Computerize Medical Insurance System

Topics: Health care, Health insurance, Health economics Pages: 38 (10004 words) Published: March 25, 2013

1.1 Background
Recent years have seen remarkable technological advance in computing, with computer spreading over in usage to various areas of life. The enunciation of a new era in computing as regards to health care has emerged to play a prominent role in the delivery of healthcare. The application and use of machines and computer-based technologies in health care have undergone an evolutionary process. Advance in information, telecommunication, and network technologies have led to the emergence of a revolutionary new way of health care delivery leading to new experience and knowledge that cross traditional disciplinary boundaries in the fields of information technology and health care, along with emerging knowledge that promote evidence-based medicine, e-medicine and remote e-health service (TAN, 2005) Computer have been employed in healthcare services and its use for healthcare delivery seems noticeable after finding out that it reduces the drudgery of work that characterizes the manual system. Also the need to monitor population health, insurance level and provide accurate, adequate and timely information for management decision at all level within and outside the health sector were supported to be of importance in providing healthcare delivery service which the computer is known to handle efficiently. Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. However, because Nigeria operates a mixed economy, private providers of health care have a visible role to play in health care delivery. Health Insurance is designed to pay the costs associated with health care. Health insurance plans pay the bills from physicians, hospitals, and other providers of medical services. Countries with national health insurance generally consider access to health care to be a basic right of citizenship. Historically, health insurance in Nigeria can be applied to a few instances: free health care provided and financed for all citizens, health care provided by government through a special health insurance scheme for government employees and private firms entering contracts with private health care providers. The National Health Insurance Scheme (NHIS) was launched by the Federal Government on June 6th 2005 as a health welfare scheme aimed at providing quality healthcare at an affordable cost to the general populace. It currently covers the employees of the Federal Government Civil Service (Ministries) and their families. The estimated population size is well over one million beneficiaries. This scheme has already resulted in an increased awareness around the country of health insurance in general. And the objectives of the scheme are: * To ensure that every Nigerian has access to good health care services * To protect families from the financial hardship of huge medical bills * To limit the rise in the cost of health care services

* To ensure equitable distribution of health care costs among different income groups * To maintain high standards of health care delivery services within the Scheme * To ensure efficiency in health care services

* To improve and harness private sector participation in the provision of health care services * To ensure equitable distribution of health facilities within the Federation * To ensure appropriate patronage of all levels of health care * To ensure the availability of funds to the health sector for improved services. The Computerized Medical Insurance System (CMIS) is a system that links the physician’s office or the hospital administrative office and the provider of insurance coverage by means of a central administration computer. The system provides up-to-date information to the provider of health care services as to identity of patients, insurance plans and coverage of a patient. The system also allows for real time modification of the information 1.2 Problem...
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