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
    The National Health Insurance Management Agency (NHIMA) is expected to retrieve the function of health-insurance (HI) management from the provider that has administered it until now. In that perspective SOCIEUX+ has engaged public expertise from Belgium, Estonia, Germany and Poland to work together on an Operating Model that sets-up organizational and operational arrangements. Experts and the partner have particularly focused on HR organization and the Information Management System. A final study-visit to the National Health Fund (NFZ) of Poland has helped key partner’s staff to look at how operations are carried out, as NFZ has disclosed and showcased the relevant organizational arrangements. As a result of these efforts, NHIMA will be able to run HI independently, therefore enhancing the State’s role in social HI and starting to build conditions for universal coverage.
    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
    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
    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
    Partner Institution
    State Agency for Mandatory Health Insurance (under the Cabinet of Ministers)
    Type of Assistance
  • 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
    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
    To provide a social protection framework that increases access to healthcare services in the form of a NHI scheme that is built on innovative healthcare financing mechanisms
    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
    Le Forum International sur la couverture maladie dans la zone CIPRES permet de déterminer les modalités et les conditions pour la mise en place et la gestion d?une couverture maladie efficace des popu
    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
    To enable access to care that is equitable, appropriate and geared towards healthy living, recovery and or rehabilitation to ensure increased productive activity and quality of life.
    Partner Institution
    Ministry of Health and Wellness
    Type of Assistance
    Institutional (Regulatory & Policy)
  • Health financing reform and introduction of mandatory health insurance

    Start activities
    apr-16
    End activities
    nov-17
    Code
    2015-23
    Description
    Support the government of Azerbaijan and in particular to the State Agency for Mandatory Health Insurance (SAMHI) in creating the necessary conditions for the introduction of mandatory health insurance
    Partner Institution
    State Agency for Mandatory Health Insurance under the Cabinet of Ministers [Nazirlər Kabineti yanında İcbari Tibbi Sığorta üzrə Dövlət Agentliyinin]
    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
    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