Likkasa.com

Examplery organisation chart of a sickness fund

Аutomatised financial and information flow system of a sickness fund

Basic areas of activity for organisational development of a sickness fund

Staff management

The overall performance of the sickness fund is largely determined by the quality and motivation of the staff. Critical management tasks in the process of assembling staff are as follows:

• Staff selection
• Staff training and development
• Drawing up employment contracts with appropriate payment category
• Setting up principles and criteria for promotion
• Organising payment of salaries and deduction of social security contributions and taxes; supervision of staff in respect of holidays, sick leave etc.

Financial management

The task for financial management is to keep the sickness fund’s financial (business) plan counterbalanced, which includes maintaining an adequate operative reserve to cover unforeseeable short term risks. It is also part of financial management to forecast incomes and costs (staff salaries, equipment etc.). The sickness fund must observe developments in resources and the development of costs.

Planning

Planning is an integral part of managing a sickness fund. Specific planning activities are listed below:

• annual budget planning (forecasting expenditures and income)
• planning of infrastructure (in order to provide appropriate health care services
• planning of health care activities and programs (to meet objectives such as preventive medicine etc.)

Accounting

Proper accounting is a very important issue. Accounting and frequent reporting form the basis for planning, efficient administration and cost containment. The accounting system must outline a clear picture of all the financial flows in the sickness fund.

Computerised information systems

The overall efficiency of a sickness fund’s activities can be enhanced through the use of computerised information systems. The use of computers can help to achieve the following objectives:

• up-to-date information on utilization of health care providers
• the prevention of fraud
• the standardisation of administrative procedures
• the facilitation of centralised and decentralised information on entitlements, benefits received and claim histories
• the production of statistical information

Computerisation brings greater clarity and a more useful database for administrative purposes. In order to make full use of a computerised system, it is important to ensure, that appropriate data is collected.

Those sickness funds that use IT-technology will receive more transparency, more quality and efficiency of health care services. The performance, efficiency and quality indicators will show the results of improvement.

Standardisation of administrative procedures

The sickness fund has to use productivity figures and indicators for planning and monitoring. Therefore health care department’s work flow plan has to be standardised and to adapt a monthly data and indicator analysis and evaluation about utilisation of health care facilities.

Monitoring

Quality standards

Quality has a number of dimensions, and it is difficult to define. Broadly however, it relates to the style of services offered, ensuring that health care is delivered on time and to an appropriate standard. Process outcomes relate to the method of treatment. A key process outcome therefore is concerned with the establishment of good clinical practice and treatment protocols. These should be based on evidence of effectiveness wherever possible, though it is recognised that clinical judgements will also be important. The value of protocols is that they help to define pathways through the health care systems. This ensures the provider to be able to meet appropriate (quality) standards.

Internal Monitoring

It is important to establish internal monitoring procedures for sickness funds. Internal monitoring is a task of the sickness fund. It concerns all questions related to the internal management, such as analysing administration costs, cost benefit relationships and organisation of activities, and developing proposals to improve performance. Internal monitoring should be the task of a qualified internal auditor. Internal monitoring is also concerned with the provision and utilisation of health care services.

Detailed internal monitoring is needed of:

• fulfilment of implementation of the sickness funds health policy
• financial control and accounting
• invoices
• data protection requirements
• documentation and reporting