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.

scholarly journals Comparison of Machine Learning Algorithms for Processing of Health Insurance Claim

2020 ◽  
Vol 5 (2) ◽  
pp. 01-19
Author(s):  
Paridhi Saxena ◽  
◽  
Abhishek Seth ◽  
Gangesh Chawla ◽  
Ranganath Singari
Keyword(s):  
Machine Learning ◽  
Health Insurance ◽  
Consumer Satisfaction ◽  
Insurance Industry ◽  
Machine Learning Algorithms ◽  
Insurance Companies ◽  
Insurance Claim ◽  
Lifestyle Behaviour ◽  
Customer Lifetime ◽  
Health Insurance Industry

The health insurance industry protects against financial losses resulting from various health conditions. Since a long, it has relied on statistics and data to calculate risks and thereby, centre attention more profoundly on a particular target audience for increasing the operational efficiency of the industry. Technologies like Machine Learning and Artificial Intelligence prove to be an efficient tool for enabling insurance companies to predict the Customer Lifetime Value (CLV). This can be done using customer lifestyle behaviour data allowing to assess the customer's potential profitability for insurance companies. This creates a more personalised marketing offer within the audience. The insurance industry and its components constitute a dynamic and competitive sector representing approximately 2.7 percent of the US Gross Domestic Product (GDP). As customers have become progressively scrupulous about narrowing down their specific requirements, insurers and insurance companies are scrutinizing techniques for improving business operations and consumer satisfaction. An attempt in this regard has been made to analyse the “sample insurance claim prediction dataset" using various machine learning models including Decision tree, Random Forest algorithms, Naïve Bayes, K-nearest neighbour algorithm, Supper Vector machines and Neural Networks. A comparative analysis is performed to generate reports.

scholarly journals The Critical Success Factors and Integrated Model for Implementing E-Business in Taiwan’s SMEs

2011 ◽  
pp. 1109-1133
Author(s):  
Te Fu Chen
Keyword(s):  
Business Model ◽  
Critical Success Factors ◽  
Success Factors ◽  
Business Models ◽  
Integrated Model ◽  
Common Language ◽  
Business Sector ◽  
Integrated Models ◽  
Critical Success

To date, identifying barriers and critical success factors (CSFs) and integrating business model in implementing e-business for SMEs, have not been systematically investigated. Few existing studies have derived their CSFs and business models from large companies’ perspectives, and have not considered the needs of integration for smaller businesses. This chapter is aimed to bridge this gap. Existing studies on CSFs and e-business models were reviewed and their limitations were identified. By integrating insights drawn from these studies, as well as adding some new factors, the author proposed a set of 18 CSFs which is believed to be more useful for SMEs. The importance of the proposed CSFs was theoretically discussed and justified. In addition, a case study was conducted to evaluate the extent of success of this proposition. The overall results from the case study assessment were positive, thus reflecting the appropriateness of the proposed CSFs and integrated models. The set of CSFs and integrated models can act as a list of items and an easy to follow model for SMEs to address when adopting e-business. This helps to ensure that the essential issues and factors are covered during implementation. For academics, it provides a common language for them to discuss, and study the factors crucial for the success of e-business in SMEs. This study is probably the first to provide an integrative perspective of CSFs and integrated model for implementing e-business in the SME sector. It gives valuable information, which hopefully will help this business sector to accomplish e-business visions.

scholarly journals The Critical Success Factors and Integrated Model for Implementing E-Business in Taiwan's SMEs

2011 ◽  
pp. 169-194
Author(s):  
Te Fu Chen
Keyword(s):  
Business Model ◽  
Critical Success Factors ◽  
Success Factors ◽  
Business Models ◽  
Integrated Model ◽  
Common Language ◽  
Business Sector ◽  
Integrated Models ◽  
Critical Success

To date, identifying barriers and critical success factors (CSFs) and integrating business model in implementing e-business for SMEs, have not been systematically investigated. Few existing studies have derived their CSFs and business models from large companies’ perspectives, and have not considered the needs of integration for smaller businesses. This chapter is aimed to bridge this gap. Existing studies on CSFs and e-business models were reviewed and their limitations were identified. By integrating insights drawn from these studies, as well as adding some new factors, the author proposed a set of 18 CSFs which is believed to be more useful for SMEs. The importance of the proposed CSFs was theoretically discussed and justified. In addition, a case study was conducted to evaluate the extent of success of this proposition. The overall results from the case study assessment were positive, thus reflecting the appropriateness of the proposed CSFs and integrated models. The set of CSFs and integrated models can act as a list of items and an easy to follow model for SMEs to address when adopting e-business. This helps to ensure that the essential issues and factors are covered during implementation. For academics, it provides a common language for them to discuss, and study the factors crucial for the success of e-business in SMEs. This study is probably the first to provide an integrative perspective of CSFs and integrated model for implementing e-business in the SME sector. It gives valuable information, which hopefully will help this business sector to accomplish e-business visions.

Capitalizing on Illness: The Health Insurance Industry

1974 ◽  
Vol 4 (4) ◽  
pp. 583-598 ◽  
Author(s):  
Thomas Bodenheimer ◽  
Steven Cummings ◽  
Elizabeth Harding
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Access To Health Care ◽  
Insurance Industry ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
Health Insurance Industry

The private health insurance industry in the United States began as a money-collection mechanism for hospitals and doctors, and has evolved into an important profit-making sector of the economy. Blue Cross is dominated by hospital representatives and serves to channel money into the nation's hospitals. Physicians control Blue Shield and are its principal beneficiaries. And commercial insurance companies are closely linked to banks and industrial corporations through the country's large financial empires. Some effects of this elite control over the health insurance industry have been inadequate and distorted insurance coverage, discrimination against the elderly, the sick, and the poor, and rapidly rising medical costs. In addition, the control of Medicare and Medicaid by private insurance institutions has contributed to the enormous inflation produced by these programs. Though governments, consumers, and even the insurance industry itself are beginning to apply controls to the unprecedented medical inflation of the late 1960s, these controls tend to limit access to health care, especially for low-income people. Unless insurance companies are barred from the health care field and a public financing mechanism based on progressive taxation is introduced, health care will never be an equal right for everyone in the United States.

scholarly journals The Private Insurance Market: Not Very Big and Not Insuring Much, Either

2018 ◽  
Vol 46 (4) ◽  
pp. 877-882 ◽  
Author(s):  
Jacqueline Fox
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Private Health Insurance ◽  
Insurance Industry ◽  
Private Insurance ◽  
Insurance Market ◽  
Insurance Companies ◽  
Medicare Program ◽  
Health Insurance Industry

Creating a single national health insurance pool is not likely to destabilize the economy by supplanting the private health insurance industry. This industry insures a relatively small percentage of the population and holds very little of the risk such insurance implies. In effect, insurance companies function as middlemen, bundling risk packages to distribute to other, larger companies and so serve a limited purpose. Were insurers to handle claims for a national pool as they do for the Medicare program, any destabilization to the economy more broadly would be further minimized.

scholarly journals Critical success factors in insurance companies

2020 ◽  
Vol 25 (1) ◽  
pp. 215-233 ◽  
Author(s):  
Jasmina Selimović ◽  
Danijela Martinović ◽  
Džana Hurko
Keyword(s):  
Customer Satisfaction ◽  
Service Quality ◽  
Performance Indicators ◽  
Critical Success Factors ◽  
Success Factors ◽  
Insurance Companies ◽  
High Quality ◽  
Critical Success ◽  
Five Factors ◽  
Business Conditions

The topic of this research are critical success factors (CSFs) with a focus on factors that constitute the basis for the success of insurance companies. There are no critical success factors common to all enterprises, all areas and all activities. In insurance companies, key performance indicators primarily depend on the service quality and the level of customer satisfaction. In contemporary business conditions, the relevance of the service has been increasingly important. Therefore, the concept named 5P is suggested, standing for purpose, pride, partnership, protection and personalization, as these five factors define the requirements that must be met, if the insurer’s service is to be perceived to be of high-quality, achieve client satisfaction and build client loyalty. The paper presents a research into the perception of insurance service and factors of insurance quality in the Federation of Bosnia and Herzegovina (FBiH). Research results correspond to the 5P concept and reveal the security factor as the most important factor for the insured. A fast and efficient payment of claims, the attitude of the salespeople toward the insured, described in terms of respectful and knowledgeable staff, as well as the clarity of promotion and the availability of insurance service also ranked high.

Cloud-Based ERP Systems Implementation: Major Challenges and Critical Success Factors

2021 ◽  
pp. 2150034
Author(s):  
Ahmad Saleh Shatat ◽  
Abdallah Saleh Shatat
Keyword(s):  
Business Model ◽  
Significant Relationship ◽  
Critical Success Factors ◽  
Success Factors ◽  
Survey Instrument ◽  
Erp Systems ◽  
Critical Success ◽  
Systems Implementation ◽  
Research Outcomes ◽  
Two Factors

Cloud-based ERP systems are substantially expanding, which is expected shortly to demonstrate a significant impact on the current business model. Identifying the Critical Success Factors (CSFs) and the major challenges of the cloud-based ERP systems implementation will pave the pathway for prospective clients to adopt cloud ERP systems and take advantage of this novel IT-based cloud revolution. This research identifies the top 10 CSFs that contribute to delivering a successful cloud-based ERP systems implementation. A survey instrument was distributed to 70 enterprises using cloud-based ERP systems. The research outcomes indicate a positive and significant relationship between eight CSFs and the cloud-based ERP systems implementation. However, only two factors demonstrate a positive but not significant correlation. Overall, the results of this study show a notable impact of the CSFs on the cloud ERP systems implementation.

Critical Success Factors of Web-Based E-Service

2011 ◽  
pp. 2071-2092
Author(s):  
Sang M. Lee ◽  
Teuta Cata
Keyword(s):  
Organizational Support ◽  
Success Factors ◽  
Insurance Industry ◽  
Relevant Literature ◽  
Insurance Companies ◽  
Organizational Size ◽  
Web Based ◽  
Critical Success ◽  
Online Sales ◽  
Intangible Benefits

This study focused on the adoption of Web-based applications in the insurance industry. An in-depth investigation of relevant literature on the technology adoption process and related issues, and the data collected from auto and life insurance companies identified several factors that affect e-insurance performance (in terms of both tangible and intangible benefits). Web site availability, organizational support, customer pressure, degree of business integration, an e-business plan, organization age, and organizational size were identified as critical factors for online performance. This study also revealed that insurance companies perceive more tangible and intangible benefits when they do substantial business through online sales.

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