The National Health Insurance Fund (NHIF) is a state health insurance fund that ensures that healthacare and medical treatment costs, as well as reimbursement medicines and medical equipment are paid for everyone insured by public health insurance. The detailed patient-level cost accounting project was initiated to determine the cost of treatment services provided by the Compulsory Health Insurance Fund (CHIF) as accurately and objectively as possible, thus ensuring a fair payment to the treatment institutions for the provided treatment services and for efficient and rational use of CHIF funds, as well as to provide as much as possible and better quality treatment services for patients. In the course of the project, based on a methodology for accounting and distribution of treatment costs prepared by the consultancy services company, an information system was designed and implemented to enable the cost of treatment and maintenance (economic activities) of medical institutions to be distributed and analyzed in various sections, including analysis based on specific diagnoses and diagnoses-related groups at the level of each patient and according to individual treatment facilities. NHIF has acquired a tool that allows to determine and compare cost of treatment services of different medical institutions, to perform cost analysis, to model possible cost change scenario (what if analysis). Treatment facilities can also use the tool for their performance evaluation purposes. Integrations with the NHIF financial management and accounting system, and medical information systems were also designed and implemented.




Project period



SAP Profitability and Cost Management (SAP PCM), SAP Business Objects, JAVA