Health insurance system as an organization needs its information system in order to properly function. This study is an initial attempt to identify current status and problems of health information system for the self-employed health insurance program.
The objective of a health insurance information system is to improve health insurance management; handling of membership, premium collection, more effective utilization of health service resources, medical audit and public relations, etc. Self-employed health insurance program can be viewed as a relationship between insurance office and multi-hospital health information subsystems. An information model is designed´ to facilitate decision-making process in managerial activities of the currently ill-functioning organization. The model emphasizes the importance of key information to be collected and of how to utilize the various performance measures for better system achievement.
Efforts are made to identify essential performance measures of self-employed health insurance program. The study initially classifies the information required into two categories: business management information and information on medical care provision. Then, four kinds of key managerial performance measures are selected which the designed information system is systematically geared to produce. They are the information on 1) membership, 2) quantities of insurance medical care, 3) cost of insurance operation, 4) quality of insurance care. Possible performance measures for the above key variables are detailed out, however, further elaboration is called for.
Current operational status, its small membership and poor financial ´management, are two of the major constraints in developing health insurance information system. Therefore, restructuring the self-employed health insurance program should be undertaken prior to the development of its information system.
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