InfoSure Health Insurance Evaluation Methodology & Information System - Principles and General Procedures

Structure and technique:

The InfoSure methodology consists of three main parts:

• A qualitative questionnaire
• A coded multiple-choice questionnaire
• A statistical part.

The choice of questions provided in the standard InfoSure package is intended to guide the evaluator in his/her interviews. Not every single question has to be addressed in an interview situation. The findings of the qualified interviews are entered into the tool, either as free text answers or categorized in the multiple-choice part.

The qualitative part, with its sets of questions, explanations and possible answers, gives the evaluator the leeway to describe clearly the health insurance approach that has been taken. There is always the possibility to explore other aspects as well.

The multiple-choice part offers a selection of possible answers to the questions posed in the qualitative part. These categories can be extended to suit individual requirements.

The statistical part is intended for collection of financial and epidemiological data.

Figure 1: Main steps and resulting products of InfoSure

Content

The main contents covered by the qualitative and multiple choice questionnaires are:

• Conditions at the time of starting the health insurance scheme, with the related problems that were encountered or supposed to be tackled.
• All relevant reference groups / persons involved in the planning and implementation and in providing the necessary support.
• Description of the beneficiaries: Definition of membership, the manner in which members are recruited and registered, the defined and actual benefits for the target group that is supposed to gain from the health insurance scheme.
• Financial aspects of a health insurance: Risk determination, calculation of contributions, contribution collection, level of copayments, financial management, support from other organisations.
• The benefit package: Covered and excluded benefits, reason why certain benefits have been excluded, included or extended, claim processing.
• Legal status of the scheme and the way it fits into the national health care policy.
• Administration: How the health insurance scheme is set up and the workflow organised.
• Overview of the general health situation in the region and country, existing health care services, including quality aspects of the benefits offered.
• Contracting with multiple health care providers or an exclusive provider network.
• Level and method of provider payment.
• Functions of the state, including supervision and regulation of providers and insurers.
• Types of regulatory measures that have been invoked.
• Financial data, membership statistics, morbidity data, utilisation rates of different health care facilities, general demographic data (the gender and age-specific distribution of the membership data is particularly interesting).

Procedure

The information and data collection is supposed to be carried out by trained evaluators. The evaluation can be linked to consultancy services. Once a minimum number of data records have been entered, the comparative information may be used in order to identify interesting aspects for further investigation, advisory, or to prepare a publication. The case studies and reports can be published also on the InfoSure Website (Please proceed to our "Links" page and search for "infosure".).

Exemplary fields of interest

The following topics are of particular interest for the analysis:

• Solidarity mechanisms implemented in the health insurance scheme.
• To what extend the establishment of a health insurance scheme has actually improved access to health care services of the target group.
• The manner in which the health insurance scheme has changed the relationship between service providers and users (success or failure in strengthening patients’ interests).
• The political influence generated by local, regional or other health insurance schemes on the national health care strategy.