Healthcare Domain knowledge for Software Testers
Mankind has always been searching for basic needs. During occasions and festivals family, friends and relatives share their wishes for well being of all his beloved. He would like to remain healthy.
Reason for Health deterioration
Human nature forces him to participate in the human race for prosperity, chasing his dreams of becoming successful in each and every area. Starting from schooling, getting expected qualifications, achieving that dream job, and acquiring wealth, He has neglected his health.
Factors affecting human health
There are many factors that determine health condition of human staying in urban or rural countryside of any country. Air pollution, water pollution, use of hazardous pesticides and fertilizers by farmers to produce crop, fruits and livestock in bulk has imparted various health issues to humans and animals feeding on these foods. Living in competitive and overpopulated urban neighborhoods and lifestyle has mental disorders such as depression, anxiety, alcohol use disorders, and physical defects such as low back pain, neck pain, sensory defects, essential vitamins, and minerals deficiency in the blood resulting in anemia, lack of energy.
Impacts of sedentary lifestyle on health
Due to sedentary lifestyle without physical exercise causes 85% of the population worldwide suffer from pulmonary, indigestion, obesity, blood pressure, elevated cholesterol level, cardiovascular diseases. The importance of health can never be ignored or underestimated.
Health care is related to maintenance or improvement of health conditions through prevention, diagnosis, treatment, cure of illness, injury, or physical defects. Various medical professionals and experts from hospitals and medical centers assist and improve the health of patients in various departments like dentistry, optometry, midwifery, nursing, and intensive care units.
Health care insurance and its importance
It is right of every human being to live healthy and therefore health care facilities should be provided by the government and healthcare professionals at affordable charges. Health care or medical treatment industry includes services to treat patients for cure, prevent and rehabilitate them by skilled health care professionals at hospitals and treatment centers. It is an individual’s duty to take medical assistance and keep them healthy by providing nutritional food and health supplements and medicines.
Looking into expensive medical charges, it is mandatory to secure our loved one’s health and plan in advance for any unforeseen illness or mishap like accidents, so that medical charges can be taken care by Health Insurance Provider Company.
The parties involved in the healthcare service domain are explained below
Insurer – health insurance policy providers who look after all the medical treatment expenses for policyholder.
Policy holder – one who is covered for the sum insured amount of medical expenses by paying the premium to the insurer
Provider – healthcare professional, a registered doctor or physician treating a patient, a policyholder for his illness.
TPA – is an interface between policyholder and insurer company, who processes the claim for the medical treatment charges and reimburse them to the facility, hospital, and medical doctor.
Broker – is an agent that sells the health insurance policy to the customer against the premium amount for the sum insured healthcare expenses covered under the policy.
The Healthcare domain is not a single entity but functions as an integration of various systems working in sync with each other to provide expected healthcare benefits offered by the health providers. As an end result, medical expenses should be duly paid once approved by the insurer. Policyholders should only take necessary rest after the treatments by a health provider. Software testers have to validate the functioning of individual systems separately and then after integrating these systems as a healthcare workflow.
The systems that work together for the healthcare system are
insured_member system – to maintain records of policyholder, his medical history, type of insurance, the sum insured, benefits, coverage, and validity of the policy.
healthcare_provider system – maintain a list of hospitals and health insurer associated to for TPA for coverage, health policy details
health_claims system – maintain a list of illness, treatment to be undergone, approximate expenses of medical treatment, the sum insured by the policyholder, claims to process, the outstanding amount in case of claim rejection.
policy_insurer system – maintain a list of ailments, treatment procedures, coverage for a particular ailment, policy coverage, associated hospitals, and health centers.
The healthcare system should be thoroughly tested for positive scenarios as well as negative scenarios in order to prevent any fraud for false claims and policyholder not getting medical treatment and expenses in case of systems not working as desired.
It is right of every human being to live healthy and therefore health care facility should be provided by government and healthcare professional at affordable charges. Health care or medical treatment industries include services to treat patients for cure, prevent and rehabilitate them by skilled health care professionals at hospitals and treatment centers. It is individual’s duty to take medical assistance and keep them healthy by providing nutritional food and health supplements and medicines.
Healthcare system is build after integrating various systems such as policy holder (insured member), healthcare provider, health claim, and policy insurer system. Software testers should validate only valid entry in each of these system accepted and policy holder and health provider should benefit from the premium paid and claim settled by Insurer Company all function simultaneously.
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