Objective:
The project’s objective is to establish a national standard information exchange between health plans organizations (HPOs) and healthcare providers (HPs) centred on epidemiological analysis.
Methods:
National Supplementary Health Agency – NSHA (“Agência Nacional de Saúde Suplementar”) was created in 2000 and is responsible for regulating and assisting private health maintenance organizations. Supplementary health attends approximately 25 per cent of Brazilians, estimated as 180 million of people. The lack of widely common information standards in private sector and the difficulties found with the complex information exchange among HPOs and HPs have led NSHA to elaborate a national standard set of information exchange, known as the supplementary health information exchange (TISS – “Troca de Informação em Saúde Suplementar”). TISS project was developed from August 2003 until July 2004 and sponsored by the Interamerican Development Bank.
Several claims already changed between HPOs and HPs have been analyzed and many visits and interviews have been made to HPOs and HPs to discuss which relevant information should be exchanged, not only for billing purpose but also for epidemiological analysis. The project has considered national unique identifiers for beneficiaries, providers and health plans.
NSHA has presented TISS project to stakeholders in seminars and meetings organized in different regions in Brazil since July 2004 until December 2005. NSHA is introducing legislation to enforce the compliance to the standards established by consensus.
It has been a historical fact in Brazil bringing together HPOs and HPs to discuss standard information exchange in order to facilitate epidemiological analysis. Many groups have been formed all around the country in order to adapt their billing forms. A permanent national health information standards advisory committee is being created so that future changes should be deeply discussed among experts including repres entatives of HPOs, HPs, consumers, purchasers and policy makers.
Conclusions:
Standard information exchange on private health sector is the only way to improve public health policies, to construct a solid set of performance measures and to establish accountability in healthcare market. Private healthcare sectors can significantly improve quality and provide meaningful information to consumers, purchasers and others. The process of managing a national set of indicators based on a standard information exchange and between HPOs and HPs will be constantly evolving and broad-based participating.