MR Microinsurance_2012_03_29.indd - International Labour ...

150 Health insurance
tion criteria; 2) concurrent, such as through case management of a hospitalization;
or 3) retrospective, through analysis of claims, encounters or surveys of patients.
– Screening and periodically auditing the general quality of care in contracted
health facilities. Quality indicators can include simple and measurable criteria
such as hours of operation, availability of medical staff, availability of essential
drugs and diagnostic equipment, and hygiene.
– Implementing and monitoring compliance with standard treatment protocols.
Such protocols may be in the public domain and published by organizations
such as the World Health Organization or a Ministry of Health, as seen in
Cambodia and Lao PDR, or they may be proprietary and developed by the HMI
scheme and/or its network providers.
Promoting service quality through liaison officers
All seven case studies confirm that clients perceive greater quality of care when a
liaison officer assists them in accessing health services. Liaison officers often perform
tasks such as:
– welcoming patients and orienting them towards the facility;
– verifying benefits and eligibility;
– registering new enrolees and collecting premiums;
– visiting hospitalized patients and serving as an advocate to ensure that appropriate
care and services are being provided, and helping prepare the patient and
family for discharge; and
– collecting feedback on patient satisfaction and outcomes through surveys or
interviews.
Liaison services can increase the perception of value and quality and in turn
increase trust in the scheme and encourage renewals, contributing to the
scheme’s sustainability. However, since they have a cost, HMI schemes must evaluate
when and how to provide such services efficiently. For example, the scheme
must decide whether to provide a liaison service just for hospitalizations or also
be present in outpatient settings. An optimal cost-benefit arrangement may be
achieved by providing a liaison at facilities that have a minimum number of clients
or claims (Microcare). Another cost-efficient strategy can be for a liaison
officer to cover several facilities on a rotating basis, or only during peak hours
(GRET-SKY). Technology developments such as the spread of mobile phones
have also stimulated development of call centres, which can provide many of the
liaison services desired remotely and at considerably lower cost (five case studies,
including FMiA).