The Bulgarian National Health Insurance House

The Bulgarian National Health Insurance House runs a 100% Romanian software application

SIVECO Romania extends its expertise to the area of national healthcare system computerization

In the context of the reassessment of the performance of public healthcare systems, a growing number of organizations in the medical sector have become connected to software infrastructures and common communication systems. This is also the case of the Bulgarian National Health Insurance House, which has decided to implement within its units a complex IT system that would increase the efficiency of its management, financial and process-control activities.

Coverage of the NHIF computer system

• 5.000 family doctors
• 2.500 pharmacists
• 400 hospitals
• 9.000 specialists
• 600 laboratories
• 15.000 annual contracts between medical service providers and the health insurance fund
• 17.000 monthly reportings

Description of the Bulgarian Health Insurance System

The configuration and development of the computer system for the National Health Insurance House of Bulgaria - NHIH had to start from the medical realities in this country, at the time of the beginning of the project. Practically speaking, prior to computerization, all operations needed to carry out and monitor medical processes were performed manually, which led to an enourmous waste of resources.

In collaboration with its highly experienced partners, who understood the importance of this project, SIVECO Romania practically replaced the old system, governed by paperwork, with a new computerized system, with all the intrinsic advantages.

The process of introducing IT technologies in the Bulgarian Health Insurance system is the most important project of its kind in Bulgaria, due to its complexity and magnitude. The essential objective of this undertaking is the development of a unitary and improved health insurance system, in all its functional aspects.

After joint efforts that took nearly 2 years, SIVECO Romania and its partners have successfully completed the integrated management system for NHIH, fulfilling all the requirements of the Client, point by point.

The new IT system has substantially improved the activity of NHIH - the central body for the control and reinbursement of medical and pharmaceutical services in Bulgaria. Consequently, NHIH is currently able to keep track of all its resources in a complex and exhaustive manner.

The implementation of the information system for NHIH is part of the project entitled "Health Sector Reform" financed by the World Bank under a financing agreement with the Bulgarian government. The multiple functionality of the information system that lies at the basis of the functioning of NHIH significantly contributes to increasing the level of transparency for all operations at all levels of the Bulgarian healthcare system.

Benefits

By the very nature of its duties, the Bulgarian National Health Insurance House is responsible not only for the quality of medical services, but also for the correct expenditure of health insurance funds. That is why the computerization of NHIH has positive effects on the activity of the medical personnel in charge as well as on the medical services to which the Bulgarian patients have access.

With its multiple functions and uses, the information system at NHIH is targeted at all the factors involved in the functioning of the medical system.

• The implementation of this system has improved collaboration between the Bulgarian National Health Insurance House and specialized organizations with which it collaborates
• Family doctors, hospitals, laboratories, specialized doctors, dentists, drugstores, drug producers now have the possibility of reporting and communicating electronically
• The information concerning the reimbursement of medical and pharmaceutical services is taken over by the centralized database of the National Health Insurance House, thus making the centralization and checking of data much easier

The Integrated Information System of the Bulgarian Health Insurance House aims to make easier the transfer of information between the various components of the public health system by means of:

• Collecting and managing the economic and medical information needed for the efficient functioning of the Health Insurance System
• Transparency concerning the control and mangement of the budget-related activities of the Fund
• Electronic records concerning insured persons and providers of medical services
• Making data reporting to providers of medical services more efficient
• Uniformity in applying medical norms and legislation at a national level
• Highlighting and controlling costs for each insured person
• Interconnection with entities external to the system and with the providers of medical and pharmaceutical services by means of the existing on-line and off-line interfaces

Evolution of The Project

The Integrated Information System developed by SIVECO Romania and its consortium partners, starting in 2006, is the most important way of making the Bulgarian healthcare services more efficient.

The first stage in the development of the integrated information system for the National Health Insurance House ended in February 2008, when the first module of the system was successfully completed.

The entire implementation process for the integrated information system of NHIH was completed in September 2008, resulting in reduced administrative costs, more efficient expenditure managment, and, implicitly, improved quality of medical services.

The first functional component, Kernel 1, is a standard back-office system, covering all the administrative operations within the National Health Insurance House and its regional departments.

Kernel 1 is used for the management and control of budgets, fixed assets, public procurement and administrative contracts. This component manages and controls the resources of the National Health Insurance House and its regional departments, and activities are carried out by means of constant and consistent communication between the headquarters and their subordinated departments.

The second component, Kernel 2, is a system destined for the management of reinbursement applications for expenses concerning services provided by medical and pharmaceutical service providers.

This module generates and controls:

• the recording of reports by the medical and pharmaceutical service providers in the health sector (hospitals, pharmacies, drug producers, primary care medical offices, specialized medical centers, dental medical centers)
• the recording of insured persons, of the contracts concluded between the medical and pharmaceutical service providers and the National Health Insurance House.

Kernel 2 supervises the activities of the parties involved in the health sector, in order to make payments to medical and pharmaceutical service providers, but also in order to guarantee the quality of services offered to insured persons. At the same time, Kernel 2 is also used for predictions and statistical analyses.

The two basic components of the system are assisted by various support applications, including activities such as internal financial audit, medical audit, management of complaints and many others.