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Health Insurance

Health Insurance . Hadi Rabee Reem Sawafta. Health Insurance . Difintion Risk pooling risk sharing . History of health insurance . *  Germany  1883 * Britain  1911 * France ** Palestine  1994. The objectives of health insurance:.

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Health Insurance

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  1. Health Insurance HadiRabee ReemSawafta

  2. Health Insurance • Difintion • Risk pooling\ risk sharing

  3. History of health insurance * Germany 1883 * Britain1911 * France ** Palestine 1994

  4. The objectives of health insurance: • 1) remove the financial barrier between the patient and access care • 2 ) social trust • 3)Improve the level of medical services . • 4 ) the provision of financial resources

  5. Types of health insurance : 1)The government health insurance: USA Medicaid \\ S-CHIP 2) The private health insurance Employer-sponsored insurance

  6. Health Insurancein PALESTINE

  7. Types of health insurance 1)The government health insurance. 2) The private health insurance. 3) UNORWA insurance .

  8. GHI

  9. Insured familes 117125 family - WB

  10. Includes : Family members : wife, husband, children below 18, Single daughters, university students below 26 years and parents over 60 years old . *** Add of memb increase the payment .

  11. Types of participation in GHI : • 1) Compulsory participation for the government and municipality employees \ 5% of the their basic salary , 40-75 NIS . • 2)Voluntary participation for all self-employed people , pay a fixed premium of NIS 75 per month . • 3) Workers in Israel \ special compulsory insurance .

  12. Cont …. • 4) Contracts insurance to the self-employed groups who are affiliated to occupational societies or associations . • 5) Hardship cases are covered by the supplement services of the Ministry of Social Welfare, who pays NIS 40 . • 6) Al aqsa GHI : for unemployed people after the second intifada , but the number now declines coz of restriction by MOH .

  13. Cont …. • 7) Ministry of Prisoners affaires . • 8) fore the university students !!! and for the recently graduated doctors . Problems: political, financing problems and administrative inefficiency problems .

  14. Services Services included : all services present in the MOH buildings …. Services that are not included: - plastic surgery . -Treatments of infertility . -traffic accidents and work accidents …

  15. Free • -Handicapped, • Thalassemia, • Hemophilia patients, • Children below 3 years , • Vaccinations • High risk pregnancy .

  16. Private health insurance General insurance companies as a part of their insurance program \ only 3% of pop . It costs more than the GHI . Any person can participate by his own fees , even the one who is insured by the GHI . e.g : An Najah National University insure at Ala’lmyeh for insurance .

  17. UNRWA : For any person who carries the card of UNRWA . Must cover all the services in any hospital freely , but now they cover only 70 % of the health service • Escaping from responsibility !!.

  18. Prposed law for health insurance reform : Goals : 1.separate healthcare pro\ purch . 2. compulsory participation _ sustainability 3.improve acces to healthcare services .

  19. Objects • Equity \ autonomous . • Basket of sevices including puplic health services . • Free of charge : children (5 years) pregnant women , tx for : cancer \ commdse \ mental illness \ drug addic & substance abuse

  20. Financing : • 1.premiums . • 2.co-payments . • 3.donations • 4. MOL – unemployed . • 5. MOSA – poor . Participation: mandatory for the entire Palestinians \ enforced through salary deductions and employer taxes ….

  21. Health Insurancein ISRAEL

  22. The MOH is responsible for the development of health policy, operation of the nation's public health services and management of the governmental health care budget Medical services and insurances are provided through four health insurance companies, known as sick funds : clalit \ Maccabi \, Meuhedet \ Leumit . They are globally known as HMO : health maintenance organization .

  23. HMO Type of MCO : manage care organizasion in USA and some other contries . Members select a primary care physician (PCP) Preventive care for a lower copayment or for free, in order to keep members from developing a preventable condition .

  24. References .. .1. WHO website 2. Dr.Fahd Al-sayed . 3. The Palestinian Independent Commission For Citizen’s Right . 3. مديرية الصحة الفلسطينية – نابلس .

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