openIMIS for Employment Injury Insurance
- Saurav Bhattarai
- Marco Kalin
The Challenge: : Ensuring prompt and smooth access to benefits for injured workers
Many countries are striving to introduce social insurance schemes to protect workers and their dependents in the case of occupational injuries and diseases. Such schemes ensure that injured workers have access to the health and rehabilitation services they need, and that they or their survivors promptly receive cash benefits to compensate for loss of income. As such, they form one element of the basic social protection guarantees envisioned under the Sustainable Development Goals (Target 1.3: national social protection systems for all) and are essential for reducing poverty.
As contributory social insurance schemes for employment injury gain in favour, there is a growing need for digital solutions which can help to manage the complex information flows involved. An effective accident reporting system and simple, efficient claims procedures are needed to ensure that workers or their survivors receive benefits promptly. Paper-based systems make the exchange of data between employees, employers, healthcare providers, and insurance scheme operators slow, cumbersome and susceptible to errors and fraud. Digitalisation allows for more efficient data management, helps to streamline business processes, and provides the information needed to monitor a scheme’s performance.
Not all digital systems are created equal, however. Interoperable digital solutions based on open source technology enable the seamless exchange of data between different information systems, such as those maintained by social security agencies or health insurance scheme operators. This results in smoother, more efficient processes and removes the need to develop expensive custom-made software from scratch.
openIMIS supports the following core processes:
Enrolment
Accident reporting
Health service utilization
Health service claims generation and submission
Claims review process
Processing and payment of claims
For employees, openIMIS simplifies enrolment procedures, makes it easy to verify one’s coverage status at point of care and ensures prompt receipt of benefits in case of injury. For employers it provides a one-stop solution for managing both enrolment and accident reporting, with seamless links to information from hospitals about treatment and rehabilitation. For health facilities, it streamlines the processes associated with a health financing scheme and makes it easy for them to receive reimbursements. For scheme operators it reduces operational costs, allows for better monitoring and analysis of the scheme’s overall performance, and enables information to be shared between different health and social protection schemes.
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