Impact of claim settlement procedure of health insurance companies on customer satisfaction during the pandemic: A case of third-party administrators
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DOIhttp://dx.doi.org/10.21511/ins.13(1).2022.06
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Article InfoVolume 13 2022, Issue #1, pp. 66-80
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The claim settlement process is one of the most critical aspects of health insurance. Many policyholder grievances often surface during claim settlement, which will likely shape the insurer’s reputation. Hence, this study aims to evaluate the relationships between hypothesized factors concerning the third-party administrator’s claim settlement process as perceived by policyholders. The paper used the data of policyholders from Delhi/NCR, India, who have availed the cashless claims in the last three years. In the process, a total of 790 questionnaires were sought to be. The methodology used was the extractive factor analysis comprising the KMO test, reliability assessment with Cronbach’s Alpha, and correlation assessment. The study attempted to evaluate all the contributing factors that shape the third-party administrator’s behavior during the claim settlement. Therefore, different factors were identified (themes A, B, C, and D). The study reported a significant relationship between insurance company perceptions (0.162), network hospital perceptions (0.182), product design (0.180), insurance agent (0.332), communications (0.114), disclosure (0.122), internal practices (0.143), and TPA claim settlement prospects across the Indian perspective. The contextual impacts on individual and group decision-making must be monitored and accommodated across effective public policy management concerning settlement of health insurance claims. The study findings could help insurers create business models leading to better customer satisfaction and congruence between agents, policyholders, TPAs, and health insurance companies.
- Keywords
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JEL Classification (Paper profile tab)I13, G22
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References38
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Tables8
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Figures3
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- Figure 1. Proposed conceptual model
- Figure 2. Aggregate effect modeling: SEM
- Figure 3. SEM model option-1
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- Table 1. Mapping the nature of determinants with dimensions
- Table 2. Inclusion and exclusion criteria set
- Table 3. Variance examination
- Table 4. Causal path relationship: Aggregate
- Table 5. Regression weights
- Table 6. Model-fit indices
- Table 7. Summary of regression outcomes
- Table 8. Literary support for model
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- Agarwal, A. (2011). Emphasis on trust – grievance management in insurance. IRDA Journal, 9(10), 25-27.
- Ahire, N., & Rishipathak, P. (2020). Assessment of satisfaction levels of health insurance poli settlement process sin Pune. Indian Journal of Forensic Medicine and Toxicology, 14(4), 7179-7183.
- Al Kahtani, M. (2020). The change management strategy in the Private Sector Insurance companies after Covid-19. Journal of Research in Administrative Sciences, 9(1), 12-17.
- Alrahbi, D. A., Khan, M., Gupta, S., Modgil, S., & Jabbour, C. C. J. (2022). Challenges for developing health care knowledge in the digital age. Journal of Knowledge Management, 26(4), 824-853.
- Bharath, Y. (2005). A stitch in time... Insurers must allay customer anxieties at first go. IRDA Journal, 3(7), 21-22.
- Bhat, R., & Babu, S. K. (2004). Health Insurance and third party administrators: Issues and Challenges. Economic Political Weekly, 39(28), 3149-3159.
- Bhat, R., & Jain, N. (2007). A study of factors affecting the renewal of health insurance policy (Working Paper No. 2007-01-02). IIMA.
- Campbell, R. J. (2008). Change management in health care. Health Care Management, 27(1), 23-39.
- Chatterjee, S., Chaudhuri, R., Thrassou, A., & Vrontis, D. (2021). Antecedents and consequences of knowledge hiding: The moderating role of knowledge hiders and knowledge seekers in organizations. Journal of Business Research, 128, 303-313.
- Christina, C., & Hartini, S. (2020). The impact of service innovation on customer satisfaction in healthcare. Jurnal Konsep Bisnis Dan Manajemen, 7(1), 107-109.
- Dave, H. S., Patwa, J. R., & Pandit, N. B. (2021). Facilitators and barriers to participation of the private sector health facilities in health insurance and government led schemes in India. Clinical Epidemiology and Global Health, 10(1), 100699.
- Dhar, P., & Sharma, G. (2019). Claim settlement mechanisms and Indian health insurance sector: A critical insight. Research Explorer, 7(23), 50-41.
- Dilawari, P. K. (2015). Third-party administrators: Awareness and perceptions of policyholders about facilitation of insurance service delivery through TPAs. Health Care: Current Reviews, 3(3), 43.
- Dutta, M. M. (2020). Health Insurance sector in India: An analysis of its performance. XIMB Journal of Management, 17(1/2), 97-109.
- Gautam, V., & Kumar, M. (2012). A study on attitudes of Indian consumers towards insurance services. Management Research and Practice, 4(1), 51-62.
- Geiger, S., & Kjellberg, H. (2021). Market mash ups: The process of combinatorial market innovation. Journal of Business Research, 124(1), 445-457.
- Huang, Z., & Benyoucef, M. (2017). The effects of social commerce design on consumer purchase decision-making: An empirical study. Electronic Commerce Research and Applications, 25, 40-58.
- Islam, R., Liu, S., Biddle, R., Razzak, I., Wang, X., Tilocca, P., & Xu, G. (2021). Discovering dynamic adverse behavior of policyholders in the life insurance industry. Technological Forecasting and Social Change, 163, 120486.
- Joseph, M., Stone, G., & Anderson, K. (2003). Insurance customer’s assessment of service quality: A critical evaluation. Journal of Small Business and Enterprise Development, 10(1), 81-92.
- Lee, J., & Marlowe, J. (2003). How consumers choose a financial institution: Decision making criteria and heuristics. International Journal of Bank Marketing, 21(2), 53-71.
- Lee, N., Ahn, S., & Lee, M. (2020). Mixed method investigation of health consumer’s perception and experience of participation in patient safety services in health insurance. BMJ Open, 10, e035831.
- Malhotra, S., Patnaik, I., Roy, S., & Shah, A. (2018). Fair play in Indian health insurance (Working Paper No. 228). National Institute of Public Finance and Policy New Delhi.
- Mathur, T., Paul, U. K., Prasad, H. N., & Das, S. C. (2015). Understanding perception and factors influencing private voluntary health insurance policy subscription in Lucknow region. International Journal of Health Policy Management, 4(2), 75-83.
- Mehta, S., Saxena, T., & Purohit, N. (2020). The New Consumer Behaviour paradigm amid COVID-19: Permanent or transient? Journal of Health Management, 22(2), 291-301.
- Muller, W. (1981). Theoretical concepts of Insurance Production. The Geneva Papers on Risk and Insurance, 6(21), 63-83.
- Naibaho, E. R., Fauzi, A., & Sadalia, I. (2020). The effect of marketing mix on satisfaction of customer insurance products unit link. International Journal of Research and Review, 7(2), 47-55.
- Nandapala, Y., & Jayasena, K. P. N. (2020). Micro-segmentation method for claim handling process in health insurance claims data. Proceedings International Conference on Advances in Computing and Technology (ICACT–2020) (pp. 103-105).
- Nebo, G. N., & Okolo, V. O. (2016). Effects of the strategies for customer satisfaction on the performance of insurance firms. IOSR Journal of Business and Management, 18(5), 78-90.
- Newes-Adeyi, G., Helitzer, D. L., Caulfield, L. E., & Bronner, Y. (2000). Theory and practice: Applying the ecological model to formative research. Health Education Research, 15(3), 283-291.
- O’Connor, G. E., & Kabadayi, S. (2020). Examining antecedents of health Insurance Literacy: The role of locus of control, cognitive style and financial knowledge. The Journal of Consumer Affairs, 54(1), 227-260.
- Owolabi, A. O., & Agboola, O. O. (2018). Insurance purchase: Price, Product, Promotion and Consumer’s attitude perspectives. Business and Management Horizons, 6(1), 44-46.
- Rao, G. V. (2004). What do your customers really want? IRDA Journal, 2(9), 18-19.
- Reshmi, B., Sreekumaran, N., Sabu, K. M., & Unnikrishnan, B. (2012). Awareness, attitudes and their correlates towards health insurance in an urban South Indian population. Management in Health, 16, 32-5.
- Selimović, J., Martinović, D., & Hurko, D. (2020). Critical success factors in insurance companies. Journal of Contemporary Management Issues, 25(1), 215-233.
- Shijith, V. P., & Sekher, T. V. (2015). Who gets health insurance coverage in India? New findings from nation-wide surveys. XXVII IUSSP International Population Conference. Busan, Republic of Korea.
- Wofford, L. E., Troilo, M. L., & Dorchester, A. D. (2010). Managing cognitive risk in real estate. Journal of Property Research, 27(3), 269-287.
- Yusuf, T. O., Gbadamosi, A., & Hamadu, D. (2009). Attitudes of Nigerians towards insurance services: An empirical study. African Journal of Economics, Finance and Banking Research, 4(4), 34-46.
- Zwanka, R. J., & Buff, C. (2021). COVID-19 Generation: A conceptual framework of the consumer behavioral shifts to be caused by the COVID-19 pandemic. Journal of International consumer marketing, 33(1), 58-67.