Added value for health insurance
Jean-Paul Dercq, Healthcare Research and Development manager
Jean-Paul Dercq considers eHealth as an important advance for healthcare insurance and payments and especially in terms of communication between providers (communication of health data, results of examinations), communication with insurers and with the authority (simplification of administrative flows), as well as for the quality of care (the establishment of registers, online availability of recommendations on good practice).
A clear distinction between freely chosen basic services and added value services developed to communicate health data is the most striking original feature of the developed strategy.
As a result, professionals can develop applications required for their practice or have these developed by using available, free, guaranteed components (Service Level agreement) which are technically documented and audited (encryption).
One of the mechanisms used for the healthcare provider will be data recycling. This will free it from the need to re-enter identical data several times for different purposes. The typical example is the Cancer Register: the data can be shared voluntarily between the hospital doctor, his file and the register. Furthermore, this information sharing can have its value enhanced for reimbursement procedures by insurer bodies, e.g. for the multidisciplinary oncology consultation. In this case, data input serves three objectives:
- file holding
- the register
- reimbursement
Obviously, only relevant data is communicated in each of the flows.
As regards the medical file and in contrast to other countries, a mechanism to support the exchange of data between providers is envisaged rather than a centralised file.
This offers a double advantage:
- a less restrictive system (greater freedom of format and content)
- it confirms the dispensers as the decision-makers on which information that they make available or not.
The security mechanisms (user management, logs, encryption) are industrial quality standard.
Another example is the simplification of the procedure for authorisation by insurers’ consultant doctors of certain medicines in chapter I. Implementation of this priority is planned for 2010.
It is expected that the prescribing doctor can receive an immediate response during the same consultation when the prescription is drawn up for a high percentage of requests for approval. The approval will also be available almost immediately for the pharmacist who issues the medicine.
A further example is the gradual extension of billing to insurer bodies (third party payer) or patient reimbursement requested through an electronic channel. The third payer’s action will be speeded up through this mechanism, which could have effects on accessibility to healthcare. Reimbursement of the patient requested by an electronic channel will avoid the need for the person to travel.
Registers requested by professionals themselves so they can develop peer-reviews are organised in modular format, which will make it possible to respond to a growing number of requests.
Databases incorporating recommendations on synthesised good practice will make the latest findings from evidence-based medicine available to dispensers online immediately.
Authentic data sources will be made available to dispensers. For example, for medicines, these will comprise updated data relative to launch on the market and reimbursement procedures. So there is no further need to acquire and install successive versions of this database, as the chapter IV procedure will be integrated into it.
Telemonitoring will also use the platform’s basic services and thus permit improved tracking and increased participation by the patient.
The eHealth platform will very clearly offer undeniable advantages to dispensers, patients and institutions.
