《854参保人和缴费者的沟通.ppt》由会员分享，可在线阅读，更多相关《854参保人和缴费者的沟通.ppt（35页珍藏版）》请在三一办公上搜索。
1、1,Communication with insured and contribution payers,collection of contributions 与参保人和缴费者的沟通Changchun,October 12-16,2009长春,2009年10月12-16日Mr.Tomaz Marcun,international expert health insurance information systems国际专家Mr.Tomaz Marcun 医疗保险信息系统,Agenda日程,To present EU best practices in business processes:展
2、现欧盟业务流程最佳实践:Communication with insured and contribution payers.和参保人员和交保费者进行沟通Collection of contributions.征收缴费Show experience on using IT in these processes.展示信息技术在流程中应用的经验Focus on public health insurance systems(Bismarcks model).重点放在公众医疗保险系统(Bismarcks 模式).,1-Communication with insured and contributi
3、on payers1-与参保缴费者的沟通,Instruct Insured and Contribution Payers参保和缴费指导,Prepare and maintain instructions for registration of insured.准备并完善参保登记说明Instructions for particular types of insured(employee,elderly,student,).为特殊参保类型（雇员，老人，学生）制定特别的介绍Prepare and maintain forms.制定并保存表格Prepare and update codes.制定并
4、更新代码Define required attachments to be delivered.确定规范所需提交的附件,Instruct Insured and Contribution Payers对参保和缴费者提供指导,Provide instructions in paper form(booklet).提供纸质版的介绍（小册子）Publish on the web.在网站上公布,Registration 登记,Check received registration forms delivered by contribution payers or self-employed citiz
5、ens.检查缴费者和自雇者提交的登记表Check attachments.检查附件Enter data into information system 输入数据到信息系统Application software must contain comprehensive business rules data controls.所用于申请的软件必须包括全面的业务规定-数据控制,Registration登记,Reject application if not complete or do not match requirements.拒绝不完整或不符合要求的申请Issue confirmation o
6、f registration.发出确认登记Archive forms and attachments.文档与附件的存档Manage paper archive.管理纸质文档Scan or microfilm.扫描或缩微拍摄,Registration Semi Electronically登记 半电子化,Publish electronic forms on the web with built-in controls(use widely used formats like Microsoft Word,Excel,).在网站上公布电子表格并实行内部控制（用较为广泛的格式例如微软Word，Ex
7、cel,)Applicant prepares forms electronically.申请者准备电子表格Print out,delivery in paper.打印，提交纸质版Benefits:益处:Better quality of data.数据质量提高Simplified procedure for smaller contribution payers.简化缴费流程,登记-电子版,Registration on the web portal.网站登记User identification and authentication with digital certificate.使用电
8、子证书对用户进行辨别鉴定Use of electronic signature.使用电子签名Attach scanned documents(confirmations).附扫描文档(确认)EU legislative framework on e-Commerce and eSignature.电子商务和电子签名的欧盟立法框架,Registration Electronically(2)登记-电子版(2),Integrate portal into backend system(no manual transfer of data).登记信息和系统的结合(无需人工数据传输).Provide
9、feed back to applicant on the portal.在登记端口提供申请者的信息反馈Manage eArchive.文档的电子管理,Registration Electronically(3),Web solution could be part of some other portal-e.g.governmental portal for company registration.网络解决办法可成为一些其他端口的一部分例如：政府端口的商业登记Benefits for health insurance:医疗保险的益处：Decrease costs of registrat
10、ion and management of documents.降低注册和文档管理成本Benefits for applicant:申请者的益处:Higher availability of service(24/7).服务的更高的可用性(24/7).,Issue Health Insurance Card发放医保卡,After successful registration of insured.参保者成功登记后Order card at card supplier.从卡片供应商处订购卡片Manage cards lifecycle.管理卡片周期If health insurance dat
11、a stored on the card,provide solutions for regular data update.如果医疗保险数据存储在卡上，提供数据定期更新的解决方法,Manage Changes in Insurance Register保险登记变更管理,De-registrations.注销登记Manage changes in data.数据变化的管理Insured(e.g.change of address).参保者(例如：地址变更)Contribution payer(e.g.change of status,closing business).缴费者(例如：状况变更，
12、公司关闭),Maintain Register of Insured Persons参保者的登记维护,Check for duplicate insurance records(e.g.registered as student and as employed).检查重复的保险记录(例如：作为学生同时作为雇员登记的)Receive regular updates from national registers(register of population,business register,terrestrial register,).从国家登记处更新信息(人口登记，商业登记，陆地登记,).C
13、heck for persons with expired basis for insurance status(e.g.deaths,).检查参保者保险过期状况(例如：死亡,).,Monitor Registration Process监督登记程序,Monitor performance of manual registration process.监督人工登记程序的执行Time needed to process registration.登记过程所需的时间Check the scope of use of electronic registration.检查使用电子登记的范围If sco
14、pe is low-promote electronic solutions如范围窄 提倡电子解决方案,Large Contribution Payers大型缴费者,Set up electronic exchange of registration data with large contribution payers.为大型缴费者建立数据登记的电子交换机Examples:案例:Pension Fund registers retired persons.退休人员退休金登记Unemployment Fund registers unemployed persons.失业人员失业金登记Gove
15、rnment registers public servants.公务员政府登记Benefits:益处:Quicker processing,cost reduction.加快处理速度，降低成本Less data errors(no manual data entry).降低数据错误(无需人工数据登记).,Am I Insured?我参保了吗?,Insured seeks for information if his insurance is valid.参保者可查询信息如果保险有效Provide basic information(yes/no)or detailed information
16、.提供基础信息(是/否)或详细信息Take care of personal data security.确保私人数据安全性,Am I Insured?(2)我参保了吗?(2),Examples of solutions:案例解答：Provide information at health insurance office.医疗保险办公室提供信息Web application网站申请Secure access by users code or smart card.用户密码或智能卡安全登录Yes/no status without security if allowed by law.如法律允
17、许，是/否状态无需安全认证,Am I Insured?(3)我参保了吗?(3),Examples of solutions(2):案例解答(2):Mobile phone application-SMS message:手机申请 短信:Input:health insurance number.投入:医疗保险号码.Output:yes/no.产出:是/否.Electronic kiosk(terminal).电子信息亭(终端).,Publish General Information公布一般信息,Provide public access to information of:为公众提供以下信息
18、的获取:Business operations of health insurance agency.医疗保险机构业务运行The scope of rights.权利的范围Insurance premiums.保险费Contact information of healthcare providers.医疗服务提供方联系方式Waiting times for healthcare services,医疗服务等待时间,Publish General Information(2)公布一般信息(2),Publish information on the web.网站信息公布Issue printed
19、 materials:发放印刷材料:Booklets to be picked up by insured and contribution payers.为参保和缴费者提供的小册子Posters in health insurance offices and at healthcare providers.在医疗保险办公室和医疗服务提供方张贴海报Publish on electronic media(screens).电子媒体（大屏幕）信息公布Provide automatic telephone voice messages.提供自动语音信息服务,Answer to Questions问题
20、解答,Answer to questions of insured and contribution payers.参保缴费问题解答At the health insurance offices.医疗保险办公室解答 By phone.电话解答Set up call centre(complex process!).建立呼叫中心(过程较为复杂!),Call Centre呼叫中心,Train operators.培训接线员Provide them knowledge databases(questions&answers).为其准备相关知识的数据库(问题&答案)Manage work force
21、schedules.工作记录管理Monitor operations.监督接线员Manage technical equipment.技术设备管理,Manage Complains申诉管理,Receive.收到申诉Prepare answers.准备反馈Send.发送Build database of cases.建立案例数据库Archive.存档,Promote Healthy Life Style提倡健康的生活方式,Prepare content.准备内容Healthy live habits.健康的生活习性Risk factors.危险因素Use web for publishing.使
22、用网站公布Issue printed materials.发放印刷材料,Promote Healthy Life Style(2)提倡健康的生活方式(2),Some health insurance agencies finance programmes and trainings for insured.有些医疗保险机构为参保者出资组织活动和培训In some countries insured who participate can benefit in lower contributions.有些国家参保者可降低缴费,2-Collection of contributions2-征缴,D
23、ifferent Models不同的模式,Contributions collected by:征收缴费:Health Insurance agency.医疗保险机构Some other national or regional agency(e.g.tax administration).国家或地区其他机构(例如：税务机构),Data is Key Resource数据为主要资源,Data is key resource to enable efficient control of contribution payment.数据为确保缴费有效控制的主要资源Gather as much det
24、ailed data as possible(per insured person,per month).尽可能详细的收集数据(每人、每月),Electronic Solutions电子版解决方案,Get data of paid contributions in electronic form:电子版缴费数据收集:From agency which collects contributions.从征缴机构获取Directly from contribution payer e.g.set up web portal for data upload and gradually require
25、all contribution payers to send detailed data.从缴费者直接获取 例如：建立登记端口的数据上传并且逐渐的要求所有缴费者输入详细数据,Control of Contribution Payment缴费的控制,Check contribution payments against registration database.检查缴费情况以及数据库登记情况Act according to legislation in case if obligations not settled.依法为履行其义务的:Penalties to be paid.缴纳罚金App
26、ly for reimbursement in case of company bankruptcy.如公司破产可申请返还费用,Limit Healthcare Services有限的医疗服务,If obligations not settled limit healthcare services of insured persons.如尚未确定义务-参保者有限的医疗服务Provide data to healthcare providers.为医疗服务提供方提供数据using health insurance card or 使用医保卡或by on-line data access.在线数据
27、存取,Conclusion总结,Manage high quality of data in register of contribution payers,insured persons.管理缴费参保者高质量数据的存储Provide data for controlling payment of contributions.为控制缴费提供数据,Conclusion(2)总结(2),Use IT solutions to:利用信息技术解决：Simplify procedures inside health insurance agency.简化医疗保险机构的手续Reduce data errors by manual data entry.减少人工数据输入的错误Simplify communication with contribution payers and insured.简化缴费和参保沟通Provide good transparency of business processes to insured persons.为参保者提供业务流程中更好的透明度,35,Thanks for attention谢谢,
