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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
The result of the evaluation process is a case study. The information in
the qualitative part aims to give precise answers to the questions and
sub-questions and, where necessary, compensate for limitations or gaps
in the questionnaire. The multiple-choice part helps to classify and
compare different health insurance schemes. The statistical part supplements quantitative data which have some bearing on the health insurance performance.
The multilingual questionnaires are available in two forms:
- As printed version
- As software-based version.
Both versions can be used by the evaluator to conduct the interviews
with the management of an insurance scheme, stakeholders, beneficiaries,
providers, and other groups of interest. The case study is entered into
the InfoSure information system that can be accessed via Internet. This
system allows processing, grouping and analysis of the collected informationin a variety of ways. It is also possible to make editorial changes to the data entered, to modify the questionnaire, or to logically connect individual case studies.
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.
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