mündet im Ergebnis, dass der grenzüberschreitenden Patientenmobilität in der EU quantitativ gesehen nach wie vor eine geringe Bedeutung zukommt. Es bleibt abzuwarten, ob seitens der Mitgliedstaaten in Zukunft Initiativen gesetzt werden, um dies zu ändern. ; This masters thesis deals with the topic of "cross-border health services within the European Union", with the main focus being on the Patient Mobility Directive. If an insured person from one member state would like to make use of a health service in another member state, the following questions are primarily asked: 1. Which law applies? 2. How do I have to proceed in order to obtain reimbursement? The primary goal of this work is to clarify these questions and to provide an understandable overview for patients and insured persons. The work creates a good delimination of the applicable regulatory systems, examines the effects of EU health law on Austrian law and explains the procedure to the Austrian health insurance carriers. One of the sources was an expert interview with the deputy head of the benefits department of the Tyrolean regional health insurance fund. Finally, the thesis deals with the question of the current status of cross-border patient mobility. This leads to the result that the cross-border patient mobility is still of little importance in quantitative terms within the EU. It remains to be seen whether future iniatives will be taken by the member states to change this. ; vorgelegt von: Mag. iur. Christine Cottogni ; Abstract in englischer Sprache ; Universität Innsbruck, Universitätslehrgang Medizinrecht, Masterarbeit, 2021 ; (VLID)5800579

This working paper explores the position of the voluntary health insurance within the scope of the mandatory health insurance as a main tier of health insurance in the Republic of Macedonia. The main subject of research is the legislation regulating this issue (Law on voluntary health insurance), the application and functionality of its provisions; and also the accomplished results considering the fact that this law has been in force almost 4 years. For this purpose an analysis will be made of the statistical data on the number of insured persons under the voluntary health insurance. A brief comparison with several Balkan countries will be made in terms of the legal solutions for voluntary health insurance and also in the development of the voluntary health insurance through the statistical data of the insured persons under the voluntary health insurance scheme. This paper will also address some of the positive experiences in the countries in which the voluntary health insurance functions appropriately and simultaneously with the mandatory health insurance. The goal of this working paper is to point out the shortcomings of the voluntary health insurance system in Macedonia and to provide some ideas for improvement, to develop better, cheaper and more accessible health services for the Macedonian citizens. This goal can be accomplished with deregulation and liberalization of the health insurance sector, through amendments to the Law on health insurance aimed at balancing the basic and additional package of health care services and amendments to the Law on voluntary health insurance aimed at providing a greater freedom for all market participants in the health insurance system. Also, the idea of this paper is to examine the possibility to allow some citizens that would fulfill the necessary conditions, to abandon the mandatory health insurance system and join the voluntary health insurance system.

This working paper explores the position of the voluntary health insurance within the scope of the mandatory health insurance as a main tier of health insurance in the Republic of Macedonia. The main subject of research is the legislation regulating this issue (Law on voluntary health insurance), the application and functionality of its provisions; and also the accomplished results considering the fact that this law has been in force almost 4 years. For this purpose an analysis will be made of the statistical data on the number of insured persons under the voluntary health insurance. A brief comparison with several Balkan countries will be made in terms of the legal solutions for voluntary health insurance and also in the development of the voluntary health insurance through the statistical data of the insured persons under the voluntary health insurance scheme. This paper will also address some of the positive experiences in the countries in which the voluntary health insurance functions appropriately and simultaneously with the mandatory health insurance. The goal of this working paper is to point out the shortcomings of the voluntary health insurance system in Macedonia and to provide some ideas for improvement, to develop better, cheaper and more accessible health services for the Macedonian citizens. This goal can be accomplished with deregulation and liberalization of the health insurance sector, through amendments to the Law on health insurance aimed at balancing the basic and additional package of health care services and amendments to the Law on voluntary health insurance aimed at providing a greater freedom for all market participants in the health insurance system. Also, the idea of this paper is to examine the possibility to allow some citizens that would fulfill the necessary conditions, to abandon the mandatory health insurance system and join the voluntary health insurance system.

Abstract Background The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 through an Act of Parliament (Act 650) as a strategy to improve financial access to quality basic health care services. Although attendance at health facilities has increased since the introduction of the NHIS, there have been media reports of widespread abuse of the NHIS by scheme operators, service providers and insured persons. The aim of the study was to document behaviors and practices of service providers and clients of the NHIS in the Kassena-Nankana District (KND) of Ghana that constitute moral hazards (abuse of the scheme) and identify strategies to minimize such behaviors. Methods Qualitative methods through 14 Focused Group Discussions (FGDs) and 5 individual in-depth interviews were conducted between December 2009 and January 2010. Thematic analysis was performed with the aid of QSR NVivo 8 software. Results Analysis of FGDs and in-depth interviews showed that community members, health providers and NHIS officers are aware of various behaviors and practices that constitute abuse of the scheme. Behaviors such as frequent and 'frivolous' visits to health facilities, impersonation, feigning sickness to collect drugs for non-insured persons, over charging for services provided to clients, charging clients for services not provided and over prescription were identified. Suggestions on how to minimize abuse of the NHIS offered by respondents included: reduction of premiums and registration fees, premium payments by installment, improvement in the picture quality of the membership cards, critical examination and verification of membership cards at health facilities, some ceiling on the number of times one can seek health care within a specified time period, and general education to change behaviors that abuse the scheme. Conclusion Attention should be focused on addressing the identified moral hazard behaviors and pursue cost containment strategies to ensure the smooth operation of the scheme and enhance its sustainability.

The impression that work can be good for a worker's health is a powerful one especially when it is combined with the idea that returning people to work may also have positive benefits for employers and government, physical and vocational rehabilitation and reintegration assumes even greater significance. The Social Security Organization of Malaysia (SOCSO) is a statutory body governing the Employment Accident Insurance Scheme and the Invalidity Pension Scheme. SOCSO covers over 6 million workers and processes over 70,000 new claims annually. SOCSO introduced the RTW Program in 2007 which is a comprehensive multidisciplinary biopsychosocial rehabilitation program for its Insured Persons who are experiencing disability due to accidents in the workplace or those claiming for invalidity. This rehabilitation program is unique as it involves the concept of "disability management" in which each Insured Person who is referred to the program, is assigned to a Disability Case Manager who is actively involved throughout the return to work process. This presentation discusses the justification of introducing the RTW programme in Malaysia, with reference to the underlying rationale, association between work and rehabilitation, evidence to establish a positive relationship between health and work, and the benefits of RTW for employees, employers and SOCSO. Up to date (December 2013), 11,090 workers were motivated to participate in the SOCSO RTW Programme and 7,881 (71%) have returned to gainful employment. This clearly shows the success of the RTW Programme in not only returning a disabled worker to work but to give them their lives back. Due to this success, SOCSO has started to build its National Rehabilitation Centre for the purpose of RTW which will be ready in mid-2014. However, there is still room for improvements which establish the way forward for SOCSO in creating a more disability-management-centric system.

The Social Security Organisation (SOCSO) of Malaysia introduced the Return to Work (RTW) Program in 2007 which is a comprehensive multidisciplinary biopsychosocial rehabilitation program for its Insured Persons who are experiencing disability due to accidents in the workplace or those claiming for invalidity. This rehabilitation program is unique as it involves the concept of "disability management" in which each Insured Person who is referred to the program, is assigned to a Disability Case Manager who is actively involved throughout the return to work process. Up to date (December 2013), 11,090 workers were motivated to participate in the SOCSO RTW Programme, and this requires many work processes, countless paper-work and massive physical files and document management. Due to this massive information flow, the demand for a more efficient information system is needed. From the beginning, the whole idea was to create an accessible, quick and user-friendly application. The application is now used by the SOCSO RTW Department in managing their information. This application was built on an open source platform which can be access through the internet. It is also a "learning application" where it uses its historical data to assist the case managers to generate standard rehabilitation plans and forecast possible return to work outcomes. The beauty of such application is that it is easily replicated, configurable (email notifications, reminders, etc) to meet the needs of the case managers in various jurisdiction. The scope of the application can also be easily defined to meet the size of an enterprise using the application. With better management of information, this application has contributed in reducing processing time, repetitive paperwork, minimal storage areas and almost real-time flow of information in the SOCSO's RTW Case Management system. Apart from that, the application now stores a wealth of information such as rehabilitation strategies for various disability or illnesses or demographic backgrounds.

many countries have introduced competitive health insurance mechanisms, while introducing regulation to avoid risk selection and ensure solidarity between the sick and the good. The 'regulated competition' model is thus applied to basic health insurance in Switzerland, the Netherlands, Germany and Israel. It inspires the reform of health insurance in the United States. In order to analyse the functioning of such a system, the case of Switzerland is considered, looking at potential interferences between the supplementary insurance market and competition in the basic insurance market. The current organisation of health insurance in France differs from that of the Swiss system. However, the question of regulating the supplementary insurance market could be raised in the long term. Twelve years after the introduction of regulated competition, the results in Switzerland are disappointing. While for the same contract the differences in premiums between insurance companies may be very large, the proportion of policyholders changing cash remains low. Everything happens as if insured persons did not compete. Our analysis shows that the low mobility of insured persons results from the co-existence of two health insurance markets with different rules: the market for basic insurance, where risk selection is prohibited, and for supplementary insurance, where it is authorised. Estimates show that the propensity to change funds is much lower among holders of additional insurance who feel that their health is not excellent. The right to select applicants for supplementary insurance undermines competition on the basic insurance. ; Many countries have introduced competition in health insurance markets. Managed competition settings have been implemented in order to avoid risk selection problems. In Germany, the Netherlands, Switzerland and Israel citizens can choose between different providers for basic coverage. In this article, we focus on the specific case of Switzerland which implemented managed competition in basic health ...

Insurance for hospital care in the United States covers more than three-quarters of the population and pays more than half of hospital bills paid from private income. Benefits to many insured persons are minimal and some bene fits important to health are not regularly provided. Coinsur ance, deductibles, experience rating, and costs of nongroup commercial insurance limit the effectiveness of coverage. Hospital costs are rising. Hospital costs can be kept within bounds by insurance benefits and payments designed to encour age quality of care, community review and control through planning and licensure, review and control of unnecessary hos pital utilization and construction, and by recognition of the importance of organization of medical care as a method of promoting quality and curtailing costs.

ABSTRACTStatutory health insurance is a centerpiece of the German welfare state, which considers itself to be a "social insurance state." At the same time, due to a large volume of interpersonal redistributions that occur in health insurance, it is the most ambitious branch of the country's social insurance system. The stability of the health scheme thus depends on a "culture of solidarity" to maintain the legitimacy of these redistributions. This article analyzes recent changes in the legislative framework of the statutory health insurance. It asks whether these changes which predominantly aim to contain employers' nonwage labor costs by making the insured bear a larger share of total health care spending, are possibly weakening the moral infrastructure of the welfare state. To this end, findings from qualitative interviews with insured persons are evaluated in view of recently approved and currently proposed legislative changes to the health scheme. The analytical focus is the question whether the two equity principles of this scheme, delivering health care according to medical need and financing it according to the "ability‐to‐pay," are becoming endangered.

Statutory health insurance is a centerpiece of the German welfare state, which considers itself a "social insurance state." At the same time, due to a large volume of interpersonal redistributions that occur in health insurance, it is the most ambitious branch of the country's social insurance system. The stability of the health scheme thus depends on a "culture of solidarity" to maintain the legitimacy of these redistributions. This article analyzes recent changes in the legislative framework of the statutory health insurance. It asks whether these changes, which predominantly aim to contain employers' nonwage labor costs by making the insured bear a larger share of total health care spending, are possibly weakening the moral infrastructure of the welfare state. To this end, findings from qualitative interviews with insured persons are evaluated in view of recently approved & currently proposed legislative changes to the health scheme. The analytical focus whether the two equity principles of this scheme, delivering health care according to medical need & financing it according to the "ability-to-pay," are endangered. 51 References. Adapted from the source document.

The paper analyzes the revenue and expenditure of the Social Insurance Fund (SIF) from 1999 to 2010. This period covers the first years of the reformed social security system and the time at which a number of regulatory change was introduced. In the analyzed period both revenue and expenditure of social insurance increased, while revenues grew faster than expenses. The higher revenue growth marked by subsidies from the state budget than revenues from social security premiums. Among the largest share of expenditure accounted for transfers to the population, which were paid primarily in the form of pensions. The analysis shows that the reform of social security system, despite the delays in the implementation of certain objectives, contributed to many positive changes. It affected the growth of insured persons, a drop in payments of inability to work, and the increase in the average age of persons who have been granted pension benefits.

Zentrales Element unseres Gesundheitssystems sind die Versicherten, die mit Ihren Beitragszahlungen einen großen Teil des Systems finanzieren und mit ihren individuellen Verhalten als Patient einen entschiedenen Teil der Dynamik dieses System innerhalb des politischen Rahmens und seiner Grundstrukturen ausmachen. Mit ihren Entscheidungen nehmen sie jedoch auch zunehmend eine Konsumentenrolle ein, beispielsweise bei individuellen Gesundheitsleistungen. Basierend auf den Daten der neuen FFB-Patientenumfrage soll dieser Beitrag einen ersten Einblick in die Motivationen und Hintergründe solcher (Konsum-) Entscheidungen geben. ; Central element of our medical system are the insured persons. With their contributions they finance a dominant part of the system. And with their individual behaviour patients contribute an important part to the dynamics of the system within the political framework. With their decisions making they have increasingly adopted the role of a consumer, for example for individual health efforts. This article gives a first impression of the motivation and the background of such consumer decisions. The analysis is based on the data of the new FFB patient-survey.

Analyzing the laws that regulate certain types of compulsory social insurance, the author studied standard-setting powers of social insurance funds in social security. The sources of social security law are proved to be normative legal acts of social insurance funds, which regulate the security of financial support and social services to the insured persons (or persons equated to them) when the insurance event is taking place.The signs of acts of social insurance funds are singled out: they are taken by the competent social insurance funds - the Board of the Pension Fund of Ukraine, the Board of Fund of mandatory state social insurance against unemployment of Ukraine; the Board of Social Insurance Fund of Ukraine; according to the procedure established by the laws regulating the certain types of compulsory social insurance or Statutes of the social insurance funds; they are expressed in the form of resolutions; they contain legal norms regulating relationships that arise in their own activity (governance of certain types of obligatory state social insurance, the the accumulation of insurance fees, and the provision of the payments' funding); they are binding for all insurers and insured persons whom they concern.The author criticizes the feasibility of legislative empowering of the social insurance fund with the right to determine the amount of social benefits. These issues should be regulated by the act of the Verkhovna Rada of Ukraine on the separate kinds of compulsory social insurance.The acts of social insurance funds are proved to be corporate by their legal nature, as the resolution of the Board of the social insurance funds are the result of legislative activity of the competent authorities, aimed at regulating relations in the provision of benefits and services to members of these funds. ; З'ясовано нормотворчі повноваження соціальних страхових фондів у сфері соціаль­ного забезпечення. Обґрунтовано, що джерелами права соціального забезпечення є нор­мативно-правові акти соціальних страхових фондів, які регулюють питання надання застрахованим особам (або особам прирівняним до них) матеріального забезпечення і соціальних послуг при настанні страхових випадків. Встановлено, що нормативні акти органів соціального страхування ухвалюють у визначеній документальній формі компе­тентні органи від імені соціальних страхових фондів, у чітко встановленому порядку, містять обов'язкові правила поведінки, що передбачають порядок реалізації права на соціальне забезпечення. Аргументовано, що за своєю юридичною природою вони є корпоративними актами.

Abstract
One of the recent changes in the Czech Republic's pension system was provoked by a petition to the Constitutional Court. The setting of bend points for determining the amount of pensions depending on the insured person's previous earnings was contested as discrimination against higher income categories. The Constitutional Court granted the petition. The result was an approval and implementation of an amendment to Act No. 155/1995 Coll., on Pension Insurance, that for the purposes of calculating the level of old-age pensions favoured the highest income decile at the expense of most other insured persons, namely those with middle incomes. Simultaneously, the political criterion of fiscal discipline was applied to ensure the financial sustainability of the pension system. In analysing this case, we critically adopt the theory of actor-centred institutionalism and the theory of the policy cycle. From the nature of the analysed case it follows that we pay attention mainly to the legislative process which resulted in the amendment. Our methodology is dominated by analysis of documents (legal norms, court decisions, political programmes, official publications) and political and administrative communication (including debates on legislative drafts in the executive and legislature).

AbstractTaiwan's National Pension Insurance (NPI) is a compulsory defined benefit pension insurance scheme. However, paying the NPI premium is not mandatory. We use the NPI administrative data of more than 489 million observations to investigate the NPI's sustainability and inequalities for various groups. We find that NPI participants pay their premiums either consistently or not at all. Although the overall willingness to pay the premiums has been declining, one group of the insured persons consistently pays, thereby maintaining the sustainability of the NPI. Intergenerational and intragenerational inequalities are both found in the NPI; however, the government's premium subsidy reduces intragenerational inequality, except for young adult males who need the NPI and regularly pay premiums. Our empirical results suggest that subsidising these young male citizens strengthens the NPI's sustainability and mitigates the intergenerational and intragenerational inequalities of the NPI.