Re: [Health] Insurance

[Luis Falcon]

Dear Carlos 

On Mon, 18 Apr 2016 15:13:53 -0500
Carlos Eduardo Sotelo Pinto <address@hidden> wrote:

> Hello Luis
> 
> 2016-04-18 14:16 GMT-05:00 Luis Falcon <address@hidden>:
> 
> > Hi Carlos !
> >
> > On Mon, 18 Apr 2016 10:55:31 -0500
> > Carlos Eduardo Sotelo Pinto <address@hidden> wrote:
> >  
> > > Any update? or suggest?
> > >
> > > 2016-04-17 16:01 GMT-05:00 Carlos Eduardo Sotelo Pinto <  
> > > address@hidden>:  
> > >  
> > > > Dear Coders
> > > >
> > > > About Insurance companies and their management, I have a lot of
> > > > questions on a implementation that I have done on my country
> > > > since the way it is working is far from the way that is works
> > > > on my country. I guess insurance must be a module by itself in
> > > > order of disabled it when is no needed, cause it generates a
> > > > lot of confusing on final users  
> >
> > Please try to be concise on what do you want to achieve, and we
> > might be able to help you. Also, please don't cross-post to
> > multiple mailing lists.
> >
> > GNU Health core module provides the following insurance
> > functionality :
> >
> > * Insurance companies
> > * Type of insurance
> > * Insurance plans
> >
> >
> > * Associate the insurance and insurance plan to a product (Service)
> > * Associate the insurance and the validity period to a person
> > * Multiple insurances / plans per person
> >  
> 
> ​Unfortunately this way doesn't work on Perú cause is far to how
> insurances companies and plans are managed​.
> 
> ​Just for write something about it​.
> 
>    - We have fixed and regular plans
>    - Fixed: anything service or product have a global amount in a
> period, as example, I could pay USD 100 per week, and all service in
> each week will
>       be included ( invoiced to insurance company as insurance
> customer )
>       - Regular: a common invoice
>    - We have "co aseguro", "co pago", "deducido" as payment types for
>    patients as they could be in
>       - fixed price
>       - percent of agerement value to the insurance company
>    - Prices are calculated from an agreement between insurance
>    and institution
>       - Services, bases on SEGUS, the service authority for services
> prices on all the country
>       - Kairos, a punctuation for products that is something like
> price = kairos_number_product * kairos_punctuation_agreement
>       - Agreement, for some specific services like a bed
> 
> Now, invoicing this to the insurance company is a more complex process
> 

Thanks for the feedback ! What you're explaining is  the
insurance localization for Peru. You will also have private insurances,
and each of them will have different policies / plans, etc..


> Then, how is working health for insurance just make confusion on final
> users, that is the reason on I have disabled it on health for my
> country and the reason that I guess that insurance could be a
> independent module in order on use or no use it
> 

On GNU Health we provide the framework to build upon the localization
specific for each country or company.

So, in most places around the world, the following applies, and this is
what GNU Health provides :

* Insurance entities (state authorities, private companies, syndical..)
* Insurance plans
* People that bear those insurance(s) (and those who don't)
* Products associated to those insurances ( you pay periodically )
* Medical services, and medicaments that you are entitled to have with
  the insurance(s) that you currently have.
* Invoicing those Medical services / medicaments

I agree that insurance an policies are complex and very dependent on
each country, and that you need to localize it.

While at it, you might want to ask in the health-es mailing list,
especially in the cases of Argentina, where it has been implemented,
both in private and public institutions. I know the insurance in
Argentina, and it can tell you that they get quite complex, yet it's
been done .

Of course, anything that can be included in the base GNU Health system
that is universal for the insurance management, is most welcome and
we'll be happy to include it on the next release.

All the best,
Luis

> Best regards
> 
> 
> 
> 
> >
> > It is up to the localization for each country, insurance type,
> > insurance plan, for things such as to know which health services are
> > included, discounts on selected health services, etc...
> >
> >
> > All the best
> > Luis
> >
> > --
> > Dr. Luis Falcon, M.D., BSc
> > President, GNU Solidario
> > GNU Health: Freedom and Equity in Healthcare
> > http://health.gnu.org
> >
> >
> >  
> 
>