Course Description
| Course | Code | Semester | T+P (Hour) | Credit | ECTS |
|---|---|---|---|---|---|
| HEALTH INSURANCE | - | Spring Semester | 2+0 | 2 | 3 |
| Course Program |
| Prerequisites Courses | |
| Recommended Elective Courses |
| Language of Course | Turkish |
| Course Level | First Cycle (Bachelor's Degree) |
| Course Type | Elective |
| Course Coordinator | Prof.Dr. Yeter USLU |
| Name of Lecturer(s) | Lect. Ramazan ÜLGER |
| Assistant(s) | Research Assistant Yaşar Gökalp |
| Aim | To provide the students with the main scope of health insurance and its importance in health management. |
| Course Content | This course contains; Health Services System and Limits of Health Services System, Basic Criteria in Health Organization,Major Finance Models of Health System and Role and Importance of Insurance,Health Insurance Terminology and Classification,Analysis of Private Health Insurance Market by Historical, Technical and Distribution Channels in Turkey,Basic Legislation of Private and General Health Insurance ,Organizational Structure, Underwriting and Production Processes of PHI-I,Organizational Structure, Underwriting and Production Processes of PHI-II,Claims and Preauthorization Processes of PHI,Network and Contract Management at PHI,Sustainability for Health Expenditures: Payment Systems and Financial Tools for Chronically Diseases,Complementary and Supplementary Health Insurance (CSHI),Tourism, Health and Insurance,Analyzing Health Data and Strategic Targets-I,Analyzing Health Data and Strategic Targets-II. |
| Dersin Öğrenme Kazanımları | Teaching Methods | Assessment Methods |
| At the end of this course, students; | ||
| 1. Interpret health system and subsystem of health services from macro financial perspective | 16, 4, 9 | A |
| 2. Explain the roles and importance of a variety of financial sources | 16, 4, 9 | A |
| 3. Define health expenditure by source and distribution and explain importance of sustainable finance system for health expenditures. | 16, 4, 9 | A |
| 4. Explain insurance and related subjects and expressing main work frame of insurance system. | 16, 4, 9 | A |
| 5. Discuss social and private health insurance,understand the importance of regulation, organization and functional structure of general health insurance. | 16, 4, 9 | A |
| 6. Identify organizational and functional structure of private insurers and their relationships with healthcare providers | 16, 4, 9 | A |
| Teaching Methods: | 16: Question - Answer Technique, 4: Inquiry-Based Learning, 9: Lecture Method |
| Assessment Methods: | A: Traditional Written Exam |
Course Outline
| Order | Subjects | Preliminary Work |
|---|---|---|
| 1 | Health Services System and Limits of Health Services System, Basic Criteria in Health Organization | Examination of sample cases related to the subject |
| 2 | Major Finance Models of Health System and Role and Importance of Insurance | Examination of sample cases related to the subject |
| 3 | Health Insurance Terminology and Classification | Examination of sample cases related to the subject |
| 4 | Analysis of Private Health Insurance Market by Historical, Technical and Distribution Channels in Turkey | Examination of sample cases related to the subject |
| 5 | Basic Legislation of Private and General Health Insurance | Examination of sample cases related to the subject |
| 6 | Organizational Structure, Underwriting and Production Processes of PHI-I | Examination of sample cases related to the subject |
| 7 | Organizational Structure, Underwriting and Production Processes of PHI-II | Examination of sample cases related to the subject |
| 8 | Claims and Preauthorization Processes of PHI | Examination of sample cases related to the subject |
| 9 | Network and Contract Management at PHI | Examination of sample cases related to the subject |
| 10 | Sustainability for Health Expenditures: Payment Systems and Financial Tools for Chronically Diseases | Examination of sample cases related to the subject |
| 11 | Complementary and Supplementary Health Insurance (CSHI) | Examination of sample cases related to the subject |
| 12 | Tourism, Health and Insurance | Examination of sample cases related to the subject |
| 13 | Analyzing Health Data and Strategic Targets-I | Examination of sample cases related to the subject |
| 14 | Analyzing Health Data and Strategic Targets-II | Examination of sample cases related to the subject |
| Resources |
| Emine Orhaner, Türkiye'de Sağlık Sigortası, 2018. |
Course Contribution to Program Qualifications
| Course Contribution to Program Qualifications | |||||||
| No | Program Qualification | Contribution Level | |||||
| 1 | 2 | 3 | 4 | 5 | |||
| 1 | PQ-1. Learns the national health conditions and the development, implementation and performance evaluation of appropriate health policies, as well as the theoretical and practical knowledge of organization and management of the health sector. | X | |||||
| 2 | PQ-2. Uses theoretical and practical knowledge on business world and management with a critical approach to plan, organize and lead health and health service providers at national and international level. | X | |||||
| 3 | PQ-3. Identifies the relevant job roles in subdivisions of health system organizations and learns about their duties and responsibilities. | X | |||||
| 4 | PQ-4. Knows the social, environmental and behavioral factors related to the development of public and individual health. | X | |||||
| 5 | PQ-5. Applies the knowledge and skills on management of health institutions to manage the functions such as management, production, human resources, finance, accounting, marketing, patient and public relations, quality and patient safety, occupational health and safety, information technologies. | X | |||||
| 6 | PQ-6. Analyzes the information on health management scientifically and interprets their results, creates innovative, ethical, socially responsible and sustainable solutions, by using quantitative, qualitative techniques and digital technology innovatively for problem solving and exploiting opportunities in health management. | X | |||||
| 7 | PQ-7. Decide independently and demonstrates leadership qualities in identifying health management problems, develops proposals for solutions, applies them effectively and efficiently and assesses outcomes. | X | |||||
| 8 | PQ-8. Takes responsibility as an individual and/or team member to solve the problems encountered in managing health institutions. | X | |||||
| 9 | PQ-9. Evaluates the personality, culture and behavioral characteristics of the health institutions’ employees and directs them towards the aims of the institution. | X | |||||
| 10 | PQ-10. Decides on and applies different ways of accessing information. | X | |||||
| 11 | PQ-11. Continuously develops their professional knowledge and skills; open to change, innovation, entrepreneurship and lifelong learning. | X | |||||
| 12 | PQ-12. Shares the views and suggestions on health management issues in writing and orally with stakeholders and communicates effectively with colleagues using an English level of at least European Language Portfolio B1 General. | X | |||||
| 13 | PQ-13. Solves problems using effective communication methods, has the ability to use the language in written and oral communication in a correct and proper manner using the terminology of health institutions. | X | |||||
| 14 | PQ-14. Uses information and communication technologies and computer software at least at the European Computer Use License level. | X | |||||
| 15 | PQ-15. Yönetim felsefesini ve yönetimin fonksiyonlarını her bir birime uygun olacak biçimde yönetim uygulamalarına yansıtır. | X | |||||
| 16 | PQ-16. Birey olarak dış görünüm olumlu tutum ve davranışlarıyla kuruma örnek olur; sürekli gelişme ve değişime açıktır. | X | |||||
| 17 | PQ-17. Sağlık yönetimi ile ilgili hukuki düzenlemeler ile toplumsal, bilimsel, mesleki etik ilkelere uygun, ülke ya da dünya genelinde genel sağlık sorunlarına duyarlı davranır, çözüm önerilerini yorumlar ve değerlendirir. | X | |||||
Assessment Methods
| Contribution Level | Absolute Evaluation | |
| Rate of Midterm Exam to Success | 20 | |
| Rate of Final Exam to Success | 80 | |
| Total | 100 | |
| ECTS / Workload Table | ||||||
| Activities | Number of | Duration(Hour) | Total Workload(Hour) | |||
| Course Hours | 14 | 2 | 28 | |||
| Guided Problem Solving | 0 | 0 | 0 | |||
| Resolution of Homework Problems and Submission as a Report | 0 | 0 | 0 | |||
| Term Project | 1 | 15 | 15 | |||
| Presentation of Project / Seminar | 1 | 1 | 1 | |||
| Quiz | 0 | 0 | 0 | |||
| Midterm Exam | 1 | 16 | 16 | |||
| General Exam | 1 | 31 | 31 | |||
| Performance Task, Maintenance Plan | 0 | 0 | 0 | |||
| Total Workload(Hour) | 91 | |||||
| Dersin AKTS Kredisi = Toplam İş Yükü (Saat)/30*=(91/30) | 3 | |||||
| ECTS of the course: 30 hours of work is counted as 1 ECTS credit. | ||||||
Detail Informations of the Course
Course Description
| Course | Code | Semester | T+P (Hour) | Credit | ECTS |
|---|---|---|---|---|---|
| HEALTH INSURANCE | - | Spring Semester | 2+0 | 2 | 3 |
| Course Program |
| Prerequisites Courses | |
| Recommended Elective Courses |
| Language of Course | Turkish |
| Course Level | First Cycle (Bachelor's Degree) |
| Course Type | Elective |
| Course Coordinator | Prof.Dr. Yeter USLU |
| Name of Lecturer(s) | Lect. Ramazan ÜLGER |
| Assistant(s) | Research Assistant Yaşar Gökalp |
| Aim | To provide the students with the main scope of health insurance and its importance in health management. |
| Course Content | This course contains; Health Services System and Limits of Health Services System, Basic Criteria in Health Organization,Major Finance Models of Health System and Role and Importance of Insurance,Health Insurance Terminology and Classification,Analysis of Private Health Insurance Market by Historical, Technical and Distribution Channels in Turkey,Basic Legislation of Private and General Health Insurance ,Organizational Structure, Underwriting and Production Processes of PHI-I,Organizational Structure, Underwriting and Production Processes of PHI-II,Claims and Preauthorization Processes of PHI,Network and Contract Management at PHI,Sustainability for Health Expenditures: Payment Systems and Financial Tools for Chronically Diseases,Complementary and Supplementary Health Insurance (CSHI),Tourism, Health and Insurance,Analyzing Health Data and Strategic Targets-I,Analyzing Health Data and Strategic Targets-II. |
| Dersin Öğrenme Kazanımları | Teaching Methods | Assessment Methods |
| At the end of this course, students; | ||
| 1. Interpret health system and subsystem of health services from macro financial perspective | 16, 4, 9 | A |
| 2. Explain the roles and importance of a variety of financial sources | 16, 4, 9 | A |
| 3. Define health expenditure by source and distribution and explain importance of sustainable finance system for health expenditures. | 16, 4, 9 | A |
| 4. Explain insurance and related subjects and expressing main work frame of insurance system. | 16, 4, 9 | A |
| 5. Discuss social and private health insurance,understand the importance of regulation, organization and functional structure of general health insurance. | 16, 4, 9 | A |
| 6. Identify organizational and functional structure of private insurers and their relationships with healthcare providers | 16, 4, 9 | A |
| Teaching Methods: | 16: Question - Answer Technique, 4: Inquiry-Based Learning, 9: Lecture Method |
| Assessment Methods: | A: Traditional Written Exam |
Course Outline
| Order | Subjects | Preliminary Work |
|---|---|---|
| 1 | Health Services System and Limits of Health Services System, Basic Criteria in Health Organization | Examination of sample cases related to the subject |
| 2 | Major Finance Models of Health System and Role and Importance of Insurance | Examination of sample cases related to the subject |
| 3 | Health Insurance Terminology and Classification | Examination of sample cases related to the subject |
| 4 | Analysis of Private Health Insurance Market by Historical, Technical and Distribution Channels in Turkey | Examination of sample cases related to the subject |
| 5 | Basic Legislation of Private and General Health Insurance | Examination of sample cases related to the subject |
| 6 | Organizational Structure, Underwriting and Production Processes of PHI-I | Examination of sample cases related to the subject |
| 7 | Organizational Structure, Underwriting and Production Processes of PHI-II | Examination of sample cases related to the subject |
| 8 | Claims and Preauthorization Processes of PHI | Examination of sample cases related to the subject |
| 9 | Network and Contract Management at PHI | Examination of sample cases related to the subject |
| 10 | Sustainability for Health Expenditures: Payment Systems and Financial Tools for Chronically Diseases | Examination of sample cases related to the subject |
| 11 | Complementary and Supplementary Health Insurance (CSHI) | Examination of sample cases related to the subject |
| 12 | Tourism, Health and Insurance | Examination of sample cases related to the subject |
| 13 | Analyzing Health Data and Strategic Targets-I | Examination of sample cases related to the subject |
| 14 | Analyzing Health Data and Strategic Targets-II | Examination of sample cases related to the subject |
| Resources |
| Emine Orhaner, Türkiye'de Sağlık Sigortası, 2018. |
Course Contribution to Program Qualifications
| Course Contribution to Program Qualifications | |||||||
| No | Program Qualification | Contribution Level | |||||
| 1 | 2 | 3 | 4 | 5 | |||
| 1 | PQ-1. Learns the national health conditions and the development, implementation and performance evaluation of appropriate health policies, as well as the theoretical and practical knowledge of organization and management of the health sector. | X | |||||
| 2 | PQ-2. Uses theoretical and practical knowledge on business world and management with a critical approach to plan, organize and lead health and health service providers at national and international level. | X | |||||
| 3 | PQ-3. Identifies the relevant job roles in subdivisions of health system organizations and learns about their duties and responsibilities. | X | |||||
| 4 | PQ-4. Knows the social, environmental and behavioral factors related to the development of public and individual health. | X | |||||
| 5 | PQ-5. Applies the knowledge and skills on management of health institutions to manage the functions such as management, production, human resources, finance, accounting, marketing, patient and public relations, quality and patient safety, occupational health and safety, information technologies. | X | |||||
| 6 | PQ-6. Analyzes the information on health management scientifically and interprets their results, creates innovative, ethical, socially responsible and sustainable solutions, by using quantitative, qualitative techniques and digital technology innovatively for problem solving and exploiting opportunities in health management. | X | |||||
| 7 | PQ-7. Decide independently and demonstrates leadership qualities in identifying health management problems, develops proposals for solutions, applies them effectively and efficiently and assesses outcomes. | X | |||||
| 8 | PQ-8. Takes responsibility as an individual and/or team member to solve the problems encountered in managing health institutions. | X | |||||
| 9 | PQ-9. Evaluates the personality, culture and behavioral characteristics of the health institutions’ employees and directs them towards the aims of the institution. | X | |||||
| 10 | PQ-10. Decides on and applies different ways of accessing information. | X | |||||
| 11 | PQ-11. Continuously develops their professional knowledge and skills; open to change, innovation, entrepreneurship and lifelong learning. | X | |||||
| 12 | PQ-12. Shares the views and suggestions on health management issues in writing and orally with stakeholders and communicates effectively with colleagues using an English level of at least European Language Portfolio B1 General. | X | |||||
| 13 | PQ-13. Solves problems using effective communication methods, has the ability to use the language in written and oral communication in a correct and proper manner using the terminology of health institutions. | X | |||||
| 14 | PQ-14. Uses information and communication technologies and computer software at least at the European Computer Use License level. | X | |||||
| 15 | PQ-15. Yönetim felsefesini ve yönetimin fonksiyonlarını her bir birime uygun olacak biçimde yönetim uygulamalarına yansıtır. | X | |||||
| 16 | PQ-16. Birey olarak dış görünüm olumlu tutum ve davranışlarıyla kuruma örnek olur; sürekli gelişme ve değişime açıktır. | X | |||||
| 17 | PQ-17. Sağlık yönetimi ile ilgili hukuki düzenlemeler ile toplumsal, bilimsel, mesleki etik ilkelere uygun, ülke ya da dünya genelinde genel sağlık sorunlarına duyarlı davranır, çözüm önerilerini yorumlar ve değerlendirir. | X | |||||
Assessment Methods
| Contribution Level | Absolute Evaluation | |
| Rate of Midterm Exam to Success | 20 | |
| Rate of Final Exam to Success | 80 | |
| Total | 100 | |