Actions in Health Insurance

  • Development of a target operating model for NHIMA

    Start activities
    22-05-2023
    End activities
    13-10-2023
    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.
    Partner Institution
    National Health Insurance Management Authority
    Type of Assistance
    Organisational management (structures & functions)
  • Review and completion of the legal framework of health insurance

    Start activities
    24-04-2023
    End activities
    17/07/2023
    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.
    Partner Institution
    Ministry of Health
    Type of Assistance
    Legislative & regulatory framework development Institutional capacity buildin
  • Support to the Social Security Corporation of Jordan in adopting a referral mechanism

    Start activities
    21-11-2022
    End activities
    10-03-2023
    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.
    Partner Institution
    Social Security Corporation
    Type of Assistance
    Institutional capacity building
  • 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

    Start activities
    05/09/2022
    End activities
    24-02-2023
    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.
    Partner Institution
    National Health Insurance Institute [Institut National d?Assurance Maladie du Togo] (INAM)
    Type of Assistance
    Organisational capacity building
  • Strengthening capacities of the public health insurance fund in Uzbekistan in the area of price setting

    Start activities
    23-06-2022
    End activities
    20-03-2023
    Code
    2022-01
    Description
    Uzbekistan State Health Insurance Fund established in December 2020 is invested with the mandate to improve the access to healthcare services and the efficiency of the sector. At the initial stage, the fund is responsible for the formulation and piloting of new public health funding schemes. The peer-to-peer cooperation with the experts from Estonia, France, Czech Republic, and Germany reinforced the capacities of the Fund to manage this process, from identification of packages of reimbursable healthcare services to proposing guidelines for the price-setting mechanism and performance-based assessment. The Fund was also supported in implementing the pilot project in one of the regions.
    Partner Institution
    State Fund Health Insurance
    Type of Assistance
    Organisational capacity building
  • Operational Review of the National Health Insurance Scheme in Zambia

    Start activities
    18-04-2022
    End activities
    30-09-2022
    Code
    2022-02
    Partner Institution
    National Health Insurance Management Authority
    Type of Assistance
    Institutional capacity building
  • Feasibility study for the establishment of a compulsory or voluntary health insurance mechanism in Kongo Central

    Start activities
    05/04/2021
    End activities
    30/06/2022
    Code
    2020-06
    Description
    SOCIEUX+ has been solicited by the Ministry of Health and Social Affairs of the Province of Kongo Central to formulate a feasibility study regarding the establishment of a compulsory or voluntary health insurance mechanism in the Province. To this end, SOCIEUX+ facilitated exchanges (on site and on-line) between the national partners (including mutualist organizations) and European experts in the field of health systems (financing, governance and health care delivery). Several experts from France delivered an inventory of the health system’s components in place in the province of Kongo Central, then a study on the financial feasibility of the health insurance system, and a prospective study on how such a health insurance system should be governed and organized.
    Partner Institution
    Kongo Central Provincial Government [Gouvernement provincial du Kongo Central]
    Type of Assistance
    Institutional capacity building
  • Support in the implementation of a health financing reform and introduction of mandatory health insurance

    Start activities
    11-04-2016
    End activities
    24-11-2017
    Code
    2015-23
    Description
    Peer-to-peer exchanges involving experts from Croatia, Estonia, France, Lithuania, and the United Kingdom supported the State Agency for Mandatory Health Insurance (SAMHI) of Azerbaijan in setting the stage for the introduction of a mandatory health insurance scheme. First, experts advised on the national policy paper “Concept for Health Financing Reform and Introduction of Mandatory Health Insurance” and the Action Plan for its implementation, with a particular attention to the development of indicators for performance assessment of healthcare providers. A study-visit to Estonia allowed Azeris officials to witness how mandatory health insurance was introduced in a country transitioned from a former Soviet model. The final action’s deliverable was a roadmap detailing the concrete steps for the reform of the health system based on mandatory health insurance.
    Partner Institution
    State Agency for Mandatory Health Insurance (under the Cabinet of Ministers)
    Type of Assistance
    Legislative & regulatory framework development
  • Support to the International Forum on health coverage in the CIPRES area

    Start activities
    03/03/2019
    End activities
    03/05/2019
    Code
    2018-32
    Description
    The Conférence Interafricaine de la Prévoyance Sociale (CIPRES) is a long-standing partner of SOCIEUX+. It gathers social security entities from 18 countries, mainly from Francophone Africa. In this circumstance the CIPRES Secretariat requested SOCIEUX+ to mobilize two public experts to share their country experiences and models on the occasion of the annual Forum on health coverage in the CIPRES area. Experts from France and Luxembourg have covered the following themes: an intervention of the financing of universal health coverage and good practices on the governance of organizations running health insurance schemes. The Forum took place in Lomé (Togo) in March 2019.
    Partner Institution
    Conférence Interafricaine de la Prévoyance Sociale (CIPRES)
    Type of Assistance
  • Improving technical management tools available to INAM

    Start activities
    02/04/2018
    End activities
    02/08/2019
    Code
    2017-39
    Description
    The experts’ contribution targeted several dimensions of organizational capacities and tools that are key to allow the Institut National d’Assurance Maladie (INAM) of Togo to efficiently run an extension of health insurance coverage to private sector’s workers and aim to full, universal coverage. Among the matters tackled by mobilized teams of experts from France, Italy, and Romania were contracting capabilities and management of agreements with health care providers, costing of medical procedures, and economic and actuarial analysis. The technical assistance has thus provided very specific, methodological and operational recommendations that aim to enlarge INAM’s set of tools and knowledge necessary to efficiently run health insurance.
    Partner Institution
    National Health Insurance Institute (INAM)
    Type of Assistance
    Organisational management (structures & functions)
  • Social Health Protection Reform and Policy

    Start activities
    Jan-18
    End activities
    09/11/2018
    Code
    2017-27
    Description
    The Ministry of Health and Childcare of Zimbabwe was committed, through this action, to engage the Cabinet of the President in the process of creating an inter-ministerial committee for national health insurance in collaboration with the other main institutional stakeholders. Experts from France, Germany, and Italy developed together with the partners a roadmap consisting of 9 different steps, including institutional tasks (set-up of an inter-ministerial steering committee, establishment of a statutory body in charge of pooling funds and enrolment of population), and technical ones (costing estimates, enrolment and contribution procedures, legal framework for the implementation of NHI).
    Partner Institution
    Ministry of Health and Child Care
    Type of Assistance
    Institutional (Regulatory & Policy)
  • Support to the “International Forum on Health Coverage in the Conférence Interafricaine de la Prévoyance Sociale Area (CIPRES)”

    Start activities
    Aug-17
    End activities
    Aug-17
    Code
    2017-19
    Description
    Experts from France and Luxembourg provided two written (paper) and visual (PowerPoint) presentations as background documents for the International Forum on Health Coverage in the CIPRES area, expected to take place in Brazzaville on 4-6 October 2017.
    Partner Institution
    Inter-African Conference on Social Welfare [Conférence Interafricaine de la Prévoyance Sociale]
    Type of Assistance
     International events (awareness raising)
  • Development of a national social health insurance system

    Start activities
    29/01/2018
    End activities
    15/07/2018
    Code
    2017-18
    Description
    The technical assistance was instrumental in letting emerge policy options for the financing of the health system in Saint Lucia in view of the introduction of a national health insurance (NHI). Experts from France, Germany and Italy accompanied emerging policy options on a concrete context analysis. A second outcome was an individual capacity development of key staff of the Ministry of Health and Wellness on policy design in relation to public health policies. The theoretical learning was linked to the current project of introduction of NHI, with experts helping to outline the distinct phases and steps that shall be accomplished for introducing NHI in Saint Lucia.
    Partner Institution
    Ministry of Health and Wellness
    Type of Assistance
    Institutional (Regulatory & Policy)
  • Support for the set up of universal health insurance

    Start activities
    oct-2015
    End activities
    sep-2016
    Code
    2015-09
    Description
    Experts mobilized from France and Lebanon delivered an analysis of Togo’s Institut National d’Assurance Maladie (INAM)’s institutional organization and capacities. The assessment focused on the challenges faced by INAM in view of the extension of health coverage, clarified the institutional responsibilities, while identifying issues requiring further technical assistance to INAM, such as the preparation of a strategic plan, the enhancement of internal capacities in the field of “risk management,” and the development of a management information system. The first two topics were then addressed by experts through peer-to-peer exchanges with the relevant INAM’s executives and staff, presenting models and good practices applicable to INAM’s context and needs.
    Partner Institution
    Institut National d’Assurance Maladie (INAM)
    Type of Assistance
    Institutional Strengthening
  • Building capactiy of the UTM to enable the management of universal health insurance coverage

    Start activities
    oct-2015
    End activities
    jun-2016
    Code
    2015-14
    Description
    The Technical Union of Malian Mutual Insurers (UTM) is one of three functioning bodies responsible for health insurance coverage. The UTM functions as an umbrella organisation for about 30 (of 164) voluntary mutual health insurance schemes. The UTM supports the creation, development and technical supervision of schemes and the management of a common health insurance platform for all its members. The National Strategy to Extend the Coverage of Mutual Health Insurers was adopted in 2011 to improve the accessibility to healthcare of populations in the rural and informal sectors. It is backed by a 10-year Health and Social Development Plan for 2014-2023, which aims at increasing insurance coverage to 20% of the target population and, in the long-term, universal health coverage. In this context, UTM began to redefine its strategies to improve its capacity and political position in the perspective of shouldering responsibility in achieving universal health coverage. At an operational level, it produced an internal organisation reform plan for 2014-2016. Organisation and individual capacity building was essential to enable the implementation of this plan. Experts mobilised by SOCIEUX worked with the UTM staff on outlining scenarios for strategic options and organisational structure. To do this, they started by assessing the existing institutional strategy and corporate capacities. An outline of the needed structures and competences followed. A first draft of a guideline to develop the UTM’s Strategic Development Plan resulted from this work, which set preliminary core objectives, mission, vision and main working axes for the UTM.
    Partner Institution
    Technical Unition of Mutual Health Insurance [Union Technique de la Mutualité] (UTM)
    Type of Assistance
    Institutional Strengthening