Members of the OpenHIE community have historically identified the need for shared data exchange to meet the clinical needs of the health care delivery system. The provision of healthcare, documentation of health care delivery, and subsequent data sharing is also closely interwoven with health sector financing. Documentation and sharing of health data are critical for episodic as well as longitudinal care; this data forms the information substrate for health financing.
The OpenHIE Health Financing toward UHC working group is focused on identifying health care financing data exchange needs, and working synergistically with the OpenHIE community to ensure that data exchange processes and requirements meet the needs of the health care financing communities. The WHO defines health financing as the “function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system”. Health financing includes three main components for revenue raising, pooling of funds and risk, and purchasing. This community will primarily focus on the functions and data needed by the health purchaser and for our purposes, a health purchaser is any institution that buys health care goods, services, and interventions on behalf of a covered population. Health purchasers can include the ministry of health, social health insurance agencies, special purchasing agencies, local or national government authorities, other ministries (such as the ministry of defense), private insurance companies, and community-based insurance funds. If needed, this community may prioritize using national health insurance use-cases as a basis for evaluating the health financing requirements, but it is our intention to be broadly open to any health financing related scenarios.
This workgroup is designed to identify and address these health care financing data and data exchange needs, as well as respond to future needs. This working group is open and all are welcome to participate in working toward the following goals:
Serve as a collaborative workspace for sharing of best practices as well as novel proposed solutions to health care financing data exchange
Identify and prioritize foundational requirements needed to meet data elements and data exchange needs of health care financing
Identify and create alignment around standardized terminologies that will meet the data and data exchange needs of the international health care financing communities
Work to develop and/or identify solutions that meet these requirements
Develop documented data sharing use cases that describe the fundamental flow of information to support strategic purchasing
Build new or refine existing OpenHIE workflows to incorporate health finance data sharing use cases
Represent, and give voice, to the real world needs of countries as they implement health purchasing schemas within the auspices of a national data sharing architecture
Engage and collaborate with other stakeholders groups, such as the community of practice being supported by the Joint Learning Network on health insurance management information systems, to identify data exchange needs
Engage and collaborate with developers and implementers working with health insurance/finance solutions, such as openIMIS (open insurance management information system)
The OpenHIE Health Financing towards UHC community calls will focus on building relationships between participants and building common language to achieve the goals described above. If you are interested in contributing or learning more, please feel free to join the mailing list at https://groups.google.com/forum/?hl=en#!forum/ohie-health-insurance, email is ohie-health-insurance@googlegroups.com. Also feel free to contact Jamie Thomas if you have further questions.
Useful glossary of health finance and UHC related terminology: https://www.hfgproject.org/ghana-uhc-workshop-glossary/
(1) http://www.who.int/healthsystems/topics/financing/en/
(2) Using Data Analytics to Monitor Health Provider Payment Systems: A Toolkit for Countries Working Toward Universal Health Coverage. Joint Learning network for Universal Health Coverage, Results for Development (R4D), PATH, PharmAccess Foundation; 2017.