Good Practices in Social Security Good practice in operation since: 2015 Automatized payment for breastfeeding grant A case of the EsSalud - Social Health Insurance Institute EsSalud - Social Health Insurance Institute Peru Published 2030 www.issa.int
1 Summary Article 10 of the Constitution of Peru acknowledges and entitles the progressive and universal right of every person to social security. Within this scope, the Act Nº 26790 Modernizing Social Security for Health was enacted, based on the constitutional principles that acknowledge the right to welfare and entitles people to the free access to the services provided by public, private or mixed entities. Based on this premise, the Social Health Insurance Institute (Seguro Social de Salud (EsSalud)) provides financial services to their covered patients, trying to cover the expenses that could arise due to potential contingencies. One of the financial services offered is the breastfeeding grant - an amount of money provided in order to contribute to the care and welfare of the newborn. Thus, in order to improve the quality of the care services provided to our covered patients, EsSalud has issued the Directive N 003-GG-ESSALUD-2015, by means of which we implement the new payment procedure for the breastfeeding grant, which will be developed below. CRITERIA 1 What was the issue/problem/challenge addressed by your good practice? The payment of the grant was postponed because, in some cases, it took up to 76 days as of the newborn's birth date due to the basic requirement of having the National Registry of Identification and Civil Status (Registro Nacional de Identificación y Estado Civil (RENIEC)) submit a physical national identification card (documento nacional de identidad (DNI)) of the newborn. These initial procedures resulted in the late delivery of the services provided for the care of the newborn. The causes were the following: A physical ID of the newborn must be submitted. The newborn must be registered as beneficiary of the covered patient. The mother must be registered in EsSalud if she is not the policy holder. The Form 8002 must be submitted, filled-in and signed by the covered patient and the employer. Restrictions on information transfer from the National Superintendency of Customs and Tax Administration (SUNAT).
2 The Central Management of Insurance and Financial Benefits reported that, on 2014, only 4,679 (3 per cent) of 155,232 submitted applications were processed and payed within the first 28 days of life of the newborn; as a result, in 97 per cent of the cases, the benefit was collected on the 29 th day. Therefore, the Directive N 03-GG-ESSALUD-2015 was issued in order to pay the breastfeeding grant. With this procedure, the payment is carried out within 72 working hours after submitting the application for the payment of the breastfeeding subsidy. CRITERIA 2 What were the main objectives and the expected outcomes? a) Main objectives Effective and timely payment of the breastfeeding grant in order to contribute to the protection of the life, integrity, and development of the newborn. b) The expected results are the following: Implementation of a new payment procedure for the breastfeeding grant. Automatic delivery of the information on the person affiliated to EsSalud that receives services in an assistance center with the Electronic Birth Registration System (Sistema de Registro de Nacimiento en Línea (SRNL)) for its validation in our systems. Requirements to apply for the grant: Form 8011 and ID of the mother. The recipient mother will access to the grant within 72 working hours after submitting the application in any of the agencies of the Bank authorized by EsSalud. CRITERIA 3 What is the innovative approach/strategy followed to achieve the objectives? The strategies of the course of action were the following: Reduced amount of documentation required to apply for the breastfeeding grant. (simplification). Automatized reception and rating of accreditation and family relationship (efficiency). Reception of applications for the breastfeeding grant's payment in a One-Stop Window.
3 Information sent directly to the Online Registry System for Births of the RENIEC, which is compared against our Safety Assurance System 13SAS to verify the birth of the liveborn person. The payment for the grant will be deposited within 72 working hours after submitting the application (promptness). In the cases of Health Centers of EsSalud that do not have the SRNL, the mother of the newborn will be able to process automatically the registry for the infant in the security offices, validating immediately the information in the SAS, and thereby accrediting the policy holder and the relationship between the mother and the newborn. It is important to take down ideas on the challenges that EsSalud has assumed in association with the product of the breastfeeding grant. The purpose is that EsSalud's associates keep their compromise with the task of making the above-mentioned product sustainable over time, applying it through the country for everyone to benefit from it. CRITERIA 4 Have the resources and inputs been used in an optimal way to achieve the set objectives and the expected outcomes? Please specify what internal or external evaluations of the practice have taken place and what impact/results have been identified/achieved so far. We have created a procedure that allows us to optimize resources and time for both the institution and the covered patient through an automatized process. 1. We have used external and internal resources. Regarding the external resources, the information is sent through the SRNL directly from the RENIEC. 2. This feature allows the already concealed data to be sent to the banking institution authorized by EsSalud by means of a payment order, which will be effective within 72 working hours after the process takes place, allocating the benefit directly to the recipient mother or guardian. 3. With the information from the Online Registry System for Newborns, we eliminated the obligation of submitting the infant's ID, as such information is sent directly to EsSalud. 4. Consolidating in the Form 8011 (application for the breastfeeding grant) the information required for fulfilling the procedure, in which the applicant makes only one visit to apply for the benefit.
4 5. Reducing time and frequency of the processes for rating the applications, budget approval, accounting and fund transfers to the banking institution authorized by EsSalud. 6. About 90 % of the submitted and processed applications will be paid through the automatized process in the banking institutions authorized by EsSalud. Internal assessments: Periodic monitoring of the new procedure, enabling the product breastfeeding grant to satisfy adequately the established objectives. Monitoring and follow-up of the automatized process for the breastfeeding grant. Progressive implementation of the new payment procedure for the breastfeeding grant through the country. Verification of the correct allocation of the breastfeeding grant through monitoring actions assigned in the Audit Plan, which are based on a risk focus. External assessments Even though this procedure has been implemented recently, there is a positive impact, as mothers consider it a great benefit that contributes to the care of their children. CRITERIA 5 What lessons have been learned? To what extent would your good practice be appropriate for replication by other social security institutions? The experience of implementing the procedure has allowed us to work institutionally as a team, since the process was carried out not only by the Central Management of Insurance and Financial Benefits, but also by other management organisms, whose involvement was necessary due to the importance and the complexity of the process. The simplification of a process enables the fulfillment of very important objectives, such as the payment of the breastfeeding grant. The reduction to the minimum necessary of the in-person presentation in the Institution for the procedure allows for the leveraging of time, which is spent in the care of the child. This good practice can be efficient in other institutions because: It is common that administrative procedures turn out to be tiresome for applicants, as they produce delays and even waste of time. This process reduces substantially the time spent,
5 as the payment is processed automatically; the process also assists the mother to receive in a timely and quick manner a benefit that contributes to the care of the infant. The promptness of the process generates trust in the applicant, as they feel greater support by the State. Improvement on the care services' quality, human services and support to the citizens. Resources and time saving for the Management. The result has enabled the Management to reach goals and overcome internal and external setbacks. Greater motivation, self-esteem and self-awareness, since, with the help of everyone, we can provide a better service to the covered patient. We can rest assured that our product of breastfeeding grant can be reproduced by any other institution, since our experience has revealed that, through this process, the requirements for the procedure can be reduced to the maximum, also considering that our common goal is that the benefit reaches the recipient mother of the newborn on a timely manner, contributing to the care and the development of the child in their most vulnerable stage in life - the first days of life.