openIMIS offers scheme operators to generate pre-defined standard reports through its Reports function. There are 18 reports that are available as default in the openIMIS distribution, however all implementations are encouraged to review and configure/customize the list according to their needs.
Primary operational indicators - policies report
Code | Primary indicators | Dimension | Description |
---|---|---|---|
P1 | Number of policies | Time, Insurance product | The number of policies of given insurance product on the last day of a respective period (Status of the policy is Active, the last day of period is within <Effective date, Expiry day>) |
P2 | Number of new policies | Time, Insurance product | The number of new policies of given insurance product during a respective period (Enrolment date is within the respective period, there is no preceding policy with the same (or before converted) insurance product forgiven policy) |
P3 | Number of suspended policies | Time, Insurance product | The number of policies for given insurance product that were suspended during a respective period (Status of the policy is Suspended, suspension took place within the respective period) |
P4 | Number of expired policies | Time, Insurance product | The number of policies for given insurance product that expired during a respective period (Status of the policy is Expired, expiration took place within the respective period) |
P5 | Number of renewals | Time, Insurance product | The number of policies that were renewed forgiven insurance product (or a converte done) during a respective period ( Enrolment date is within the respective period, there is a preceding policy with the same (or before converted) product forgiven |
P6 | Number of insurees | Time, Insurance product | The number of insurees covered by policies of given insurance product on the last day of a respective period (An insuree belongs to a family with an active coverage on the last day of the respective period-see P1 ) |
P7 | Number of newly insured insurees | Time, Insurance product | The number of insurees covered by new policies of given insurance product during a respective period (An insuree belongs to a family with newly acquired policy during the respective period-see P2 ) |
P8 | Newly collected Contributions | Time, Insurance product | Amount of acquired Contributions (for policies of given insurance product) during a respective period ( Date of payment of a Contribution is within the respective period) |
P9 | Available Contributions | Time, Insurance product | Amount of Contributions that should be allocated for policies of given insurance product for a respective period provided a uniform distribution throughout the insurance period takes place. (If the respective period overlaps with <Effective date, Expiry day> of a policy then a proportional part of corresponding Contributions relating to the respective period is included in available Contributions) |
Primary operational indicators - Claims Report
The core indicators used for creating Primary operational indicators - Claims Report are:
Code | Primary indicators | Dimension | Description |
---|---|---|---|
P10 | Number of claims | Time, Health facility, Insurance product | The number of claims for given insurance product that emerged during a respective period (Start date of a claim is within the respective period) |
P11 | Amount remunerated | Time, Health facility, Insurance product | Amount remunerated for claims for given insurance product that emerged during a respective period (Start date of a claim is within the respective period) |
P12 | Number of rejected claims | Time, Health facility, Insurance product | The number of claims for given insurance product that emerged during a respective period and were rejected (Start date of a claim is within the respective period and the Status approval of the claim is Rejected) |
Derived Operational Indicators Report
The core indicators for generating the Derived Operational Indicators Report in openIMIS are
Code | Derived | Dimension | Description |
---|---|---|---|
D1 | Incurred claims ratio | Time, Insurance product | It is the ratio P11/P9 |
D2 | Renewal ratio | Time, Insurance product | It is the ratio P5/P4 |
D3 | Growth ratio | Time, Insurance product | It is the ratio P2/P1-for immediately preceding period |
D4 | Promptness of claims settlement | Time, Insurance product | It is the average (date of sending to payment- Date of submission of the claim) for all claims relating to given insurance product and emerging in a respective period Date of sending of payment is not in the structure of Claim, it has to be retrieved from a journal-can be?) |
D5 | Claims settlement ratio | Time, Health facility, Insurance product | It is the ratio (P10-P12)/P10 |
D6 | Number of claims per insuree | Time, Insurance product | It is the ratio P10/P6 |
D7 | Average cost per claim | Time, Health facility, Insurance product | It is the ratio P11/P10 |
D8 | Satisfaction level | TimeDistrict, Health facility | The average mark from feedbacks received in a respective period |
D9 | Feedback response ratio | Time, District, Health facility | The ratio of number of feedbacks received (up to time of creation of the report) and number of feedbacks asked for in a respective period |