Constraint one: budget is annual, cases are not
An employer approves a number for a year. A case arrives in the fourth week of December, needs a deposit, and does not respect the fiscal calendar. Programmes that ignore this end up either refusing care in December or waiting three weeks for an emergency approval. Both are worse than budgeting a contingency band in advance.
Constraint two: duty of care ends somewhere — write down where
The employer owes a duty of care. It does not owe clinical judgement, and it cannot be the entity that decides which hospital. A programme that blurs these three becomes a liability in the first serious case. Our agreement states what we carry — coordination, translation, scheduling, accompaniment, reporting — and what stays with the employer and the treating hospital.
Constraint three: employee health data crosses a border
HR needs to know whether someone can work. It does not need the diagnosis. We send a work-capacity statement: fit to work, fit with adjustment, or temporarily unfit, with dates. Diagnosis stays between the employee, the treating physician and, where legally required, the payer.
An HR dashboard that shows a diagnosis is a data-protection incident waiting for a calendar entry.
How we structure it
One coordinator named in the agreement, an annual service window, per-case settlement against the agreed band, and a quarterly review that looks at turnaround and refusal reasons rather than at case narratives. The review is deliberately boring: it is the part that keeps the programme from becoming a series of exceptions.
约束一：预算是年度的，病例不是
雇主批的是一年的数字。病例可能在十二月第四周到达，需要押金，不理会财年日历。忽视这一点的方案，最后不是十二月拒绝接诊，就是等三周的临时审批——两者都比预先留出一条应急区间更糟。
约束二：照护责任有边界，把边界写下来
雇主负有照护责任，但不负有临床判断责任，也不能成为"决定去哪家医院"的主体。把这三件事混在一起的方案，会在第一个重症病例上变成责任。我们的协议写明：我们承担什么——协调、翻译、排期、陪诊、报告；什么留在雇主与接诊医院。
约束三：员工健康数据要跨境
人事需要知道一个人能不能上班，不需要知道诊断。我们发的是劳动能力说明：可正常上班、需调整岗位后上班、暂时不能上班，附带日期。诊断留在员工、主诊医师之间，以及在法律要求时留在付款方之间。
一个显示诊断的人事看板，是一次等着被排进日程的数据安全事件。
我们怎么搭
协议里点名一位协调员、一个年度服务窗口、按约定区间逐案结算，以及按季度复盘——复盘看的是周转与婉拒原因，不看病例故事。这个复盘刻意做得很枯燥：正是它让方案不至于变成一串例外。