دور جــودة الخدمات في كفاءة أداء المنشأة بالتطبيق على الصندوق القومي للتأمين الصحي (دراسة حالة 2005 – 2011م)

Abstract

The Islam urges the Muslims to Perfect their work. Prophet Muhammad Prayer and Peace be upon Him Said (Verily Allah loves if one of you did some work, he should perfect it). To attain the level of perfection we should perfect the design of the service we are planning to offer. And this requires that the design must be identical to the prescription of the required design to perform the proper work in the proper manner so as to attain the point of Zero error. If the approach of excellence was applied in all the work of the organization the efficiency of the organization will increase. Part of the excellence approach is to involve the personnel in discussing work problems, the continuous improvement of performance and that personnel would look to errors as a precious opportunity for improvement and that each mistake is regarded as a pearl that is worth searching. Moreover, the attention should shift from quantity to quality to realize efficiency in all its forms, efficiency of personnel, equipment and their use, efficiency in materials and information. The research has discussed the problem of the National Fund’s inability to attract customers and problem of poor quality and its effect on the cost of the services offered. The research had set forth the following hypotheses: 1. Poor ability to attract customer has negative effect on the performance of the National Fund for Health Insurance. 2. Low quality has negative effect on attracting customers. 3. Low service cost degrade service quality. The analysis of the data using the analytic and descriptive methodologies proved validity of the hypotheses. To achieve this efficiency the researcher found out that this demands constant attempts to simplify procedures of service rendering through computerization. The National Health Insurance Fund (NHIF) has already started this. Also the researcher found that distribution of health services is unfair among the different states of the country. In the Western sector 99% of the rendered service is provided indirectly whereas in Khartoum State 5% of the services are provided directly. This is disfigurement in the map of service distribution. Moreover, the health insurance is unable to attract customers for reasons explained in the research including: not all medicines are entered under the umbrella of health insurance, shortage of sufficient qualified medical cadre complicated procedures, some chronic diseases are excluded from the list of health insurance and suspension of work in official holidays. The lack of realization of excellence led to high service cost and inability to attract the informal sector. In addition to that the research explained how to provide low-cost and high-quality service by applying the quality approach, health education for protection against diseases and supporting the program of disease-fighting and health camps. After revealing all these obstacles the researcher came out with solutions that will help in upgrading the efficiency of (NHIF) to render better services for its customers. The most important results include: 1. Unavailability of most medicines in the pharmacies of health insurance specially quality high-priced medicines which reduces quality and weakens ability. 2. The procedures of offering health insurance services are complicated and simplification of procedures is urgently needed. 3. Lack of proximity of the centers which offer medical and medicinal services from residential areas weakened their ability to attract customers. 4. Closure of centers which offer medical service during official holidays reduced their ability to attract customers as well as degrading the efficiency of performance. The research came out with following recommendations: 1. The necessity of simplifying the procedures of offering the services of health insurance centers. 2. Establishment of health insurance centers near residential areas. 3. The medical service should cover all diseases and the necessity of providing all medicines in health insurance pharmacies.