A coding system for diagnosis and management of medical problems - for the purpose of completing group health insurance claim forms

Since 1994, group health insurers in Trinidad and Tobago have been requesting more specific details diagnosis and other services rendered to patients on Health Claim Insurance Forms. The argument put forward by group health insurers is that "Health plans provide coverage on a "per ailment" basis with specified limits applicable to each ailment. It is therefore necessary to know what ailment is being treated to ensure that plan limits are not exceeded". This presented the problem of medical information passing from the doctor to the patient's place of work and then to the insurance company without confidential cover. In cases where the doctor limits the information to protect doctor/patient confidentially, the forms are often returned creating additional work and delay in reimbursement of claims. This is generally frustrating to all parties concerned. In 1984 a coding system was designed for 3 columns on existing forms - diagnosis, type of visit and services rendered - the aim being to provide, through the use of simple codes, specific information while preserving confidentially. Codes number only from 1 to 21 (major systems) with sub-code between the major systems makes it very simple to use. The coding system was accepted by group health carriers in Trinidad and Tobago in 1984 and has been computerized and used for both external and internal business. Doctors (mainly general practitioners and obstetrician-gynaecologists) have been coding with ease, and patients now submit health claim forms without reservations(AU)

The role of social security in the provision of medical care in the English-speaking Caribbean

This paper reviews the current role of social security institutions in financing health care and explores possible alternative avenues for their participation