参保人和缴费者的沟通

1,Communicationwithinsuredandcontributionpayers,collectionofcontributions与参保人和缴费者的沟通Changchun,October12-16,2009长春,2009年10月12-16日Mr.TomazMarcun,internationalexperthealthinsuranceinformationsystems国际专家Mr.TomazMarcun医疗保险信息系统,Agenda日程,TopresentEUbestpracticesinbusinessprocesses:展现欧盟业务流程最佳实践:Communicationwithinsuredandcontributionpayers.和参保人员和交保费者进行沟通Collectionofcontributions.征收缴费ShowexperienceonusingITintheseprocesses.展示信息技术在流程中应用的经验Focusonpublichealthinsurancesystems(Bismarcksmodel).重点放在公众医疗保险系统(Bismarcks模式).,1-Communicationwithinsuredandcontributionpayers1-与参保缴费者的沟通,InstructInsuredandContributionPayers参保和缴费指导,Prepareandmaintaininstructionsforregistrationofinsured.准备并完善参保登记说明Instructionsforparticulartypesofinsured(employee,elderly,student,).为特殊参保类型（雇员，老人，学生）制定特别的介绍Prepareandmaintainforms.制定并保存表格Prepareandupdatecodes.制定并更新代码Definerequiredattachmentstobedelivered.确定规范所需提交的附件,InstructInsuredandContributionPayers对参保和缴费者提供指导,Provideinstructionsinpaperform(booklet).提供纸质版的介绍（小册子）Publishontheweb.在网站上公布,Registration登记,Checkreceivedregistrationformsdeliveredbycontributionpayersorself-employedcitizens.检查缴费者和自雇者提交的登记表Checkattachments.检查附件Enterdataintoinformationsystem输入数据到信息系统Applicationsoftwaremustcontaincomprehensivebusinessrulesdatacontrols.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,Rejectapplicationifnotcompleteordonotmatchrequirements.拒绝不完整或不符合要求的申请Issueconfirmationofregistration.发出确认登记Archiveformsandattachments.文档与附件的存档Managepaperarchive.管理纸质文档Scanormicrofilm.扫描或缩微拍摄,RegistrationSemiElectronically登记半电子化,Publishelectronicformsonthewebwithbuilt-incontrols(usewidelyusedformatslikeMicrosoftWord,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，Excel,)Applicantpreparesformselectronically.申请者准备电子表格Printout,deliveryinpaper.打印，提交纸质版Benefits:益处:Betterqualityofdata.数据质量提高Simplifiedprocedureforsmallercontributionpayers.简化缴费流程,登记-电子版,Registrationonthewebportal.网站登记Useridentificationandauthenticationwithdigitalcertificate.使用电子证书对用户进行辨别鉴定Useofelectronicsignature.使用电子签名Attachscanneddocuments(confirmations).附扫描文档(确认)EUlegislativeframeworkone-CommerceandeSignature.电子商务和电子签名的欧盟立法框架,RegistrationElectronically(2)登记-电子版(2),Integrateportalintobackendsystem(nomanualtransferofdata).登记信息和系统的结合(无需人工数据传输).Providefeedbacktoapplicantontheportal.在登记端口提供申请者的信息反馈ManageeArchive.文档的电子管理,RegistrationElectronically(3),Wernmentalportalforcompanyregistration.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Benefitsforhealthinsurance:医疗保险的益处：Decreasecostsofregistrationandmanagementofdocuments.降低注册和文档管理成本Benefitsforapplicant:申请者的益处:Higheravailabilityofservice(24/7).服务的更高的可用性(24/7).,IssueHealthInsuranceCard发放医保卡,Aftersuccessfulregistrationofinsured.参保者成功登记后Ordercardatcardsupplier.从卡片供应商处订购卡片Managecardslifecycle.管理卡片周期Ifhealthinsurancedatastoredonthecard,providesolutionsforregulardataupdate.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,ManageChangesinInsuranceRegister保险登记变更管理,De-registrations.注销登记Managechangesindata.数据变化的管理Insured(e.g.changeofaddress).参保者(例如：地址变更)Contributionpayer(e.g.changeofstatus,closingbusiness).缴费者(例如：状况变更，公司关闭),MaintainRegisterofInsuredPersons参保者的登记维护,Checkforduplicateinsurancerecords(e.g.registeredasstudentandasemployed).检查重复的保险记录(例如：作为学生同时作为雇员登记的)Receiveregularupdatesfromnationalregisters(registerofpopulation,businessregister,terrestrialregister,).从国家登记处更新信息(人口登记，商业登记，陆地登记,).Checkforpersonswithexpiredbasisforinsurancestatus(e.g.deaths,).检查参保者保险过期状况(例如：死亡,).,MonitorRegistrationProcess监督登记程序,Monitorperformanceofmanualregistrationprocess.监督人工登记程序的执行Timeneededtoprocessregistration.登记过程所需的时间Checkthescopeofuseofelectronicregistration.检查使用电子登记的范围Ifscopeislow-promoteelectronicsolutions如范围窄提倡电子解决方案,LargeContributionPayers大型缴费者,Setupelectronicexchangeofregistrationdatawithlargecontributionpayers.为大型缴费者建立数据登记的电子交换机Examples:案例:PensionFundregistersretiredpersons.退休人员退休金登记UnemploymentFundregistersunemployedpersons.失业人员失业金登记Governmentregisterspublicservants.公务员政府登记Benefits:益处:Quickerprocessing,costreduction.加快处理速度，降低成本Lessdataerrors(nomanualdataentry).降低数据错误(无需人工数据登记).,AmIInsured?我参保了吗?,Insuredseeksforinformationifhisinsuranceisvalid.参保者可查询信息如果保险有效Providebasicinformation(yes/no)ordetailedinformation.提供基础信息(是/否)或详细信息Takecareofpersonaldatasecurity.确保私人数据安全性,AmIInsured?(2)我参保了吗?(2),Examplesofsolutions:案例解答：Provideinformationathealthinsuranceoffice.医疗保险办公室提供信息Webapplication网站申请Secureaccessbyuserscodeorsmartcard.用户密码或智能卡安全登录Yes/nostatuswithoutsecurityifallowedbylaw.如法律允许，是/否状态无需安全认证,AmIInsured?(3)我参保了吗?(3),Examplesofsolutions(2):案例解答(2):Mobilephoneapplication-SMSmessage:手机申请短信:Input:healthinsurancenumber.投入:医疗保险号码.Output:yes/no.产出:是/否.Electronickiosk(terminal).电子信息亭(终端).,PublishGeneralInformation公布一般信息,Providepublicaccesstoinformationof:为公众提供以下信息的获取:Businessoperationsofhealthinsuranceagency.医疗保险机构业务运行Thescopeofrights.权利的范围Insurancepremiums.保险费Contactinformationofhealthcareproviders.医疗服务提供方联系方式Waitingtimesforhealthcareservices,医疗服务等待时间,PublishGeneralInformation(2)公布一般信息(2),Publishinformationontheweb.网站信息公布Issueprintedmaterials:发放印刷材料:Bookletstobepickedupbyinsuredandcontributionpayers.为参保和缴费者提供的小册子Postersinhealthinsuranceofficesandathealthcareproviders.在医疗保险办公室和医疗服务提供方张贴海报Publishonelectronicmedia(screens).电子媒体（大屏幕）信息公布Provideautomatictelephonevoicemessages.提供自动语音信息服务,AnswertoQuestions问题解答,Answertoquestionsofinsuredandcontributionpayers.参保缴费问题解答Atthehealthinsuranceoffices.医疗保险办公室解答Byphone.电话解答Setupcallcentre(complexprocess!).建立呼叫中心(过程较为复杂!),CallCentre呼叫中心,Trainoperators.培训接线员Providethemknowledgedatabases(questions&answers).为其准备相关知识的数据库(问题&答案)Manageworkforceschedules.工作记录管理Monitoroperations.监督接线员Managetechnicalequipment.技术设备管理,ManageComplains申诉管理,Receive.收到申诉Prepareanswers.准备反馈Send.发送Builddatabaseofcases.建立案例数据库Archive.存档,PromoteHealthyLifeStyle提倡健康的生活方式,Preparecontent.准备内容Healthylivehabits.健康的生活习性Riskfactors.危险因素Usewebforpublishing.使用网站公布Issueprintedmaterials.发放印刷材料,PromoteHealthyLifeStyle(2)提倡健康的生活方式(2),Somehealthinsuranceagenciesfinanceprogrammesandtrainingsforinsured.有些医疗保险机构为参保者出资组织活动和培训Insomecountriesinsuredwhoparticipatecanbenefitinlowercontributions.有些国家参保者可降低缴费,2-Collectionofcontributions2-征缴,DifferentModels不同的模式,Contributionscollectedby:征收缴费:HealthInsuranceagency.医疗保险机构Someothernationalorregionalagency(e.g.taxadministration).国家或地区其他机构(例如：税务机构),DataisKeyResource数据为主要资源,Dataiskeyresourcetoenableefficientcontrolofcontributionpayment.数据为确保缴费有效控制的主要资源Gatherasmuchdetaileddataaspossible(perinsuredperson,permonth).尽可能详细的收集数据(每人、每月),ElectronicSolutions电子版解决方案,Getdataofpaidcontributionsinelectronicform:电子版缴费数据收集:Fromagencywhichcollectscontributions.从征缴机构获取Directlyfromcontributionpayere.g.setupwebportalfordatauploadandgraduallyrequireallcontributionpayerstosenddetaileddata.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,ControlofContributionPayment缴费的控制,Checkcontributionpaymentsagainstregistrationdatabase.检查缴费情况以及数据库登记情况Actaccordingtolegislationincaseifobligationsnotsettled.依法为履行其义务的:Pe