Current Market approach

Description of the Information System for the General Health Insurance Company VZP CR

The information system VZP ensures, in the best possible manner, the support for the main activities of the health insurance company, i.e. the discharge of services connected with the provision of healthcare, ensuring the sufficient volume of financial means in the form of collection of insurance premiums, efficient inspection of the field of receipts and expenses of those means and, not last, also collection and assessment of information on the state of health of the inhabitants.

The system is implemented as distributed database (80 local databases) in the ORACLE, UNIX and WINDOWS environments. The database has been in uninterrupted operation for 8 years already. The application is updated actually, Developer 2000 being the developing environment.

In general, the activity of the health insurance company is divided into 3 areas:

• registration of the insured and collection of insurance premiums (the receipts part),
• discharge of services of provided healthcare, payments for medical products and healthcare aids (the expenses part),
• financial management of the insurance company (the accounting part).

All the parts are located at the central office and at the branches, they intermingle mutually and, apart from the VZP, also other subjects contribute to them.

A part of the information system is also its superstructure - the so-called SIS (Strategic Information System) that is implemented by OLAP technology and serves for the managerial control.

A. The Income Part

Within this part of the application the following are ensured:

• administration of the registry of the insured,
• processing of re-registrations among the health insurance companies,
• conclusion of contractual policies,
• registration of the payments of insurance premiums,
• inspection activity of the collection of insurance premiums,
• accounting for insurance premiums in relation to the individual payers, i.e. the state, employers and the self-insured,
• refunds of overpayments,
• correspondence with the insured and payers, issue of cards,
• fines, penalties and payment assessments,
• claiming receivables in administrative proceedings,
• statistics.

B. The Expenses Part

Within this part of the application the following are ensured:

• administration of the registry of healthcare providers,
• typing of submitted documents,
• validation of documents submitted by the provider,
• support of revision doctors activity,
• "moving" of documents after the insured (in case of drawing care outside the district of the place of residence), or in case of prescriptions also after the issuer (dispensation of medical products and PZT in another district),
• personal accounts of the insured,
• financial evaluation of submitted batches of documents,
• basic aggregation of information from primary documents,
• Statistical processing for the needs of inspection activity at the providers, for the needs of the Ministry of Health and for the needs of the health policy of the health insurance company,
• stacking and filing of processed documents,
• the apparatus of subsequent crosscut inspections,
• creation of methodologies and price lists, setting limits,
• liquidation of insurance events in the field of contractual insurance and treatment abroad,
• application of subsequent regulatory mechanisms oriented at the limitation of discharged medical care,
• fines, payment assessments and compensations of damage in connection with foreign fault or breach of treatment order.

C. Accounting Part

Within this part of the application the following are ensured:

• saldokonto pobočky
• o provision of advance payments,
• o payment of received invoices,
• o orders for settlement,
• o processing of bank statement, automated recognition of the payer and purpose of payment, or settlement,
• o zprocessing of postal orders,
• o accounting for advance payments and paid invoices in relation to the submitted performances (evaluation of the batch of documents),
• o supplementary charges, or receivables,
• o penalties, or conventional fines,
• o set-off of receivables against liabilities,
• o monthly or quarterly balances of cash flows between the VZP and the individual providers,
• o cash flow,
• o balance of operating field suppliers,
• branch accounting
• o automated inputs from the ledger,
• o keeping the ledger (standard accounting agenda),
• o state prescribed accounting statements,
• central office ledger
• o clearing among the branches,
• o cash flow, payment schedule, optimisation of liquidity (transfers and allocation of financial means),
• o operational fund budgeting (creation of budgets, setting limits, running automated observance of drawing),
• o balance of operating field suppliers,
• central office accounting
• o keeping ledger for foreign partners,
• o accounting of the central office,
• o automated aggregated inputs from the branches accounting agendas,
• o state prescribed accounting statements,
• financial management of the insurance company
• o statistical background materials,
• o analyses of receipts and expenses,
• o background materials for the elaboration of insurance plans.

REFERENCES

• VZP-Všeobecná Zdravotní Pojišťovna, (General Health Insurance Organization)
• HZP-Hutnická Zaměstnanecká Pojišťovna, ( Metallurgy employment Health Insurance )
• ZPMA-Zdravotní pojišťovna Metal Aliance (Health Insurance Metal Aliance)

PARTNERS

• Hewlett Packard, ORACLE

Seznam referencí [PDF]