Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia
ObjectiveTo identify the incidence of moral hazards among health care providers and its determinant factors in the implementation of national health insurance in Indonesia.MethodsData were derived from 360 inpatient medical records from six types C public and private hospitals in an Indonesian rural...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1147709/full |
| _version_ | 1797741140188856320 |
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| author | Syafrawati Syafrawati Rizanda Machmud Syed Mohamed Aljunid Syed Mohamed Aljunid Rima Semiarty |
| author_facet | Syafrawati Syafrawati Rizanda Machmud Syed Mohamed Aljunid Syed Mohamed Aljunid Rima Semiarty |
| author_sort | Syafrawati Syafrawati |
| collection | DOAJ |
| description | ObjectiveTo identify the incidence of moral hazards among health care providers and its determinant factors in the implementation of national health insurance in Indonesia.MethodsData were derived from 360 inpatient medical records from six types C public and private hospitals in an Indonesian rural province. These data were accumulated from inpatient medical records from four major disciplines: medicine, surgery, obstetrics and gynecology, and pediatrics. The dependent variable was provider moral hazards, which included indicators of up-coding, readmission, and unnecessary admission. The independent variables are Physicians' characteristics (age, gender, and specialization), coders' characteristics (age, gender, education level, number of training, and length of service), and patients' characteristics (age, birth weight, length of stay, the discharge status, and the severity of patient's illness). We use logistic regression to investigate the determinants of moral hazard.ResultsWe found that the incidences of possible unnecessary admissions, up-coding, and readmissions were 17.8%, 11.9%, and 2.8%, respectively. Senior physicians, medical specialists, coders with shorter lengths of service, and patients with longer lengths of stay had a significant relationship with the incidence of moral hazard.ConclusionUnnecessary admission is the most common form of a provider's moral hazard. The characteristics of physicians and coders significantly contribute to the incidence of moral hazard. Hospitals should implement reward and punishment systems for doctors and coders in order to control moral hazards among the providers. |
| first_indexed | 2024-03-12T14:22:35Z |
| format | Article |
| id | doaj.art-9288bb5ce3574259bbdd622efcfc7ea0 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-12T14:22:35Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-9288bb5ce3574259bbdd622efcfc7ea02023-08-18T16:10:54ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-08-011110.3389/fpubh.2023.11477091147709Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in IndonesiaSyafrawati Syafrawati0Rizanda Machmud1Syed Mohamed Aljunid2Syed Mohamed Aljunid3Rima Semiarty4Faculty of Medicine, Andalas University, Padang, IndonesiaFaculty of Medicine, Andalas University, Padang, IndonesiaDepartment of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, MalaysiaInternational Center for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia, Cheras, MalaysiaFaculty of Medicine, Andalas University, Padang, IndonesiaObjectiveTo identify the incidence of moral hazards among health care providers and its determinant factors in the implementation of national health insurance in Indonesia.MethodsData were derived from 360 inpatient medical records from six types C public and private hospitals in an Indonesian rural province. These data were accumulated from inpatient medical records from four major disciplines: medicine, surgery, obstetrics and gynecology, and pediatrics. The dependent variable was provider moral hazards, which included indicators of up-coding, readmission, and unnecessary admission. The independent variables are Physicians' characteristics (age, gender, and specialization), coders' characteristics (age, gender, education level, number of training, and length of service), and patients' characteristics (age, birth weight, length of stay, the discharge status, and the severity of patient's illness). We use logistic regression to investigate the determinants of moral hazard.ResultsWe found that the incidences of possible unnecessary admissions, up-coding, and readmissions were 17.8%, 11.9%, and 2.8%, respectively. Senior physicians, medical specialists, coders with shorter lengths of service, and patients with longer lengths of stay had a significant relationship with the incidence of moral hazard.ConclusionUnnecessary admission is the most common form of a provider's moral hazard. The characteristics of physicians and coders significantly contribute to the incidence of moral hazard. Hospitals should implement reward and punishment systems for doctors and coders in order to control moral hazards among the providers.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1147709/fullmoral hazardsup-codingreadmissionsunnecessary admissionsfraudphysicians |
| spellingShingle | Syafrawati Syafrawati Rizanda Machmud Syed Mohamed Aljunid Syed Mohamed Aljunid Rima Semiarty Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia Frontiers in Public Health moral hazards up-coding readmissions unnecessary admissions fraud physicians |
| title | Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia |
| title_full | Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia |
| title_fullStr | Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia |
| title_full_unstemmed | Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia |
| title_short | Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia |
| title_sort | incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage evidence from rural province hospitals in indonesia |
| topic | moral hazards up-coding readmissions unnecessary admissions fraud physicians |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1147709/full |
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