HIRA Training on Social Health Insurance from 24-28 July 2017, Seoul, Republic of Korea

NSSF’s 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 181,035 km2 Capital Phnom Penh Currency Riel (Average Exchange Rate: USD 1 = KHR 4,050) Calling code +855 Internet TLD .kh Population 15.3 million (WB-2014) Population growth 1.54% (2008 census) Population density 75 persons /km2 (2008 census) Labor Force 7 million (2008 census) Per capita GDP $1,020 (WB-2014) GDP $16.7 billion (WB-2014) GDP Growth 7.0% (WB-2014) Inflation 3.9% (WB-2014) Infant mortality rate 60 per 1,000 live births (2008 census) Life expectancy 72 (WB-2013) Median age(years) 24 (WHO-2013)

2. Overview of NSSF

Social Health Insurance 2. Overview of NSSF Targeted Population: (current law) - private workers - public employees NSSF schemes and coverage: Time Nov 2008 Sept 2016 2017 2018 1. Private Worker Work Injury Social Health Insurance Pension (Plan) 2. Public Employee

3. Healthcare Scheme (SHI) on Medical Claim timeline to cover members and enterprises Month year Sept 16 Oct Nov Dec Jan 17 Feb Mar Apr May Jun 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 1 5 12/25

3. Healthcare Scheme (SHI) on Medical Claim

3. Healthcare Scheme (SHI) on Medical Claim Provider NSSF agent at provider NSSF branch NSSF headquarter -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

3. Healthcare Scheme (SHI) on Medical Claim