eHealth Insurance | SIVECO Romania

eHealth Insurance

IT systems dedicated to the health insurance system

SIVECO Romania has almost a decade of experience in the designing, carrying out, integration and maintenance of information systems at a national level, in optimizing the management of funds collected from contributors for optimizing the delivery of health services, with the immediate and direct effect of increasing the health status of the insured persons.

Integrated Unique Information System (SIUI)

This system has been set into full operation since 2008, and the positive effects of its use were shortly noticed.

General information

  • The Budget financed by the National Health Insurance House in Romania (CNAS/NHIH), based on the contribution of employees and their employers
  • The system is implemented at national level at CNAS and in all the County Health Insurance Houses (CJAS) in Romania
  • The system has been developed together with 45 local partners and has involved over 300 specialists
  • The system was carried out in a consortium, along with Hewlett-Packard and STS
  • The system is integrated with the ERP product SIVECO Applications
  • Beneficiaries at national level: the entire Romanian population 

Major Objectives

  • Management of the  National Unique Health Insurance Fund (FNUASS)
  • The uniform application throughout the country of the norms regarding the conditions for granting medical assistance within the social health insurance system in Romania
  • Validation according to the conditions set through the legislation of medical and pharmaceutical services paid from FNUASS
  • Fraud prevention and detection

Stakeholders

SIUI Beneficiaries

  • all the County Health Insurance Houses
  • 53,910 Physicians            
  • 10,304 Family Doctors   
  • 95,286 Medical assistants            
  • 509 Hospitals
  • 38 Providers of ambulance services 
  • 328 Providers of homecare services
  • 458 Out-patient recovery       
  • 2,639 Providers of medical devices
  • 15 Providers of rehabilitation sanatoria services 
  • 4,140 Providers of pharmaceutical services.

Benefits

  • Complex analysis of the data collected by the system
  • Fraud prevention and detection
  • Standardization of legislation applied at a national level
  • Efficient budget use
  • Annual savings for the Health Insurance Budget generated by:
    • Removal from the system of redundant insured persons;
    • Removal of nonconformities regarding services delivered for insured persons (contributors)
    • Respecting contract clauses of medical services providers
    • Fraud attempts’ identification and their removal
    • Avoiding multiple reporting of the same prescription by several pharmacies.

Awards

In 2011, the project "Integrated Unique Information System" (SIUI) from the National Health Insurance House in Romania receives the title of "Finalist" in the competition of the best projects in the world, organized by International Project Management Association, at the Gala Awards within the 25th  IPMA World Congress, Brisbane, Australia.