No Benefit: Crisis in America's Health Insurance Industry

1995 ◽  
Vol 16 (3) ◽  
pp. 370
Author(s):  
Terence E. Carroll ◽  
Lawrence D. Weiss
Keyword(s):  
Health Insurance ◽  
Insurance Industry ◽  
Health Insurance Industry

scholarly journals Health Insurance as a Healthcare Financing Mechanism in India: Key Strategic Insights and a Business Model Perspective

2021 ◽  
pp. 025609092110270
Author(s):  
Rohit Kumar ◽  
Aditya Duggirala
Keyword(s):  
Health Insurance ◽  
Business Model ◽  
Critical Success Factors ◽  
Success Factors ◽  
Insurance Industry ◽  
Insurance Companies ◽  
Healthcare Financing ◽  
Strategic Choices ◽  
Critical Success ◽  
Health Insurance Industry

This study provides strategic insights and a business model perspective on health insurance as a vehicle for financing healthcare. It uses both primary (expert interview) and secondary data to investigate the overall disease burden and healthcare industry trends and track healthcare financing through the health insurance mechanism in India. To identify the critical success factors and to gain a business model perspective within the health insurance industry, telephonic and face-to-face interviews were held with 27 experts in the healthcare, insurance, and strategic management field. The study’s findings suggest that the growth of health insurance as a healthcare financing mechanism in India has been challenged continuously and impacted by multiple changes in the health insurance and healthcare industry over the last decade. One of the critical challenges faced by insurance companies is the high incurred claim ratio. We find the Indian health insurance industry to be very competitive and that the focus on critical success factors can help insurance companies gain a competitive advantage. The health insurance business model is unique, with varying configurations, and broadly comprises strategic choices and consequences. In this article, drawing from the strategic management literature on the resource-based view (RBV) and insights gained from the interviews of healthcare and health insurance experts, we highlight the six critical success factors relevant for competing in the health insurance business. We also list five strategic choices that can help health insurance companies improve their profitability and gain a sustained competitive advantage. We recommend that the insurance companies design and develop an innovative business model centred around lowering the claim ratio and simultaneously increasing the customer willingness to pay. To increase the customer willingness to pay and reduce the claim ratio, the insurance companies should focus on the six critical success factors and invest in the five strategic choices.

Expert Systems in Medicne:Possible Future Effects

1988 ◽  
Vol 4 (1) ◽  
pp. 121-133 ◽  
Author(s):  
P Potthoff ◽  
M. Rothemund ◽  
D. Schwefel ◽  
R. Engelbrecht ◽  
W. van Eimeren
Keyword(s):  
Health Insurance ◽  
Expert Systems ◽  
Medical Profession ◽  
Insurance Industry ◽  
General Medicine ◽  
Practical Application ◽  
Actual Knowledge ◽  
Positive Effects ◽  
The Subject ◽  
Health Insurance Industry

It should be pointed out that during the interviews most of the experts had positive expectations of ESM. The developers are more generally enthusiastic than the prospective users and affected parties who, especially in respect of the diffusion of ESM into practical application, only show a limited optimism.However, the representatives of the medical profession and the health insurance industry were convinced that ESM might contribute to cost-neutral increases of quality in out-patient and in-patient medicine. But we also understood them to say that they consider other developments in medicine to be overriding, for example, a tendency of general medicine towards a more family-oriented medicine and a reduced emphasis on technology-oriented medicine. In respect of the conception shared by developers as well as potential users that over-enthusiastic expectations should rather be restrained, we consider such a balanced expectation of positive effects of ESM to be adequate to the actual knowledge of the subject.

scholarly journals Overt dependence of health insurance industry on healthcare system

2021 ◽  
Vol 26 (1) ◽  
pp. 197-219
Author(s):  
Uma V R ◽  
Ilango V
Keyword(s):  
Health Insurance ◽  
Health Belief Model ◽  
Developing Economies ◽  
Insurance Industry ◽  
Health Belief ◽  
Correlation Technique ◽  
Perceived Vulnerability ◽  
Willingness To Buy ◽  
Health Insurance Industry ◽  
Belief Model

A vast majority of the population in the developing economies remains uninsured. Moreover, the informal sector that employs a larger section of the society is untouched by any of the government scheme. In this study, we use health belief model to examine the factors that induce willingness to buy health insurance among the illness and the non-illness group. A cross-sectional study was conducted on 1,339 participants above 20 years of age of which 351 had contracted illness in the past and 988 had not. Data was collected using questionnaire from four highly populated districts in India. The questionnaire was developed based on the constructs of health belief model. The data was statistically analysed. Kendall’s Tau-b correlation technique was used to explore the relationship between perceived vulnerability and product aversion. Logistic regression was used to find out the odds at which each independent variable, categorised based on the health belief model, contributes to willingness to buy. The model was able to predict 15% of the variance for willingness-to-buy among the illness and 27% among the non-illness groups. Findings suggest that the perceived vulnerability reduced product aversion among the illness group. Mere presence of primary and super-specialty hospitals was not sufficient for the illness group to subscribe for health insurance. Income perceptions emerged as a significant predictor among the illness group. Presence of well-established hospital, income perceptions, and subjective norms were significant predictors among the non-illness group. The growth of the health insurance industry largely depends upon the presence of well-established hospitals. In the absence of adequate healthcare facilities, attempts by the insurers to promote insurance covers will become futile. Insurers should also consider alternate segmentation patterns albeit the present socio-demographic pattern, as the health risk experience differs among individuals.

scholarly journals Life and Health Insurance Industry Investments in Fast Food

2010 ◽  
Vol 100 (6) ◽  
pp. 1029-1030
Author(s):  
Arun V. Mohan ◽  
Danny McCormick ◽  
Steffie Woolhandler ◽  
David U. Himmelstein ◽  
J. Wesley Boyd
Keyword(s):  
Health Insurance ◽  
Fast Food ◽  
Insurance Industry ◽  
Health Insurance Industry
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