Benefits To
The Public Health Insurance Scheme Administrator:
Benefits To The National Health Plan
Administrator
- In
addition, some countries like Jamaica offer a National Health Plan
which reimburses its citizens for drugs (according to the price of
the corresponding generic item), used to treat some 16 chronic
diseases. Drug treatment schedules can be set up for each
disease within the PAS database, and the system is updated with
appropriate information when a citizen is certified by an
appropriate physician, as having one or more of the pre-defined
chronic diseases. The citizen is issued a magnetic strip I.D. card,
which is required to initiate a claim at participating pharmacies.
PAS handles all of the monitoring thereafter, ensuring that there is
no abuse and that no one gets more or less than they are allowed
under the program.
Benefits
To The Public Sector Hospital
-
Some
Public Sector hospitals adopt a policy of not refusing service to a
patient who is unable to pay. This
is noble, yet expensive (and at best, difficult to monitor).
Experience has shown that many who profess an inability to
pay, are in fact being deceitful.
Some have undeclared insurance policies, while others are
financially able.
PAS,
with the permission of participating insurance carriers (and this
can be encouraged), will transmit a name enquiry through to the
various databases to establish the health insurance status of the
relevant patient. Hospitals
should be advised that cooperation is not likely (from
insurance carriers or from patients), if higher rates are charged to
those "with means."
PAS,
being an online system, can be directed to communicate with
other databases that the Public Sector may have, to establish
"means." This liability to the Public Sector can be logged
in important databases where "more leverage" in the
collection effort can be exercised.
PAS, if installed with the optional Accounts
Receivable module, will automatically charge such unpaid sums to an
account established in the name of relevant patients.
This information can be used for future follow-ups, and
outstanding balances will be prominently displayed on the patient's
next visit.
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