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Introduction
openIMIS supports beneficiary and claims management of a variety of different protection schemes (or instruments) in health and beyond. The nature of a scheme defines which functionalities and data structures in openIMIS are needed. As a prerequisite for building these in an efficient way, a well structured classification of protection schemes is needed.
Examples of Coding System
HL7 FHIR Valueset Coverage Type
HL7 defines Coverage as data structure that describes the protection of a beneficiary in the context of health services: http://hl7.org/fhir/R4/coverage.html . openIMIS is mapping this structure directly into data base tables: FHIR R4 - Coverage . There are two elements that can be used to classify the coverage of an individual:
coverage type: contains one code of a list of predefined codes: http://hl7.org/fhir/R4/valueset-coverage-type.html . It is recommended that this list comes from a generic, standardized list of classifications. Note that these are currently at a maturity level of 0.
coverage class: can contain a collection of additional attributes that can further classify a coverage.
Examples of topologies
OPM topologiy of social protection
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Social Protection
Non-contributory
Social assistance
Social transfers
Cash transfers
Vouchers
In-kind transfers
Public works programmes
Cash for work
Food for work
Fee WaversWaivers
basic health
education
Subsidies
Fuel
Food
Social care
Contributory
Insurance
Unemployment
Maternity
Disability
Work accident
Old age pension
Survivors’ benefits
Policies
Active labor market policies
Work sharing
Training
Job-search services
ISSA schemes
from https://ww1.issa.int/system/files/documents/2021-05/2-Guidelines ICT-2020.pdf, p.188
Schemes
Long-term benefits
Pensions
Disability
Hybrid benefits
Family
Health insurance
Short term benefits for income replacement
Sickness
Unemployment
Maternity
ILO social security instruments
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Medical care
Sickness benefit
Unemployment benefit
Old-age benefit
Employment injury benefit
Family benefit
Maternity benefit
Invalidity benefit
Survivors' benefit
See also: https://www.social-protection.org/gimi/Standards.action
Examples of classification approaches
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Risk: e.g. illness, long life, pregnancy, accident, death, economic loss, injury, disability, unemployment, uneducated
Type of Benefit: e.g one time payment, recurrent payment, free service, cosumablesconsumables, transmittable rights
Target Group: e.g. formal sector, informal sector, youth, mothers, under fives, poor, specific targets (HIV et al), health care workers
Type of Contribution: e.g. one time payment, recurrent payment, one time subsidy, recurrent subsidy
Examples of Coding System
HL7 FHIR Valueset Coverage Type
References
Oxford Policy Management
Oxford Policy Management (2018-03), https://www.opml.co.uk/files/Publications/a0408-shock-responsive-social-protection-systems/srsp-literature-review.pdf?noredirect=1
Oxford Policy Management (2018-01), “Shock-Responsive Social Protection Systems Research“,https://www.opml.co.uk/files/Publications/a0408-shock-responsive-social-protection-systems/srsp-synthesis-report.pdf, page 6 (figure 2)
ISSA:
ICT Guidelines: https://ww1.issa.int/guidelines/ict/pdf
HL7 FHIR:
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