Health Insurance

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Healthcare

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Sanigest provides expert technical and administrative analysis for the development and implementation of national health systems

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Sanigest excels at assisting our clients’ search for improved value-for-money by developing and deploying cutting-edge information systems for payers and providers. Our fully integrated, paperless health insurance and provider activity system, Health Planner and RAA, provide organizations with a turnkey solution to improve the management of insurance organizations. Over the past ten years, we have worked in more than ten countries to improve health insurance management, claims reimbursement, handling of membership, premium collection, more effective utilization of health service resources, medical audit and public relations through the deployment of our IT solutions.

Sanigest capabilities related to Health Insurance include:

  • Definition of the catalogue of services for included and excluded from the benefit package
  • Revision of the cost for each category of services
  • Development of payment systems, business rules, and schedules for health services
  • Specification of terms and mechanisms for contracting health providers in public and private sectors
  • Creation of an integrated management information system
  • Design of a full M&E system as a managerial tool to monitor the newly established health system
  • Research and impact assessments of the health insurance systems
  • Development of policy frameworks and action plans to support the implementation of health insurances
  • Writing of reports and documents about any area of health insurance systems

Some projects in this area include:

Dominican Republic: Technical assistance, revision of the Health Services Plan Catalog

The consultancy developed a plan of explicit health benefits for members of the Family Health Insurance in close collaboration with knowledge transfer to members of the Inter-agency Technical Committee.
Project Details

Bahamas: National Health Insurance Plan for The Bahamas

Sanigest was contracted to provide operational details on four critical aspects of the NHI: (1) defining the health benefits package; (2) costing the benefits package; (3) designing the provider payments system; and (4) financing recommendations for the Plan to ensure sustainability. Two main paths are under consideration for the NHI: (1) A comprehensive universal roll-out or (2) A phased implementation process with either some populations being targeted initially, and/ or certain benefits being targeted. Sanigest is working on both options.
Project Details

Belize: Strengthening and Rolling Out National Health Insurance

Over an 8 year period with back-to-back contracts, the Sanigest team employed their expertise in the development of the national health insurance system for the Social Security Board of Belize. Within the scope of this project, Sanigest provided assistance in the implementation of a Primary Care Model and the roll-out of the new financing and health insurance models. Sanigest provided ongoing support to the NHI in organizing the entire purchasing process and in initiating negotiation /sign-up of contracts between the Social Security Board and all providers. On the same note, Sanigest helped to make key administrative and organizational changes in the structure and functions of the Social Security Board in line with the expanded insurance model. Last but not least, team Sanigest designed a full M&E system as a managerial tool for the Social Security Board to monitor the newly established health system.
Project Details

Bahamas: Catalogue for Health Services Providers

At the request of the Bahamas Ministry of Health and National Insurance Board, Sanigest provided expert technical and administrative analysis for the implementation of the National Health Insurance (NHI), in an effort to ensure that health care for all is guaranteed, protected, and free from financial burden at the time of use.
Project Details

Costa Rica: Case Studies in the Governance of Mandatory Health Insurance

Sanigest was assigned to elaborate a case study on mandatory health insurance in Costa Rica as part of the World Bank commissioned paper “Mandatory Health Insurance in Developing Countries: Overview, Framework, and Research Program”, aimed to provide guidance on the most promising and appropriate institutional designs and governance mechanisms for member countries aspiring to reform or establish mandatory health insurance.

Project Details

Honduras: Technical Proposal and Implementation of UHI

Preparation of a Technical Proposal and Implementation of a Universal Health Insurance Model in the Department of Gracias a Dios, which includes the Health Care, Management, and Financing Model

Sanigest was assigned by UNDP to design and implement a health insurance model in the Gracias a Dios Department in Honduras. The team implemented a health care model based on a quality improvement program and access to health services of the most socially vulnerable population, as well as synchronize the assistance activities of the health units with the rest of the area service network. Sanigest also designed and implemented a financial-economic management model which allowed the establishment of a common fund for financing health service in the Gracias a Dios Department community.

Project Details

Belize: Development of Social Security Board Strategic Plan Sanigest Design, Development, and Implementation

On request of the Belize Social Security Board (BSSB), a group of Sanigest experts participated in the review and assessment of the existing BSSB strategic plan to facilitate the formulation of a new five-year strategic plan. This plan was aimed at increasing the coverage of social security in the country and improving the quality and efficiency of services at lower costs.
Project Details

Yemen: Health Insurance Training Course

Sanigest developed and successfully conducted a one week training course on the process of establishing national health insurance systems. More than 40 members of the Ministry of Health and Finance gained knowledge on the underlying principles of implementing such systems. Furthermore, Sanigest analysts studied the conditions for specifically employing a national health insurance and finance system in Yemen
Project Details

Area Expert

Gregory Arias
Consultant

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