Preparations for Transition to General Health Insurance

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Preparations for Transition toGeneral Health
Insurance

• Social Security Institution
• 31 March 2006

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Four Main Components of Social Security Reform
Component 1 Social Insurances Component 2
General Health Insurance Component 3 Payments
Without Premium Component 4 New Institutional
Structure
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GENERAL FRAME OF THE REFORM PROGRAM
UNIVERSAL HEALTH INSURANCE INTEGRATION
SOCIAL INSURANCES INTEGRATION
NON-PREMIUM PAYMENTS INTEGRATION
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Components of Integration Projects

• Analysis of the existing processes and
  development of joint business processes
• Development of application software and
  harmonizing them with new business processes
• Preparation of Information Technologies
  infrastructure
• Test processes
• Pilot implementation
• Pre-transitory preparations
• Legal Administrative Regulations
• Nominations
• Training Programs
• Transition to implementation
• System transfer transactions
• Project management activities

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Basic Transition Management Strategy Gradual
Transition

• Determination of business processes in compliance
  with Institutional Strategies and legal
  requirements, their prioritization, and realizing
  transition in compliance with these priorities.
• Before putting each business process into
  practice, completion of all technical and
  organization arrangements related to the process.

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Processes and Organizational Design
Other Reforms, Programs, Health etc.
REQUIREMENTS
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• Integration of Application and Registry System
• Integration of Premium Collection system
• Integration of Income, Salary and Other Payments

• Development of GSS Health Finance System
• Development of GSS Invoice Control and Payment
  System
• ...

• Revision of Non-Premium Payments System
• Development of System of Personal Life Level
  Determination

• Development of Monitoring Evaluation Systems
• Development of Decision Support Systems
• Development of Finance Management Systems

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• Development of Infrastructure
• Creation of National Social Security Database
• Development of UHI, SI and NPP Implementations
• Information Security Management
• Development of Supportive Systems and
  Applications
• Pilot Applications

• Institutional Communication Management
• Process Analysis and Business Modeling
• Development of Legal Administrative
  Arrangements
• Organization and Human Resources
• Development of Working Environments
• Development of Institutional Strategies
• Assets Management

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Scope of UHI Implementation Infrastructure
Development Project

• Realizing legal and administrative regulations.
• Creating health care services, drug and medical
  devices financing models
• Unifying and improving drug finance systems
• Unifying and improving medical devices finance
  systems
• Unifying and improving health care services
  financing systems
• Unifying and improving claim processing, invoice
  control and payment systems
• Establishment of UHI Monitoring and Evaluation
  system
• Establishment of UHI Inspection system
• Establishment of UHI Financial Management system
• Development of poverty and personal subsistance
  level determination system

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UHI Sub-Projects

• UHI.01 Project for Unifying drug financing
  implementations, and development of monitoring
  and evaluation system
• UHI.02 Project for Unifying medical devices
  financing implementations, and development of
  monitoring and evaluation system
• UHI.03 Project for Unifying health care
  services (inpatient and outpatient care)
  financing implementations, and development of
  monitoring and evaluation system
• UHI.04 Project for developing invoice control
  and payment system
• UHI.05 Project for developing financial
  management system

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Current Status of UHI Project

• Development of infrastructure for improvement and
  restructuring of health services financing
  management (Hacettepe University Research
  Project)
• Development of infrastructure for UHI health case
  services payments (Hacettepe University
  Additional Research Project)
• Other UHI project components are executed by SGK

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Current Status of UHI Project

• Concept Note prepared
• UHI Projet Plan prepared
• UHI.01 - Project for Unifying drug financing
  implementations, and development of monitoring
  and evaluation system
• Detailed project plan prepared
• BUT and SSK drug list and implementation
  directive united
• HÜ Research project Drug and supplier
  information databank is prepared
• HÜ Additional research project Related to drugs
  repayment of which are to be made by UHI, it is
  planned to create
• Selection criteria
• Payment model
• Monitoring evaluation and inspection system
• Other works are executed by SGK

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Current Status of UHI Project

• UHI.02 Project for Unifying medical devices
  financing implementations, and development of
  monitoring and evaluation system
• HÜ Research Project Medical devices ad
  suppliers databank is being prepared
• HÜ Additional research project Related to
  medical devices repayment of which are to be made
  by UHI, it is planned to create
• Selection criteria
• Payment model
• Monitoring evaluation and inspection system
• Other works are executed by SGK.

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Current Status of UHI Project

• UHI.03 Project for Unifying health care
  services (inpatient and outpatient care)
  financing implementations, and development of
  monitoring and evaluation system
• Preliminary analysis and design works are ongoing
• Detailed design project plan prepared
• Short Term
• HÜ Research Project Works for renewing the BUT
  prepared for 2006 in accordance with UHIs
  requirements are ongoing
• HÜ Additional Research Project To be applied by
  UHI, it is planned to create
• Health care services financing models
• Health care services contract models
• Definition and lists of health care system
  servers
• Health care service providers selection criteria
• Incentive models for protective health services
• Monitoring evaluation and inspection system

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Current Status of UHI Project

• UHI.03 Project for Unifying health care
  services (inpatient and outpatient care)
  financing implementations, and development of
  monitoring and evaluation system
• Middle and Long Term
• HÜ Research Project Know-how development on
  clinical budgeting based on Diagnosis Related
  Grouping (DRG)
• HÜ Additional Research Project Second stage of
  works for clinical budgeting relying on Diagnosis
  Related Grouping (DRG) (dissemination and
  implementation)

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UHI Institutional Transformation

• Scope of UHI Business Analysis and Modeling
  project
• Analysis of Current Business Processes
• Analysis of Current Organizational Structures
• Creating Process Designs
• Development of Organization models
• Business Modeling
• Analysis of all business processes directly and
  indirectly related to GSS and design of new
  business processes are taken into the scope of
  this project, and it is planned to be performed
  within the scope of HÜ Additional Project

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Thank you