Published by the WHO Barcelona Office for Health Systems Financing as part of their health financing policy papers, this brief explores how the Estonian Health Insurance Fund claims management process has been further digitalized over time, how this has enabled the introduction of other advanced purchasing instruments, the benefits of the digitalization of claims in health financing and lessons learned that can be used for other countries.
Estonia started digitalizing claims and the claims management submission process between health-care providers and the Estonian Health Insurance Fund (EHIF) in the mid-nineties. A claim is the key set of
data that health-care providers submit to the EHIF, with the primary purpose of obtaining payment for delivered health care. However, the data collected via the claims process serves multiple purposes, making digital claims management an essential part of the EHIF’s business process and the foundation for advanced strategic purchasing instruments.
This paper is a shorter version of the more detailed WHO technical report, The role of digital claims management for Estonia’s health insurance: a leverage for making health-care purchasing more strategic.