Management of Claims and Reimbursements: The Case of Mediclaim Insurance Policy

2002 ◽  
Vol 27 (4) ◽  
pp. 15-28 ◽  
Author(s):  
Ramesh Bhat ◽  
Elan Benjamin Reuben
Keyword(s):  
Health Insurance ◽  
Adverse Selection ◽  
Health Insurance Scheme ◽  
Insurance Company ◽  
Insurance Policy ◽  
Insurance Scheme ◽  
Induced Demand ◽  
Voluntary Health Insurance ◽  
General Insurance ◽  
The Government

The Mediclaim scheme run by the government- owned General Insurance Corporation (GIC) of India is currently the only private voluntary health insurance scheme available in India. This scheme has been in operation since 1986 and from time to time a number of revisions has been made to address the needs of its clients. The analysis of claims and reimbursements under this scheme is scanty. This paper analyses 621 claims and reimbursements pertaining to policy initiation years 1997- 98 and 1998-99 of the Ahmedabad branch of GIC's subsidiary. The study estimates that about a third of claims amount increase is due to the problems of adverse selection or provider- induced demand. The analysis of breakup of reimbursements suggests that more than one-third of reimbursements are made towards doctor's fees, followed by diagnostic charges which account for about one-fourth. The findings also suggest that the insurance company took on an average 121 days to settle the claim.

scholarly journals Adverse Selection of Voluntary Health Insurance Scheme Proposed by the Hong Kong Government

2017 ◽  
Vol 3 (3) ◽  
pp. 393
Author(s):  
Ka Kit Man
Keyword(s):  
Hong Kong ◽  
Health Insurance ◽  
Adverse Selection ◽  
Information Structure ◽  
Health Insurance Scheme ◽  
Specific Information ◽  
Insurance Scheme ◽  
Voluntary Health Insurance ◽  
Game Theoretic ◽  
The Government

<p><em>In response to increasing public heath expenditure, the Government of Hong Kong Special Administrative Region (HKSAR Government) published a consultation document in October 2010 proposing a government-regulated</em><em> “Voluntary Health Insurance Scheme”</em><em>. The present study conducts game theoretic analysis and reveals that, under specific information structure, the implementation of such a proposal would result in adverse selection in medical insurance market, resulting in outcomes in opposition to the government’s intention.</em></p>

scholarly journals Willingness to Join and Pay for Social Health Insurance Scheme Among employees in Debere Berhan Town, Ethiopia

2019 ◽  
Author(s):  
Wassie Negash Mekonnen ◽  
Mesfin Wondaferew ◽  
Adugnaw Birhane Mekonen
Keyword(s):  
Health Insurance ◽  
Willingness To Pay ◽  
Contingent Valuation Method ◽  
Social Health Insurance ◽  
Health Insurance Scheme ◽  
Social Health ◽  
P Value ◽  
Multivariable Logistic Regression Analysis ◽  
Insurance Scheme ◽  
The Government

Abstract Back ground: Social Health Insurance improves access to health services among civil servants by removing catastrophic health expenditure. In Ethiopia, only 7.3% of the population covered by health insurance. Due to this fact the government of Ethiopia initiated Social Health Insurance scheme to be applied in the formal employers and employees with compulsory membership of the scheme. This study therefore aimed to assess willingness to join and pay for social health insurance scheme among government and private employees in Debere Berhan Town, Ethiopia .Methods: Cross-sectional study was conducted .At mean time Stratified sampling technique was used to select 619 employees. A modified dichotomous contingent valuation method (CVM) was applied to elicit employees’ willingness to pay. Bi-variant and multivariable logistic regression analysis was done . Then the result at 95% CI and P value <0.05 was declared as variables have statistically significant association. Results: A total of 619 employees with response rate of 97.8% were participated in the study. About 406 (65%) of the respondents were willing to join to Social Health Insurance scheme. Of which 113 (27.8%) of employees were willing to pay the government proposed 3% premium. The employee’s average willingness to pay for social health insurance scheme was 1.88% of their monthly salary. In this study the odds of respondents who had degree and above (AOR=3.608, 95%CI 1.177-11.061), employees good perception on quality health service (AOR=3.150, 95% CI 1.140-8.699) and employees who perceive benefit packages of social health insurance as enough (AOR=5.229, 95%CI: 2.230-12 .594) were higher than the counter parts. Conclusion: Employees willingness to join of the Social Health Insurance scheme(SHIS) is low and very low number of employees agree to pay the government proposed premium for SHIS. So decision-makers should emphasize to revise the benefit packages and the premiums to be contributed. likewise insurance agency and all responsible bodies should aware the society about the importance of social health insurance for the employees.

scholarly journals Health Personnel and the Implementation of National Health Insurance Scheme (NHIS) in Federal Capital Territory, Abuja, Nigeria

2021 ◽  
Author(s):  
Ikechukwu Joseph Okafor ◽  
Abdulhamid Ozohu-Suleiman
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Personnel ◽  
Healthcare Workers ◽  
National Health Insurance Scheme ◽  
Health Insurance Scheme ◽  
Healthcare Personnel ◽  
Insurance Scheme ◽  
The Government

Acknowledged as a policy target for the government of Nigeria, healthcare provision represents an important preoccupation for the government. As with other public policies, the achievement of policy goals in Nigeria is usually encumbered by numerous factors of implementation across various sectors. In the health sector, factors such as inadequate physical infrastructure, shortage of healthcare personnel, limited medical supplies etc. have hindered the implementation of several health policies. National Health Insurance Scheme (NHIS) is one of such policies and this study examined the effects of shortage of healthcare personnel on the implementation of NHIS policy in FCT, Abuja. Specifically, the study evaluated the opinions of health workers as well as enrollees of NHIS in four purposively chosen Area Councils of the six Area Councils in FCT. This study adopted a survey research design with Rensis Likert’s five-point scale questionnaire instrument administered to both categories of respondents. The data were analyzed using the Statistical Package for Social Sciences (SPSS Version 25) and the T-tested statistical tool was used to test the hypothesis. The study found out that shortage of health personnel is a major barrier to the effective implementation of NHIS in the FCT, Abuja. Consequently, the study recommends that there should be massive recruitment of qualified healthcare personnel; training and retraining of healthcare workers; and timely and adequate remuneration for the healthcare workers in FCT, Abuja.

Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China

2006 ◽  
Vol 63 (5) ◽  
pp. 1236-1245 ◽  
Author(s):  
Hong Wang ◽  
Licheng Zhang ◽  
Winnie Yip ◽  
William Hsiao
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Adverse Selection ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Care Health

scholarly journals Factors Associated With Willingness To Join a Health Insurance Scheme Among Females in Uganda

2021 ◽  
Author(s):  
Douglas Andabati Candia
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Secondary Data ◽  
Health Insurance Scheme ◽  
The Internet ◽  
Insurance Scheme ◽  
Human Right ◽  
Factors Associated ◽  
Health Related ◽  
The Government

Abstract Background Access to quality and affordable health services is a fundamental human right. Therefore, there is a need for more reliable, affordable, and sustainable approaches to financing health services. This study sought to identify factors associated with willingness to join a health insurance scheme among females in Uganda. Methods The assessment was done using a logistic regression model and secondary data from the 2016 Uganda Demographic and Health Survey. Results The majority of females were willing to join health insurance schemes (85.28%). The willingness to join health insurance schemes increased among females with primary or secondary education as well as among females who used the internet less than once a week or almost every day. Conclusion There is a need for government to increase literacy among women since it will have an implication on their understanding of health insurance information and subsequently influence their willingness to join and pay. There is a need for the government of Uganda to revise the tax on the internet and internet-enabled devices to increase affordability and access to the internet which provides a cheaper and faster way to disseminate health-related information.

scholarly journals Health Personnel and the Implementation of National Health Insurance Scheme (NHIS) in Federal Capital Territory, Abuja, Nigeria

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Ikechukwu Joseph Okafor ◽  
◽  
Abdulhamid Ozohu-Suleiman ◽  
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Personnel ◽  
Healthcare Workers ◽  
National Health Insurance Scheme ◽  
Health Insurance Scheme ◽  
Healthcare Personnel ◽  
Insurance Scheme ◽  
The Government

Acknowledged as a policy target for the government of Nigeria, healthcare provision represents an important preoccupation for the government. As with other public policies, the achievement of policy goals in Nigeria is usually encumbered by numerous factors of implementation across various sectors. In the health sector, factors such as inadequate physical infrastructure, shortage of healthcare personnel, limited medical supplies etc. have hindered the implementation of several health policies. National Health Insurance Scheme (NHIS) is one of such policies and this study examined the effects of shortage of healthcare personnel on the implementation of NHIS policy in FCT, Abuja. Specifically, the study evaluated the opinions of health workers as well as enrollees of NHIS in four purposively chosen Area Councils of the six Area Councils in FCT. This study adopted a survey research design with Rensis Likert’s five-point scale questionnaire instrument administered to both categories of respondents. The data were analyzed using the Statistical Package for Social Sciences (SPSS Version 25) and the T-tested statistical tool was used to test the hypothesis. The study found out that shortage of health personnel is a major barrier to the effective implementation of NHIS in the FCT, Abuja. Consequently, the study recommends that there should be massive recruitment of qualified healthcare personnel; training and retraining of healthcare workers; and timely and adequate remuneration for the healthcare workers in FCT, Abuja.

PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

2015 ◽  
pp. 89-95
Author(s):  
Thi Hoai Thuong Nguyen ◽  
Hoang Lan Nguyen ◽  
Mau Duyen Nguyen
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Factors Affecting ◽  
The People ◽  
Universal Health Insurance Coverage ◽  
The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

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