• Social Protection

    Development of a target operating model for NHIMA

    Southern Africa Zambia
    Start activities
    22-05-2023
    End activities
    13-10-2023
    Partner Institution
    National Health Insurance Management Authority
    Type of Assistance
    Organisational management (structures & functions)
    Code
    2023-05
    Description
    In 2022, NHIMA collaborated with SOCIEUX+ to evaluate its scheme implementation, leading to a review of its Strategic Plan and a transition to the Ministry of Health. Now, NHIMA seeks to develop an independent operating model for HR and scheme implementation, reducing reliance on third-party administrators. This action led by German, Estonian, Belgian, and Polish expertise, resulted in a proposal for a new operating and organizational model and a study visit to the Polish National Health Fund for insights on IT and organizational capacities.
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  • Review and completion of the legal framework of health insurance

    Europe Kosovo*
    Start activities
    24-04-2023
    End activities
    17/07/2023
    Partner Institution
    Ministry of Health
    Type of Assistance
    Legislative & regulatory framework development Institutional capacity buildin
    Code
    2023-09
    Description
    In the course of this single-activity Action, a proposal for a complete revision of the Health Insurance Law has been prepared by using an incremental and highly participatory approach involving SOCIEUX+ mobilized experts from Luxembourg and Portugal and the members the multi-stakeholder working group, established for that purpose by the Ministry of Health of Kosovo* with the support of the World Bank. As result, provisions of the final draft of revised law are built on a large consensus. The reform proposal particularly looks at ways to extend health coverage to unprotected and uninsured individuals. The adoption of the revised text of now follows the legislative process of approval by the Cabinet of Ministers and the Parliament.
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  • Social Protection

    Support to the Social Security Corporation of Jordan in adopting a referral mechanism

    Middle East and Gulf Countries Jordan
    Start activities
    21-11-2022
    End activities
    10-03-2023
    Partner Institution
    Social Security Corporation
    Type of Assistance
    Institutional capacity building
    Code
    2022-18
    Description
    The Social Security Corporation of Jordan provides social insurance to employees of the public and private sector, and retirees. They do not, at the stage of the request, provide health insurance. The SSC is planning to establish a health insurance scheme to cover private sector workers and relatives and to be made compulsory to SSC contributors and their family dependents. This action, supported by Belgian and Portuguese expertise, provided the SSC with a mapping of approaches to referral mechanisms with their pros and cons as well as a roadmap for adopting a referral system.
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  • Social Protection

    Technical assistance for the evaluation of the real cost of health care procedures and the updating of the basic prices for the reimbursement of health care services

    Western Africa Togo
    Start activities
    05/09/2022
    End activities
    24-02-2023
    Partner Institution
    National Health Insurance Institute [Institut National d?Assurance Maladie du Togo] (INAM)
    Type of Assistance
    Organisational capacity building
    Code
    2022-05
    Description
    The National Health Insurance Institute (INAM) of Togo is a SOCIEUX+ long-standing partner. Together, strategic and organizational topics have been addressed, thus enhancing INAM’s role into the management of health insurance, particularly in view of the roll-out of the 2021 Law instituting the Universal Health Coverage (UHC). This Action focused on specific components of health insurance management such as tariffication of health procedures and the assessment of the quality/performance of health service provision covered by the insurance. Experts from Belgium and France helped updating the reimbursement prices of a sample, based on a price-setting methodology that will remain in INAM’s availability.
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