Classification of (Social) Protection Schemes

Owned by Uwe Wahser
Last updated: Oct 21, 2021
3 min read

Content

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 https://openimis.atlassian.net/wiki/spaces/KB/pages/1100644371 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: https://openimis.atlassian.net/wiki/spaces/OP/pages/1389297783 . 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: . 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

from https://www.opml.co.uk/files/Publications/a0408-shock-responsive-social-protection-systems/srsp-literature-review.pdf?noredirect=1:

  • Social Protection

    • Non-contributory

      • Social assistance

        • Social transfers

          • Cash transfers

          • Vouchers

          • In-kind transfers

        • Public works programmes

          • Cash for work

          • Food for work

        • Fee Waivers

          • 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

from :

  • Medical care

  • Sickness benefit

  • Unemployment benefit

  • Old-age benefit

  • Employment injury benefit

  • Family benefit

  • Maternity benefit

  • Invalidity benefit

  • Survivors' benefit

See also:

Examples of classification approaches

Jiri Nemec: Views

  • Beneficiaries’ view: Refers to all facts that should be known to potential beneficiaries, such as who can become a beneficiary, at what time and for how long, what are benefits, and when they are provided and under what conditions.

  • Payers’ view: Refers to all facts that should be known to potential payers for social insurance programs as for example what contributions should be paid, when they are paid, what happens if contributions are not paid properly.

  • Providers’ view: Describes which providers (or types of providers) will provide benefits in-kind, what benefits in-kind are provided, how benefits are claimed, and how claims are paid or settled.

  • Business processes view: Describes all processes associated with the administration of the programme, such as the process of enrolling a beneficiary, approving benefits, evaluating and clearing claims for benefits in-kind and paying benefits in cash, as well as the change management and grievance processes. In addition, the identification of beneficiaries comes under business processes.

  • Financial resources view: Describes all sources of funding for the programme and includes specifying the level of pooling, rules of possible redistribution and subsidisation.

  • Human resources view: Includes a description of all roles of the internal and external human resources participating in the administration of the programme.

  • Institutional view: Describes which institutions will oversee the administration of the programme and which institutions will participate in delivering the supporting data needed for the administration of the social protection programme.

openIMIS community workshop: Legos

from: :

  • 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, consumables, 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

References

 

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