Improving quality through accreditation: the health insurance case

1
Improving quality through accreditation the
health insurance case
12nd WFPHA World Congress 2009

• Cordeiro, H, Andreazzi, MFS, Nordskog, AG et alli

2
Introduction

• Accreditation of health organizations has become
  an important strategy to monitor health care
  quality at present.
• Its main characteristics are voluntary,
  adequacy to standards previously defined,
  carried-out by independent organizations.
• Brazil has committed to develop a process of
  accreditation of voluntary health insurance/VHI
  organizations in 2008. The target is 90 of
  beneficiaries in VHI organizations until 2011,
  that means 40 million people.

3
Objectives

• To identify, at the international level, the
  specific features of health accreditation
  programs applied to private health insurers
• To compare accreditation vis-a-vis health quality
  measure evaluation to improve safety to patients
• To discuss indicators that focus on the specific
  role of health insurers to promote a better
  healthcare services.

4
Methodology

• Review of international literature related to
  accreditation of health insurance.
• Analysis of three cases USA, Colombia and
  Australia (the project) in according to
• Uses - quality management, health utilization ,
  health providers network, privileges for medical
  specialities, patient rights, member
  connections, outcome evaluation
• Dimensions of evaluation - access, qualified
  providers, health promotion and delivery of
  services
• Standards - structure, process and outcome
• Selection and definition of indicators - market
  or public regulation

5
Results a

• Accreditation of health providers is much more
  frequently found in the literature than of health
  insurance.
• Who defines?
• Government Colombia and Australia (in public
  consultations), Chile, Canada
• Market USA (NCQA and others)
• Who uses?
• Individual decisions about buying health
  insurance USA, Colombia
• Employers decision concerning health plans for
  employeesUSA

6
Results b

• Dimensions of evaluation
• Structure and process Colombia e USA
• Emphasis in process Canada
• Outcome USA (HEDIS and CAHPS), Canada, after
  1990

7
Dimension of evaluation
8
CONCLUSIONS impacts of accreditation of health
plans

• EUA 90 accredited by NCQA.
• Brazil just starting.
• Australia proposing that health plans only
  contract with accredited providers.
• According literature, health accreditation
  promotes
• Organizational changes
• Professional development

9
AUTHORS

• hesio.cordeiro_at_ans.gov.br
• maria.andreazzi_at_ans.gov.br
• alexandre.nordskog_at_ans.gov.br
• www.ans.gov.br
• Phone [phone]