Solution for improving the administration of the single national fund of social health insurance and increasing the quality of medical and pharmaceutical services

The Unique Integrated Information System of Social Health Insurance in Romania will become a key factor in the development and improvement of medical and pharmaceutical services.

Consortium

• Hewlett-Packard as a system integrator and IT infrastructure provider - provides hardware infrastructure nationally and internationally, delivered and functional for 42 locations
• SIMAVI ensures the design, development and implementation of the 28 SIUI applications - ERP system - SIVECO Applications is in production in most county locations and provides IT support for efficiency and control of activities
• Special Transmission Service, provider of national telecommunications services - Provides operational WAN Infrastructure for 42 locations

System coverage area

National Health Insurance House

• all County Health Insurance Houses
• 53,910 doctors
• 10,304 primary care providers
• 95,286 nurses
• 509 hospitals
• 38 ambulance service providers
• 328 home care service providers
• 458 outpatient recovery service providers
• 2,639 medical device suppliers
• 15 recovery service providers in sanatoriums
• 4,140 pharmaceutical service providers.

Description of the Romanian social health insurance system

The system is built in a hierarchical structure having at the top of the pyramid the National Health Insurance House, which:

• receives, collects and processes synthetic data at national level
• coordinates the activities of the County Health Insurance Houses
• ensures at the same time the interface between the health insurance system and the other national records systems (Ministry of Interior, Ministry of Health, Ministry of Public Finance, etc.).

On the intermediate level are the County Health Insurance Houses, which:

• • carries out the basic activities within the social health insurance system

At the base of the pyramid, from the point of view of the computer system, are the providers of medical and pharmaceutical services, which collect and process:

• the medical information of the insured
• information that has an administrative character that will be the basis for the settlements between the providers and the County Health Insurance Houses.

Objectives of the SIUI system

The Unique Integrated Information System of the Social Health Insurance in Romania aims at the substantial improvement of the social health insurance system in Romania by:

• Collection and management of economic and medical information necessary for the efficient functioning of the Health Insurance System
• Transparency regarding the control and management of CNAS budgetary funds
• Evidence of insured persons and medical service providers by creating and administering the National Register of Insured Persons and the National Register of Medical Service Providers
• Streamlining the reporting of data by healthcare providers
• Uniformity in the application of norms and legislation at national level
• Highlighting and controlling costs for each insured
• Online and offline interfaces for interconnection with entities external to the system and with medical and pharmaceutical service providers

The main functionalities of the unique integrated computer system

The main functionalities of the system are the following:

• Management of the social health insurance fund at the level of the National Health Insurance House and of the County Health Insurance Houses
• Management of the insured at the level of the National Health Insurance House and of the County Health Insurance Houses
• Management of medical and pharmaceutical service providers at the level of the National Health Insurance House and the County Health Insurance Houses
• Evidence of taxpayers (taxpayers) at the level of the National Health Insurance House and the County Health Insurance Houses
• Ensuring the control of medical services at the level of the National Health Insurance House
• Computerized management of the following functions specific to the National Health Insurance House: - Dashboard for the management of the national social health insurance system - Production of unitary collections for network dissemination - Management of internal communications and with system partners - Managing relations with the organizations from which information is taken
• Computerized management of the activities specific to the following medical and pharmaceutical service providers: - primary health care providers - -specialized outpatient clinics for clinical specialties - outpatient clinics for paraclinical specialties - outpatient clinics for dental specialties - hospital units - ambulance and medical transport units - sanatoriums and preventives - health recovery clinics - home care providers - pharmaceutical units - suppliers of medical devices

The benefits of the unique integrated computer system

The main beneficiaries of the implementation of the system are the citizens who thus gain more efficient and quality medical services.

SIUI ensures total transparency of expenditures made in the Romanian health system, allowing rapid progress in aligning with European and global standards.

For the first time there will be National Registers and Databases, which will contain all the data and information necessary for a rigorous record at the level of the entire system, allowing the unique identification of each insured, an essential condition for reducing system errors.

SIUI will benefit from a high-performance hardware infrastructure at national level, which will allow an efficient operation as well as a staged update in accordance with technological evolution, as well as a platform of specific applications developed in accordance with CNAS needs, updated according to legislative changes for a period of 13 years.

The management, monitoring and support necessary for an efficient management of SIUI, will be ensured by implementing a Help Desk type call center, which will be available at national level both to the internal users of CNAS, and to the providers of medical and pharmaceutical services.

The management of CNAS and CJAS will have the possibility to perform complex analyzes on the system data.

The implementation of the project will allow the detection of errors in the social health insurance system.

The implementation of the project will allow the efficiency of the health insurance system by standardizing the application of the norms at national level, taking over the reports from the providers, taking over the reports from CJAS to CNAS.

The implementation of SIUI will allow a much increased efficiency of the budget use, by achieving annual savings in the Social Health Insurance budget generated by:

• Detection and removal of insured duplicates
• Detection and elimination of discrepancies regarding the insured
• Elimination of duplicates of medical services provided
• Blocking fraud attempts through controlled access to SIUI
• Identify and eliminate fraud attempts by verifying data
• Detection and elimination of prescription reporting by multiple pharmacies

Saved opportunity costs:

• Major impact on CNAS 'business plan regarding the amortization of SIUI system costs
• Decreasing operating costs due to the computerization of the Health Insurance System.