The delegation of NHIMA at National Health Fund Poland, Warsaw (SOCIEUX+ cooperation 2023-05). Photo: M.B..
The mission, organized by the EU Facility SOCIEUX+ and the National Health Fund (NFZ), gave seven officials and representatives from the Zambian National Health Insurance Management Authority (NHIMA) the opportunity to learn about policies, programs and policy instruments used by the NHZ and offered to the beneficiaries (including the tolls for on line access to information and health services). Exchange with regional branches of NFZ (Mazowieckie and Malopolskie) as well health a service provider in Krakow was organised to exchange the practices on cooperation between the HQ and regions as well service providers.
The main objective of the visit was to learn about organizational and operational perspectives in the Polish National Health Fund in relation to the following areas:
- Revenue mechanisms (including investment management).
- Payment mechanisms.
- Creation of a benefit package & tariff assumptions.
- Claims management system (including risk management).
- ICT systems/Infrastructure.
- Management structure of the fund.
The delegation had a chance to meet and to discuss with different stakeholders involved in the health insurance scheme and the service providing as well assessment procedure for quality control.
Besides the NFZ Headquarter other institutions (Ministry of Health, Voivodeship National Health Fund in Warsaw, E-Health Centre, Quality Monitoring Centre, Voivodeship National Health Fund in Krakow and Medical Center SCANMED SA in Krakow) shared their experience in development of public policies and instruments in the area of health insurance and service refund by the NFZ. The importance of solid legal framework on health insurance scheme; interinstitutional cooperation; access to services; quality monitoring and data collection for evidence-based policy-making were presented from the policy implementation perspective. Service provider presented their model of functioning of the center and cooperation with NFZ with the cost refoundation mechanism.
The delegation was composed by high level officials from NHIMA: Chairman and Vice Chairmen of the Board; Director General; Director for Research and Planning; ICT Director; ICT-Applications Manager and Director of Human Resources Quality Assurance and Accreditation. Particularly discussion throughout the visit was on: Fund management structure; ICT systems/Infrastructure; Claims management system (including risk management); Creating a benefit package & tariff assumptions; Revenue-increasing mechanisms (including investment management)– Payment mechanisms.
Participation to the study visit gave the opportunity to NHIMA to better understand the process of reaching the target operating model both from an organizational perspective (HR) and operational perspective (implementation of the scheme) that is independent from a 3rd party administrator. The current main challenge for NHIMA is to increase the coverage of health insurance to include individuals working in the informal sector. Therefore it is particularly important to involve all relevant actors policy makers/legislator; operator and service providers as to ensure efficient system of health coverage and service providing with adequate access and quality monitoring.
The study visit completes a technical cooperation initiated with NHIMA in January 2022 aiming at strengthening institutional capacities of the institution. The first action focused on an operational review of the newly established National Health Insurance Scheme. A second action, initiated in May 2023 focused on developing a target operating model for NHIMA and mobilized German expertise retired from Federal Association of General Local Sickness Funds, Estonian expertise from the Ministry of Social Affairs, and Belgian expertise from INAMI, the Belgian institution for health insurance.
SOCIEUX+ Action Manager
SOCIEUX+ Social Protection Advisor