Health Insurance Training in Seoul
"Explore insights from the HIRA training on social health insurance held in Seoul, Republic of Korea in July 2017. Dive into topics like Cambodia's healthcare schemes, NSSF's medical claims, and more."
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Presentation Transcript
HIRA Training on Social Health Insurance from 24-28 July 2017, Seoul, Republic of Korea
NSSFs Medical Claim Presented by Mr. Sithat Sril, NSSF July 2017
Outline of Presentation 1. Cambodia at a glance 2. Overview of National social Security Fund (NSSF) 3. Healthcare Scheme (SHI) on Medical Claim Healthcare scheme started and coverage Current flow of provider s claim and weaknesses Current flow of beneficiary s claim and weaknesses
1. Cambodia at a Glance Official language Khmer Area Capital Currency 7 million (2008 Labor Force 181,035 km2 Phnom Penh Riel (Average Exchange census) $1,020 (WB-2014) Per capita GDP Rate: USD 1 = KHR 4,050) +855 .kh 15.3 million (WB-2014) 1.54% (2008 census) $16.7 billion (WB- GDP Infant Calling code Internet TLD Population Population 2014) 60 per 1,000 live GDP Growth 7.0% (WB-2014) Inflation 3.9% (WB-2014) rate Life 72 (WB-2013) mortality births (2008 census) growth Population expectancy Median 75 persons /km2 (2008 24 (WHO-2013) density census) age(years)
2. Overview of NSSF Targeted Population: (current law) - private workers - public employees NSSF schemes and coverage: Time 1. Private Worker Work Injury Social Health Insurance Pension 2. Public Employee Work Injury Social Health Insurance Nov 2008 Sept 2016 2017 2018 (Plan) (Plan) (Plan)
3. Healthcare Scheme (SHI) on Medical Claim timeline to cover members and enterprises Month year Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Total # Covered members 248974 66805 10259 3471 1613 152237 81252 44020 35943 293 644867 # Covered enterprises 144 74 29 6 4 121 62 46 77 2 564 # Covered provinces 3 3 1 5 12/25
3. Healthcare Scheme (SHI) on Medical Claim member service utilization 35000 30000 25000 20000 15000 10000 5000 Number 0 Nov 21794 Dec 21974 Jan 22386 Feb 21494 Mar 25300 Apr 20820 May 33358 Number
3. Healthcare Scheme (SHI) on Medical Claim NSSF agent at provider NSSF headquarter Provider NSSF branch -define case name -prepare invoices and related documents then enter into excel file provided by NSSF (from July 2017 2017 the provider just provide the medical documents to nssf agents then received the file from agent extracted from HPSIP -enter data consumption in HSPIS -compare data from HSPIS system with Excel file from hospital (opd, ipd, nssf i.d
