Health insurance fund of Macedonia

The last couple of years were crucial to the transformation of the Health Insurance Fund of Macedonia. Stabilization and modernization of the Health Insurance Fund of Macedonia is vital to the improvement of health care in Macedonia. A strong health system at national level requires comprehensive and up-to-date health information. In the past Macedonia was facing the greatest challenges regarding the collection, analysis, evaluation and interpretation of the indicator data based on the Health Management Information System (HMIS).

HIFM wanted to automate workflows, enforce rules, provide access to consolidated, accurate information, and improve communication with insured persons, companies and health organizations from primary, specialist-consultative and Hospital (short‐term and long-term) healthcare.

For HIFM so far the project for centralization of the information system was the most important project. This project covers consolidation of new registers of insured persons, payers, physicians and healthcare institutions, registration for health insurance registration, submitting applications for issuing electronic health card, choice of a physician and managing the process of contracting with healthcare institutions.

Beginning this August, the joint efforts of Health Insurance Fund of Macedonia and Nextsense became visible. As a result, this project automates most of the business processes of HIFM, and enhances the quality and time for data processing in the HIFM regional services.

In order to obtain accurate and consistent database, the project also involved migration of the records of the insured persons, payers and chosen physicians in the databases from all regional services of the central system. During the process of migration the data was synchronized with the other state institutions.

Building trust and relationship with the citizens

Today, individuals have high expectations, putting pressure on the organizations to reduce the administrative complexity for them and for the health workers who interact with them. This system involves that insured persons may only present themselves with ID card without other documentary proof because the system in interoperable in real time with major government institutions and data sources.

Flexible Workstyle

The system empowers health professionals, health institutions, and insured persons with the mobility and flexibility they need to be productive, while providing your HIFM ICT team with control, manageability, and security features. In every step the system extends security-enhanced, controlled access to information and applications from anywhere while simplifying application and resource management.

State of the art technology

The new central system of HIFM system meets several key requirements, including extensibility, flexibility, reliability and interoperability. In order to achieve requirements this solution was based on Services Oriented Architecture, using state-of –the-art technologies and platforms like XML, Web Services, .NET Framework, MVC, NHibernate,…

Business Intelligence

With increasing pressure to improve performance and quality of care, HIFM leveraged business intelligence solutions to help improve the quality and efficiency of service delivery. Business intelligence solution, implemented as a part of this system, provide HIFM access to data sources and capabilities to analyze available data in a familiar environment while ensuring ICT has the ability to monitor actions and maintain control—helping to enable "self-service BI" without compromise. The centralized IT system BI solution includes data integration, reporting, and analysis.

NEXT STEPS

The Internet portal of the Health Insurance Fund of Macedonia will represent a single platform that will connect all the business processes within the Fund, all the internal users (employees of the Fund) as well as the external users of the system (insured persons, companies and health organizations).

The new portal will use state of art technology and will provide a widespread of information and content allowing two-way interaction and online transactions.

The portal will be based on Microsoft SharePoint as an Enterprise Content Management System and BizTalk Server as the Enterprise Service Bus platform that will allow interoperability and information exchange with external institutions.