This community is focused on identifying health care financing data exchange needs and working synergistically with the OpenHIE community to ensure that data exchange processes and requirements meet the needs of the health care financing communities.
The WHO defines health financing as the “function of a health system concerned with the mobilization, accumulation, and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” Health financing includes three main components for revenue-raising, pooling of funds and risk, and purchasing. The provision of healthcare, documentation of health care delivery, and subsequent data sharing are also closely interwoven with health sector financing. Documentation and sharing of health data are critical for episodic and longitudinal care; this data forms the information substrate for health financing.
This community primarily focuses on the functions and data needed by the health purchaser. (For our purposes, a health purchaser is any institution that buys health care goods, services, and interventions on behalf of a covered population). Health purchasers can include the ministry of health, social health insurance agencies, special purchasing agencies, local or national government authorities, other ministries (such as the ministry of defense), private insurance companies, and community-based insurance funds. If needed, this community may prioritize using national health insurance use-cases as a basis for evaluating the health financing requirements. Still, we intend to be broadly open to any health financing related scenarios.