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N°33  |  January   2009
Business cases

OPT (New Caledonia)

• NHIF(Bulgaria)

An integrated system to support healthcare reform in Bulgaria

Press conference in Bulgaria

From 1 January 2009, the National Health Insurance Fund (NHIF) at the heart of Bulgaria’s public health services will be using a new, fully integrated information system. The aim is to provide a reliable, secure environment to support all the highly sensitive business processes relating to healthcare services and financing. This is an enormous undertaking: the NHIF works with no less than 17,000 contractual partners, and exchanges information with numerous external organizations including the National Revenue Agency, the GRAO (the national civil register) and the foreign ministry.

The system has been developed over the past two years by a consortium led by Bull and including Romanian company Siveco and Israeli specialists Maccabi Healthcare Services. Bull Bulgaria was responsible for leading the work and delivering the project – worth over €3.5 million – with the NHIF’s own project team also making a significant contribution to its success.

As Jenny Nacheva, Director of the Budget and Finances Directorate at the NHIF explains: “The Integrated Information System provides tools for effective control and significantly facilitates the activities of the regional health insurance funds and doctors, allowing them to spot mistakes as they file their reports. What’s more, bad practices can easily be identified and eradicated.

An important new national resource

The development and implementation of the NHIF System is part of Bulgaria’s Healthcare Reform Project,financed by the World Bank. The Integrated Information System is designed to support all the NHIF’s main business processes: capturing contracts with medical service providers, processing payment requests from all these organizations (including validating the amounts they have claimed), and making the approved payments.

“We are very proud to have delivered this highly sensitive project on time and within budget,” added Andrei Petrescu, CEO of Bull Bulgaria. “A nationwide project like this is also highly significant for all the healthcare professionals involved: giving them a new kind of structure within which to operate. It has been complex to develop and tough to implement, but we have succeeded and I’d like to congratulate all the teams from the NHIF, our partners and Bull for their contributions.”

Data from the medical service providers’ reports is processed by the system and used to prepare various reports and analyses for medical and financial control. The system maintains the registers of medical service providers and patients, and provides interfaces to external registers such as the National Revenue Agency. Data relating to the medical treatment of Bulgarian citizens in EU member states can also be processed by the system.

The system consists of two main interrelated components:

  • Kernel 1: for planning and distribution of financial resources, which includes the fixed assets, budget, contract management, accounting, internal financial audit and business analysis systems
  • Kernel 2: for managing claims by medical services providers and pharmacies to reimburse their expenses: this covers claims management, objections and appeals, medical audit, quality assurance, national registers and regulatory standards.

The system verifies that healthcare services reported by doctors have actually been carried out: a real challenge involving more than 630 different types of named procedures and services. Each module includes over 100 business rules used to validate the data that is being input, with the aim of eliminating inappropriate or duplicate payments or those that fall outside the contracts made between the NHIF and medical practitioners. Over 1,000 different reports can be generated, and new types of reports can also be built very easily.

A two-year development program

Development work started in November 2006, and by May 2008 the main functionality was completed, allowing for complete horizontal and vertical integration. This meant the system was capable of running on a single, national database and performing the whole cycle of business processes. Summer 2008 saw the new system pass its operational tests in a live environment, running alongside the NHIF’s legacy systems.
Bull provided the open IT infrastructure based on high-end NovaScale servers. The technologies used in the development of the system including Magic Draw (for modeling), Eclipse (Java application development), JBoss and the Oracle database management system. Some 2,000 people are expected to use the system. Users value the integrated nature of the system, as there is no need for them to learn and use different applications. Other advantages include the user-friendly interface and initial data validation carried out by the regional health insurance funds.

Comprehensive training and support

As part of the project, the consortium trained experts from the regional health insurance funds on various system functions. This training was completed in July 2008. At that point, testing of the system began using real report data throughout the country.
NHIF and the Bull-led consortium have signed a three-year technical support agreement. The plan is also to train the NHIF’s own IT experts during this period, so they can update the system themselves once the support contract ends.

Looking ahead

The implementation of the system is expect to contribute to a fall in direct expenses, more effective distribution of funds and significant improvements in the quality of the healthcare services provided. Also, because the database maintains data at a national level, this means it could be used by other systems in the healthcare sector.   
New projects will be launched in 2009 and in the years to come in the Bulgarian healthcare sector. All will have to be linked to the NHIF information system. In addition, the European health insurance card system is due to be modernized, to standardize its use across all EU member states.

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