Qualitative Analysis of National Documents on the Role and Duties of Supplementary Medical Insurance in Health System: Evidence from Iran

Introduction:In the majority of developing countries, the volume of medical insurance services, provided by social insurance organizations is inadequate. Thus, supplementary medical insurance is proposed as a means to address inadequacy of medical insurance. Accordingly, in this article, we attempted to provide the context for expansion of this important branch of insurance through identification of essential factors affecting demand for supplementary medical insurance.Method:In this study, two methods were used to identify essential factors affecting choice of supplementary medical insurance including Classification and Regression Trees (CART) and Bayesian logit. To this end, Excel® software was used to refine data and R® software for estimation. The present study was conducted during 2012, covering all provinces in Iran. Sample size included 18,541 urban households, selected by Statistical Center of Iran using 3-stage cluster sampling approach. In this study, all data required were collected from the Statistical Center of Iran.Results:In 2012, an overall 8.04% of the Iranian population benefited from supplementary medical insurance. Demand for supplementary insurance is a concave function of age of the household head, and peaks in middle-age when savings and income are highest. The present study results showed greater likelihood of demand for supplementary medical insurance in households with better economic status, higher educated heads, female heads, and smaller households with greater expected medical expenses, and household income is the most important factor affecting demand for supplementary medical insurance.Conclusion:Since demand for supplementary medical insurance is hugely influenced by households’ economic status, policy-makers in the health sector should devise measures to improve households’ economic or financial access to supplementary insurance services, by identifying households in the lower economic deciles, and increasing their financial ability to pay. Moreover, insurance companies should adjust their insurance policy according to clients’ needs, household characteristics, and their incomes.

Purpose: In addition to playing an important role in creating economic security and investment development, insurance companies also invest. The country's insurance industry as one of the country's financial institutions has a special place in the investment process and special attention to appropriate investment policies in the field of insurance industry is essential. So that the efficiency of this industry in allocating the existing budget stimulates other economic sectors. This study seeks to model investment in the performance of dynamic networks of insurance companies. Methodology: In this paper, a new investment model is designed to examine the dynamic network performance of insurance companies in Iran. The designed model is implemented using GAMS software and the outputs of the model are analyzed based on regression method. The required information has been collected based on the statistics of insurance companies in Iran between 1393 and 1398. Findings: After evaluating these units, out of 15 companies evaluated, 6 companies had unit performance and were introduced as efficient companies. The average efficiency of insurance companies is 0.78 and the standard deviation is 0.2. The results show that the increase in the value of investments is due to the large reduction in costs and in terms of capital and net profit of companies is a large number that has a clear and strong potential for insurance companies. Originality/Value: In this paper, investment modeling is performed to examine the performance of dynamic networks of insurance companies in Iran.

The aim of this research is to study the profitability of the insurance industry in Iran during the period of 20 years from 1993 to 2013. Research method is analytical and inductive post-event. Data related to the insurance and economic indicators are including the Premium of life insurance, Premium of non-life insurance, gross domestic product and inflation and profitability of Iranian insurance companies during the years 1993 to 2013 that were extracted from the economic and insurance forms. The regression model and ARDL time series technique were used for data analysis. The research results showed that the Premium of life insurance has a positive effect on the profitability of insurance companies in Iran, but the Premium of non-life insurance has not had a significant effect on profitability, the economic indexes of research, namely GDP and inflation, have a positive and negative impact on the profitability of insurance companies in Iran, respectively.

PurposeConventional data envelopment analysis (DEA) models permit each decision-making unit (DMU) to assess its efficiency score with the most favorable weights. In other words, each DMU selects the best weighting schemes to obtain maximum efficiency for itself. Therefore, using different sets of weights leads to many different efficient DMUs, which makes comparing and ranking them on a similar basis impossible. Another issue is that often more than one DMU is evaluated as efficient because the selection of weights is flexible; therefore, all DMUs cannot be completely differentiated. The purpose of this paper is to development a common weight in dynamic network DEA with a goal programming approach.Design/methodology/approachIn this paper, a goal programming approach has been proposed to generate common weights in dynamic network DEA. To validate the applicability of the proposed model, the data of 30 non-life insurance companies in Iran during 2013-2015 have been used for measuring their efficiency scores and ranking all of the companies.FindingsFindings show that the proposed methodology is an effective and practical approach to measure the efficiency of DMUs with dynamic network structure.Originality/valueThe proposed model delivers more knowledge of the common weight approaches and improves the DEA theory and methodology. This model makes it possible to measure efficiency scores and compare all DMUs from multiple different standpoints. Further, this model allows one to not only calculate the overall efficiency of DMUs throughout the time period but also consider dynamic change of the time period efficiency and dynamic change of the divisional efficiency of DMUs.

BackgroundFinancial risk protection is one of the main goals of healthcare systems worldwide and prepayment system plays an important role to achieve it. There are some prepayment schemes, and Individual voluntary private health insurance (IVPHI) as a way can be affected by some variables.ObjectiveThis study aimed to investigates the factors affecting the purchase and selection of IVPHI coverage in Iran.MethodsThis study used secondary data from a private insurance company in Iran, collected in 2023. Data were retrospectively gathered via an online questionnaire covering demographics, health status, and lifestyle factors used to assess risk for voluntary health insurance plans. Individuals with high-risk profiles were referred to the company’s physician for a clinical examination, after which they were categorized into high-risk or low-risk groups. The insurer then decided whether to approve the purchase of individual supplementary health insurance (ISHI). After data extraction and cleaning, a multivariate logistic regression model was used to identify determinants of voluntary health insurance purchase.ResultsMost ISHI sales occurred in low-deprivation provinces (71%), with women (64%) and those aged 26–49 (70%) more likely to purchase. Higher coverage (Plan 4) was preferred across all age groups. Key factors influencing ISHI purchase included health status, basic insurance, and region, with moderate deprivation areas showing higher demand for higher coverage plans.ConclusionThe findings emphasize regional, demographic, and health status disparities in ISHI purchases. Policymakers should focus on improving access to higher coverage plans, especially in more deprived areas, to ensure equitable insurance distribution.

Insurance companies are the most important economic institutions in each country and they support other economic entities. Their proper performance play an important role in the booming the economy. Insurance companies to achieve effective and strong performance should be familiar with performance of competitors and themselves and according to their information take necessary measures. For this purpose, the current study aims to rank the private insurance companies. In this regard, financial and non-financial indicators as well as performance index for 17 private insurance companies are extracted over 4 years (2011 to 2014) based on their financial statements. The weight of each index was determined using the Shannon entropy. Then, insurance companies were ranked using TOPSIS. The results showed that based on financial indicators, Arman insurance company in 2011 and 2012 had the optimal performance from the standpoint of the criteria (1st). In the years, 2013 and 2014 Kosar insurance Company and Mihan insurance companies were at the 1st place. In addition, Alborz insurance Company had a good performance in terms of performance indexes in 2011 and 2013, (1st). In the years 2012 and 2014, Parsian and Pasargad Insurance Companies ranked 1st. Based on non-financial indicators, Asia insurance company in the period under review (2011 to 2014) ranked in the first place.

Due to the continuous improvement of the average life expectancy and the continuous decline of the overall fertility rate, the aging of the population has become one of the social realities that cannot be ignored in China. The huge number of elderly people, the rapid growth of the aging rate, the frequent population movements and the severe health conditions of the elderly have all brought tremendous pressure and challenges to China’s long-term pension mode which is mainly based on children care.Utilizing the baseline survey data of CHARLS in 2018 and based on the Intergenerational Support, this paper focuses on the relationship of children's economic support on the purchasing intention of supplementary medical insurance for the elderly. The influencing factors of purchasing intention of supplementary medical insurance service for the elderly are extended from the purchasing subject to the influencers and supporters of the purchasing subject. Overall, children's financial support has a positive relationship on the purchase of the elderly health insurance intention. The elderly who receive more financial support from their children are more inclined to purchase supplementary medical insurance, but the financial support of their children may have a reverse and substitute effect for the elderly to purchase supplementary medical insurance. Medical insurance service is not only a direct service for the elderly, but also a relief for children’s support. Taking the situation of the children of the elderly into consideration makes the formulation of medical services for the elderly more scientific, effective and can better relieve the pension pressure of the whole society.KeywordsChildren’s financial supportAging societySupplementary medical insuranceIntergenerational theory

Introduction: Supplemental health insurance is designed to fill the cost gap and service of basic health insurance. The need for supplemental health insurances is inevitable considering the increasing treatment cost on the one hand, and the impossibility of appropriate coverage of all basic services on the other hand. Supplemental health insurances are considered to be optional and provided in a group and, if desired, can be extended to the end of life. The aim of this study was to investigate mechanisms reducing dependence on government with regard to supplemental health insurance and provide high-quality and standard services in the country. Methods: This research was conducted using a library method, in which the required information was collected through valid domestic and foreign sources and the Internet. Results: The present study investigated status of treatment insurance and the related problems in Iran. Iran’s health status was assessed by investigating the health indicators offered by the World Health Organization. To improve health status and supplemental health insurance, strategies were offered in 20 paragraphs by reviewing the patterns and models presented in the previous studies. Conclusion: According to the present study, it is recommended to offer various insurance packages considering the age, gender, health status of individuals, geographical status, literacy level, income level, employment status etc.

Current study entitled Investigating therelationship between corporate reputation and customer behavioral intentions through roles of customer trust, customer commitment and customer investigates the role of corporate reputation in purchase intention and tendency to pay premiums regarding variables such as trust, commitment and recognition of customers of Iran Insurance Company in Iran, Isfahan city. In this study regarding the proposed model there is a main hypothesis (which investigates the significance of the impact of corporate reputation on customer behavioral intentions) and there are eleven lateral hypotheses (which investigate the significance of the impact of corporate reputation on customer trust, customer recognition, the impact of customer trust on customer recognition, purchase intention and tendency to pay premiums, the impact of customer recognition on purchase intention and tendency to pay premiums, the impact of customer commitment as a mediator between customer recognition on purchase intention and tendency to pay premiums). This study, from the purpose point of view can be considered as an applicable study and survey in terms of method of execution with correlation approach. Study'sstatistical sample consists of 230car body insurers of Iran Insurance Company in Isfahan city. Collecting the required data in this study were carried out by questionnaire which its reliability was calculated by Cronbach'sAlpha index of 97%. The questions of questionnaire are divided into demographic and main questions for testing hypotheses. From the 274 distributed

PurposeCustomer insurance coverage sales plan problem, in which the loyal customers are recognized and offered some special plans, is an essential problem facing insurance companies. On the other hand, the loyal customers who have enough potential to renew their insurance contracts at the end of the contract term should be persuaded to repurchase or renew their contracts. The aim of this paper is to propose a three-stage data-mining approach to recognize high-potential loyal insurance customers and to predict/plan special insurance coverage sales.Design/methodology/approachThe first stage addresses data cleansing. In the second stage, several filter and wrapper methods are implemented to select proper features. In the third stage, K-nearest neighbor algorithm is used to cluster the customers. The approach aims to select a compact feature subset with the maximal prediction capability. The proposed approach can detect the customers who are more likely to buy a specific insurance coverage at the end of a contract term.FindingsThe proposed approach has been applied in a real case study of insurance company in Iran. On the basis of the findings, the proposed approach is capable of recognizing the customer clusters and planning a suitable insurance coverage sales plans for loyal customers with proper accuracy level. Therefore, the proposed approach can be useful for the insurance company which helps them to identify their potential clients. Consequently, insurance managers can consider appropriate marketing tactics and appropriate resource allocation of the insurance company to their high-potential loyal customers and prevent switching them to competitors.Originality/valueDespite the importance of recognizing high-potential loyal insurance customers, little study has been done in this area. In this paper, data-mining techniques were developed for the prediction of special insurance coverage sales on the basis of customers’ characteristics. The method allows the insurance company to prioritize their customers and focus their attention on high-potential loyal customers. Using the outputs of the proposed approach, the insurance companies can offer the most productive/economic insurance coverage contracts to their customers. The approach proposed by this study be customized and may be used in other service companies.

Objective Implementing usage-based insurance (UBI) schemes captured the attention and has found a better practical foundation, thanks to the presence of probes for recording the driving and traveling data. The UBI is believed to provide an incentive measure through premium discounts for correcting driving and traveling behavior. However, the success of UBI implementation is dependent on different factors including the presence of alternative insurance plans, the level of privacy concerns among society, and the amount of trust within the society. Therefore, designing proper discount schemes which affect UBI acceptance by drivers and its profitability for government and insurance companies differs across countries and different scenarios. We aim to investigate the profitability of UBI Pay-As-You-Speed in Iran with a focus on the government and insurance companies. This study will be beneficial for policymakers seeking to understand the potential impact of UBI Pay-As-You-Speed in Iran. Methods The research is conducted on a synthesized population with acceptance and accident frequency models based on a self-reported survey. We assumed six UBI schemes based on previous research. The acceptance model is a logit discrete choice model and the accident frequency is based on Poisson regression. Costs of crashes are estimated based on one-year data of the Central Insurance company in Iran. After models’ estimation, the simulated population is used to estimate the resultant profit of private insurance companies and government. Results It is found that the scheme with no premium discount and no rental prices for the required monitoring device, results in the highest revenue for the government. Moreover, with an increase in the probe penetration rate, the profitability of the government increases with a greater reduction in crashes. However, this trend is not observed for insurance companies because the cost of the monitoring device and premium discounts offset the profits gained from prevented crashes. Conclusion The presence of the government as a main actor in facilitating the implementation of UBI schemes is essential or private insurance companies would be reluctant to provide these schemes to customers.

BackgroundThe cost of a medical service and its mode of payment are known to play a role in patient decision-making, as demonstrated by the pioneering RAND Corporation Health Insurance Experiment (HIE). This study explores second medical opinion (SO) utilization by payment tracks- “financial reimbursement track” and “network track” by holders of an optional supplementary health insurance. It estimates SO utilization patterns before and after a “Reimbursement-to-Networks Arrangement” regulatory reform initiated on 2015 that eliminated the reimbursement option for SO consultations specifically involving surgeons, and identifies demographic and clinical predictors associated with each payment track before the reform.MethodsRetrospective analysis of medical records data, including secondary care visits data from Clalit Health Services, Israel’s largest healthcare provider, and claims data from Clalit’s supplementary insurance. An algorithm based on data from Clalit’s electronic medical records was used to identify SO instances by payment method. Multivariate logistic regression was used to identify characteristics of SO seekers by their payment method.ResultsThere was an increase of 28% in patient demand for SO consultations via the supplementary insurance's co-payment track from 2015 to 2017 due to the regulatory reform initiated in 2015. Before this reform, patients from the Arab sector, low socio-economic groups, immigrants, and residents of central geographical areas tended to seek SO via the “network track”. Whereas patients from peripheral areas and Jewish Orthodox tended to seek SOs via the financial reimbursement track.ConclusionsIn line with the RAND Corporation HIE, we show that incentive structures, such as provider payment methods, can explain some of the variability seen in seeking specialists across health plans or payment tracks. Considerations other than cost, such as geographic distance from the service provider, play a role in deciding on the mode-of-payment for a SO. Analyzing utilization patterns can improve the tracking of regulations’ consequences on expenditure, policy, clinical outcomes, and patient satisfaction.

Background: Electronic referral system (e-Referral system) in Iran was launched to increase access to care and improve interaction. Objectives: The present study aimed to design an appropriate model for evaluating the performance of the e-Referral system in Iran. Methods: This study was conducted in three stages: 1) review of literature related to electronic referral systems, 2) qualitative phase, and 3) quantitative phase. Participants in the qualitative phase included 42 managers, policymakers of the Ministry of Health, medical universities, service providers, and recipients who were purposively selected for this study. Data were analyzed through content analysis. In the quantitative phase, the target group consisted of 604 staff of medical universities implementing the e-Referral system. Data were analyzed using the EQS (version 6.3) and SPSS (version 20) software. Chi-square test, degree of freedom, the goodness of fit index, root mean square error, adjusted goodness of fit index, and the Friedman test were used to investigate the suitability of the model. Results: Fourteen main themes were identified and classified for the model design Based on the results of the present study. The components of developing rules and regulations, stakeholder advocacy, economic evaluation, and quality of health services had average ratings of 13.99, 13.00, and 11.35, respectively, regarding their role in designing the evaluation model for the e-Referral system in Iran. Conclusion: The results of structural equation modeling showed that the components play an essential role in designing the performance evaluation model of e-Referral in the Iranian health system. This study addressed various aspects affecting the e-Referral and provided the possibility of performance evaluation in the health sector in a principled and systematic format. Health managers and policymakers can use the present study findings to discover the strengths and weaknesses of the e-Referral performance.

The Irish health care system is unusual in that there is no subsidy for access to GP services for the majority of the population. Further a high proportion of the population has subsidised and supplementary private medical insurance. Current financial incentives and flows of subsidisation between the public and private sectors produce some odd features. Careful analysis of these financing mechanisms shows extensive inequities, with those on low incomes, but above the tax threshold, being the worst off. Further, the inequities and inefficiencies have been perpetuated by a lack of transparency in the health financing system. The authors explore the case for change and the options for Social Health Insurance (SHI) design that would be most relevant for the Irish health care system. Four possible scenarios for SHI are set out to improve equity and efficiency. The models vary according to the improved access that they give their members in terms of Primary Health Care, private/semi-private hospital beds and access to consultants. At one extreme, the levelling up (Rolls Royce) option provides hospital care on a par with what is currently available through private insurance and free GP access. At the other, the 'Mini' option reduces the cost of access to GPs and lowers public sector hospital charges for the uncovered population. Drawing on data from public accounts and the private insurance industry, the authors review the resource implications of these scenarios, with and without efficiency gains. Costs range from 2.2 billion to 380 million (or from an additional 1.5% to 0.3% of GDP). The authors also analyse the potential financing mechanisms. The additional payments for the options would range from 6.0% of taxable income for the Rolls Royce option to only 2.5% for the priority PHC option and 1.1% for the Mini. With efficiency gains these rates would reduce so that the Mini option pays for itself. Finally the authors explore the issues of transition and implementation, noting the institutional, stakeholder and capacity bottlenecks which currently exist.

Objective: In order to evaluate the sustainable development ability of the supplementary medical insurance fund of a large state-owned enterprise in Anhui Province, this paper puts forward the countermeasures to promote the sustainable development of the supplementary medical insurance fund of enterprises. Methods: By constructing PSR evaluation model and using entropy method to determine the index weight, the comprehensive evaluation value of sustainable development ability of supplementary medical insurance fund of a large state-owned enterprise in Anhui was calculated. Results: Horizontally, the highest comprehensive ability is the headquarters of the large state-owned enterprise, which is 0.430, and the lowest is Qingyang County, which is 0.147; Vertically, the comprehensive evaluation value of the sustainable development ability of enterprise supplementary medical insurance increased from 0.200 in 2016 to 0.239 in 2020, with an average annual increase of 4.55%. Conclusion: The influence of pressure factors on fund operation in different regions is quite different, and the development among regions is unbalanced. It is necessary to improve the management level of enterprise, enhance the fund raising ability, pay attention to overall planning and top-level design, promote regional coordinated development as a whole, continuously improve the fund investment management ability, and actively broaden the fund investment channels.