Quality and Patient Safety – National Health Insurance Board

We continuously improve the delivery of healthcare services in a low resource environment and to enhance the overall health status of its members. We aim to objectively and systematically monitors and evaluates the quality, appropriateness, and outcomes of care and services, as well as the processes by which they are delivered.

Quality Goals and Objectives

The main goal of our quality and patient safety efforts is to ensure that NHIP members receive high quality, medically appropriate, and cost-effective health care. This idea is integrated into the clinical, non-clinical, and operational services provided to NHIP members. The program encompasses services rendered in ambulatory, inpatient, and transitional care settings and is designed to resolve areas of concern on an individual and system-wide basis.

Objectives include the following:

To improve member health outcomes and risk status
To ensure member access to medically appropriate care
To develop and evaluate efforts to reduce the unnecessary use of emergency departments, inpatient services, and readmissions
To improve member and provider satisfaction
To improve coordination and transition across care settings and among ancillary providers
To monitor adherence to NHIP-approved, evidence-based clinical practice guidelines

How we monitor quality

The NHIP uses internationally accepted measures to track the clinical outcomes achieved by the providers in our provider network. These will help us ensure that we are sending you to providers that deliver quality care while keeping you safe. In addition to ongoing tracking of specific measures, we survey patient files regularly to pick up any preventable adverse events that would indicate that you did not receive appropriate care. We also conduct regular facility visits which assess facilities along a number of important quality and safety criteria.

We also look at your experience while under the provider’s care. We conduct member satisfaction surveys which provide the NHIP with information about member experiences with the plan and its providers. The results of these surveys help the NHIP identify areas of member dissatisfaction that may require corrective action. These surveys ensure that the NHIP incorporates member input into its decision-making.