Table 2 Core departments und major functions in a public purchasing organization
Organizational unit | Responsibilities |
|---|---|
Chief executive | Oversight and overall responsibility |
Ombudsman | Independent inquiry of complaints filed |
Public relations | Communicating with the public, annual reports Working with parliament and the Ministry of Health Coordinate and exchange with international institutions Responding to objections and comments from the public |
Internal auditing | Auditing of operations of all departments and branches Reviewing fraud and corruption risks and whistle-blowing Proposing enhancements for internal operations |
Legal affairs | Reviewing supply contracts Reviewing and preparation of all contracts with providers Settlement of legal issues with insurees and providers |
Actuary and statistics | Assessing financial impact of changes to the benefit package and health technology assessment Proposing and assessing the impact of cost-sharing schemes Estimating cost implications of epidemiological and demographic trends to the benefit package Estimating cost implications on any policy decision that needs to be reflected in the composition of benefit package Calculation of contribution rates Actuarial/statistical reports |
Human resources and training | Recruiting and retention of staff Maintaining personnel records Plan and organize training / educational plans for internal staff |
Marketing | Preparation, running, evaluation of marketing campaigns Preparation of information booklets and website Answering queries of insurees, media and civil society |
Registration | Collecting forms on enrolment or renewals from field staff Recording data on households/members and sold policies Issuing insurance cards |
Service purchasing | Definition of the benefit package, including costing / pricing and health technology assessment Development of remuneration mechanisms for providers Creation and maintenance of classifications Preparation of model contracts for types of providers Negotiating with health care providers on contractual terms Accreditation / maintaining the register of providers Checking the correctness of claims, medical review Communicating with providers on findings and problems |
Finance and accounting | Accounting for all financial operations, valuating claims Producing basic accounting reports for the annual report Depositing/investing available funds |
IT | Specification of requirements for IT support Design and maintenance of all forms for business processes Communication with IT vendors Running help desk for internal staff |
Organizational development | Define the different staff positions regarding the tasks and the corresponding requirements in skills and expertise |