CH Core Coverage Profile - Proposal (Felizitas Wahl-Homner, CISTEC AG)

[wahlfe]

Implementation Guide
ch.fhir.ig.ch-core#2.0.0 /StructureDefinition-ch-core-coverage.html

coverage.type
http://build.fhir.org/ig/hl7ch/ch-core/StructureDefinition-ch-core-coverage-definitions.html#Coverage.type
should have a binding on a swiss value set; attached proposal:

• CISTEC_CodeSystem-CH-Core-HealthCoverageTypeCode-CodeSystem_20210526.xlsx

Please consider, to use the abbreviations OKP, UV, MV, etc. as proposed in the file, because it is common practice within the Swiss health system. Furthermore, the BfS-Code doesn't cover VVG/Zusatzversicherung for it isn't used within the BfS-statistics.

coverage.class.type
http://build.fhir.org/ig/hl7ch/ch-core/StructureDefinition-ch-core-coverage-definitions.html#Coverage.class.type
should have a binding on a swiss value set; attached proposal:

• CISTEC_CodeSystem-CH-Core-HealthCoverageClasseCode-CodeSystem_20210526.xlsx

Please consider, to use the abbreviations A, HP, P as proposed in the file, because it is common practice within the Swiss health system. Furthermore, the BfS-Code doesn't provide enough codes for today's insurance coverages.

Kind regards
Felizitas Wahl-Homner
CISTEC AG

CISTEC_CodeSystem-CH-Core-HealthCoverageClassCode-CodeSystem_20210526.xlsx

CISTEC_CodeSystem-CH-Core-HealthCoverageTypeCode-CodeSystem_20210526.xlsx

[oliveregger]

Abhängig von Entwicklungen auch in http://build.fhir.org/ig/hl7ch/ch-orf/StructureDefinition-ch-orf-coverage.html

[oliveregger]

http://fhir.ch/ig/ch-core/ValueSet-bfs-medstats-21-encountertype.html

[oliveregger]

related also to hl7ch/ch-orf#80 (insert CH Related Person for Coverage)

[ziegm]

https://build.fhir.org/ig/hl7ch/ch-core/branches/issue116_coverage/StructureDefinition-ch-core-coverage.html

Proposal Coverage.type:

• add CodeSystem-bfs-medstats-25-mainguarantor (to avoid introducing new codes) and CodeSystem-mainguarantor for the missing value, which is used also in CH ORF and other known use cases
• CH ORF will update the codes according this change: Update Coverage (Michaela Ziegler, ahdis ag) ch-orf#177
• 

Proposal Coverage.class.type:

• use the already existing ValueSet-bfs-medstats-21-encountertype, to avoid introducing new codes
• the proposed value "others" is not included
  • if there is an use case which has an additional value, it is possible to add ist, because the valueset binding is extensible
    • use a specific value for those use cases instead of others to be clear, what it is
• 

[ziegm]

24.04.2024 FHIR Telco:

• discussion why using the BFS numbers
• new introduced in CH Core (impact on CH ORF)
  • binding not required
• discussion about "other" (included in one and not in the other)

Proposal for CH ORF

• reduce the binding strenght to extensible (from required) -> added to CH ORF: Update Coverage (Michaela Ziegler, ahdis ag) ch-orf#177 (comment)

Vote: 13 - 0 - 1
Negative comment: seems like an adhoc solution, may there are international solutions, other resources would be use (e.g. InsurancePlan)