Cost Management Strategies in Health Insurance: A Scoping Review

Abstract

Context: Insurance plays a significant role in health systems financing. The existence of multiple risks increases the costs of insurance organizations. The present study aimed to identify cost management strategies in health insurance. Evidence Acquisition: A scoping review was conducted by focusing on published Persian and English studies in the field of health insurance worldwide by the end of June 2020. Valid keywords were searched in PubMed, Scopus, Web of Science, SID, Magiran, Google, and Google scholar. A list of authoritative sources and journals was also assessed. A total of 51 articles met the inclusion criteria and were analyzed using MAXQDA software. Results: In total, 97 cost management strategies were identified and classified into 3 groups of providers, insured individuals, and insurance organizations. The most important cost management strategies in the field of insurance internal processes are modifying payment methods and monitoring provided services and prescribed medications to providers, cost sharing, deductible, consumption management, and cultivating the use of services by insured people, strategic purchasing, coverage constraints, internal controls, using risk management and employing specialized personnel. Also, other insurance supervision institutions significantly reduce costs. Conclusion: Policymakers and managers plan and apply corrective interventions and appropriate changes to reduce the costs of insurance companies by understanding the cost control strategies of health insurance.