Claim - Percentage Referrals

From the original user guide:

The report lists all primary health care facilities (the category is Dispensary and Health Centre) in the selected district and for each such health facilities provides the following indicators:

1. The number of visits (claims) of the primary health care facility in the selected period.

2. The number of out-patient visits that have Visit Type equal to Referral in all other health facilities (irrespective of the district) for insurees with the First Service Point in the respective primary health care facility.

3. The number of in-patient stays that have Visit Type equal to Referral in all health facilities-hospitals (irrespective of the district) for insurees with the First Service Point in the respective primary health care facility.

The report can be run by users with the system role Accountant or with a role including an access to Tools/Reports/Percentage of Referrals.

Open

The query from the legacy version started from the list of Health Facilities with a Level of “D” or “C”.

For each of these, it would compute

1. the total of claims for that Health Facility. All statuses included.

2. the amount of claims for insurees with this Health Facility as first service point but claimed in a different hospital with a claim type of Referral (vs Other and Emergency) and having the date from and date to identical (therefore out-patient). This didn’t include claims without date_to

3. same as 2. but with different dates, so in-patients.

To test this report:

An insuree with a first service point of “Dispensary 1” files a claims in that health facility. The report should include a total of 1 for that health facility.

File a claim in a different hospital with “Referral” and date_from = date_to (or omit date_to). The report should now include 1 in the outpatient count.

File a claim in a different hospital with Other or Emergency as visit type. This shouldn’t impact the report.

File another claim in a different hospital with Referral and date_from = date_to. The report should have a total of outpatient of 2 instead of 1.

File a claim with Referral and several days between date_from and date_to. The inpatient count should increase.