Insurance Organizations Research Articles

Lessons Learnt from A Pilot Screening Program for Lower Extremities Atherosclerotic Disease (Lead) in A Population in Central Greece

Introduction: While screening programs for abdominal aortic aneurysms are well-established, in the peripheral arterial disease including carotid and lower extremities atherosclerotic disease (LEAD), their role is controversial without a proven benefit. The aim of the study was to present our finding from a pilot LEAD screening program in central Greece. Methods: Males > 60 years old without known diagnosis of LEAD were invited through public primary health care institutions (state insurance and municipal organizations) to participate to a screening program. Individuals were both from urban and rural areas. Age, height and weight, co-morbidities, hypertension (HT), hyperlipidemia, smoking, coronary artery disease (CAD), diabetes mellitus, chronic obstructive pulmonary disease (COPD), cerebro-vascular disease (CVD) were recorded. Also, the ankle-brachial index (ABPI) was measured from both lower limbs; abnormal values were considered those < 0.9 or >1.4. Results: Among a total of 1152 patients who joined the program (invitation acceptance was 73%) LEAD was detected in 148 (13%); including 81 (7%) with ABPI< 0.9 and 67 (5.8%) with ABPI>1.4. LEAD was associated with age (abnormal ABPI; 72.7±7 years old vs. normal ABPI; 70.9±7 years old, p=0.003), HT (abnormal ABPI; 75% vs. normal ABPI; 67%, p=0.037), COPD (abnormal ABPI; 11.5% vs. normal ABPI; 6.5%, p=0.028) and CVD (abnormal ABPI; 9.5% vs. normal ABPI; 4.5%, p=0.008). An ABPI< 0.9 was associated with age (abnormal ABPI; 74±7 years old vs. normal ABPI; 70.9±7 years old, p=0.001), HT (abnormal ABPI; 80% vs. normal ABPI; 67%, p=0.037), smoking (abnormal ABPI; 42% vs. normal ABPI; 25%, p=0.002), duration of smoking (abnormal ABPI; 38±14 years vs. normal ABPI; 32±13 years, p=0.01), packs/year (abnormal ABPI; 2±3 vs. normal ABPI; 1.5±0.9 years, p=0.002), CAD (abnormal ABPI; 35% vs. normal ABPI; 24%, p=0.02), COPD (abnormal ABPI; 14% vs. normal ABPI; 6.5%, p=0.028) and CVD (abnormal ABPI; 14% vs. normal ABPI; 4.5%, p=0.001). After multivariate analysis, increased age (0.94, CI. 0.026-5.2; p=0.022), history of HT (2.4, CI. 0.44- 3.7; p=0.05) and longer duration of smoking (0.9, CI. 0.01-6.1; 0.013) were associated with ABPI < 0.9. Only 51% of the patients with ABPI< 0.9 were under statin therapy and only 35% under antiplatelets. Abnormally higher ABPI (>1.4) was not associated with any factor. Only 42% of those patients were under statin therapy and only 15% under antiplatelet therapy. Conclusion: Incidence of LEAD was 13% in a male >60 years old population in central Greece. The incidence of an ABPI< 0.9 was 7% and it was associated with older age, HT and duration of smoking. Identification of such a population may allow better implementation of intense optimal medical treatment strategies to prevent cardiovascular mortality and morbidity. Disclosure: Nothing to disclose

Pregnancy Leave Wages Compensation based on Data Mining: Clients of Iran’s Social Security Organization

Data mining is an interdisciplinary science which exploits different methods including statistics, pattern recognition, machine learning, and database to extract the knowledge hidden in huge datasets. In this paper, we sought to develop a model for paying pregnancy period wages compensation to the Social Security Organization (SSO) clients by using data mining techniques. The SSO is a public insurance organization, the main mission of which is to cover the stipendiary workers (mandatory) and self-employed people (optional). In order to develop the proposed model, 5931 samples were selected randomly from 11504 clients. Then the K-Means clustering algorithm was employed to divide data into cluster 1, consisting of 2732 samples, and cluster 2, consisting of 3199 samples. In each cluster, the data were divided into training and test sets with a ratio of 90 to 10. Then a multi-layer perceptron neural network was trained separately for each cluster. This paper utilized the MLP network model. The tanh transfer function was used as the activation function in the hidden activation layer. Numerous tests were conducted to develop the best neural network structure with the lowest error rate. It consisted of two hidden layers. There were 5 neurons in the first layer and 4 neurons in the second. Therefore, the neural network structure was in the 5-4-1 format. Finally, the best model was selected by using the error evaluation method. The MAPE and R2 criteria were employed to evaluate the proposed model. Regarding the test data, the result was 0.96 for cluster 1 and 0.95 for cluster 2. The proposed method produced a lower error rate than the other existing models.

RESULTS OF ANALYSIS AND FORECASTING OF THE MAIN FINANCIAL INDICATORS OF THE HEALTH INSURANCE MARKET DEVELOPMENT IN UKRAINE

In recent years Ukraine against the background of systemic crisis trying to reform socially-oriented areas of society, including voluntary health insurance, which must combine market and social burdens. Under these conditions, an important scientific and practical research is forecasting financial indicators of domestic insurance companies. Aim. Conducting analysis and forecasting of the basic indicators that characterize the financial state of development of the domestic health insurance market. Materials and methods. Research materials were selected from the official websites of the National Commission which carry out state markets regulation of financial services and the League of Insurance Organizations of Ukraine for 2009–2018 years. We used historical, analytical and comparative, systematic, logical, hypothetical-deductive, mathematical and statistical methods. Results. To forecast the financial indicators of the health insurance market in Ukraine (gross insurance premiums and payments; operations transferred to reinsurance, including non-residents; net insurance premiums and payments) for 2019–2020 years; the time interval was set from 2009 year. According to the results of the calculations, we obtained regression models for different financial indicators (6 models). With the help of the selected mathematical tools, the main financial indicators of the market development for 2019–2020 years were forecasted. The analysis of the data revealed that the highest value growth rate (%) in 2020 year will be characteristic of reinsurance operations, including those transferred to non-residents (49.06 %) and the lowest - to gross insurance payments (14,41 %). It is established that the indicator of net insurance payments since 2010 year has been steadily decreasing (from 78.19 %), and according to the forecasted data in 2019 year it may be equal to 46.77 %, and in 2020 year – 44.98 %, the trend will continue to decrease. However, this indicator since 2016 year (53.9 %) and the data forecast for 2019–2020 years are in the regulatory range (from 30.0 % to 60.0 % for different types of insurance activities). Conclusions. According to the results of the research, it is established that in spite of the financial and economic crisis since 2014 year, the domestic health insurance market is characterized by positive dynamics of growth of the main financial indicators (gross insurance premiums and payments, net insurance premiums and payments). At the same time, there is a tendency to decrease the level (%) of net insurance payments indicator from 78.19 % in 2010 year to the forecast in 2020 year – 44.98 %.

Consider compliance, liability issues triggered by promoting, facilitating health care coverage

There's a good chance that a department somewhere on your campus has promoted or offered short‐term limited‐duration health insurance coverage to students, also known as STLDIs. And that could place your institution at risk of encountering potentially serious legal ramifications and compliance pitfalls even if your institution doesn't collect premiums or have a policy issued by a health insurance organization.

Epidemiology of multimorbidity in Iran: An investigation of a large pharmacy claims database.

Multimorbidity (MM) (presence of more than one chronic condition within a same patient) imposes a heavy burden on patients and health care systems. In contrast to high-income countries, the epidemiology of this phenomenon is unclear in low- and middle-income countries, particularly among Iranian population. This was a retrospective cohort study using Iranian Health Insurance Organization claims database. A framework was developed for identifying a set of 18 chronic conditions from the pharmacy claims data in Iran. All 2013 outpatient utilizers (aged 18 years or older) were included. Data were analyzed according to number of chronic conditions, gender, and age. The association between MM and utilizations of health services was examined for 2013 to 2016. In total, 481 733 people were included. Cardiovascular diseases (including hypertension) (19.1%), depression/anxiety/sleep disorders (13.7%), and acid-related disorders (10.3%) were the three most prevalent conditions. MM was present in 21.1%. Although prevalence of MM is higher in older age groups and was present in 40% of individuals aged 65 and older, the absolute number of multimorbid patients was higher in those younger than 65 years (66 271 vs 35 386). MM was more prevalent among women (22.1%) compared with men (19.5). After multivariate adjustment for age group and sex, each additional chronic condition was associated with an increase of 2.23 physician visits, 2.86 drugs dispensed, 2.32 laboratory tests, and 1.6 medical imaging. Our findings challenge the current single-disease-based assumption implicit in Iranian health care system. To take account of MM, complementary strategies should be designed and implement in health care system.

Features of Supervision in the Insurance Market

The article is devoted to the analysis of financial and legal aspects of insurance supervision. It has been determined that with the development of insurance the extent of state regulation, including supervision of insurance activity, has increased. The paper analyzes prudential insurance supervision and the development of the risk-oriented model of supervision over the largest insurance organizations. According to the results of the research, the author concludes that insurance supervision is an integral part of the effective development of the national insurance market. Insurance supervision is carried out at all stages of activity of the insurance business participants to comply with the statutory requirements concerning insurance and to support effective development of insurance services.

Who Uses The Health Services More? A Descriptive Study of Excessive Users’ Profile and Causes

Background: Identifying the causes of health services overutilization is an effective way of preventing misspending of insurance organizations' resources. Objectives: The present study was conducted to identifying demographic factors and the causes of health services overutilization among those insured by the Iran Health Insurance Organization (IHIO). Methods: The present cross-sectional study was conducted in 2017. The study population consisted of excessive users insured by IHIO in Isfahan province, of whom, 175 were randomly selected. Data obtained by the IHIO medical information system, insurance booklets and a data collection form was analyzed in SPSS-22 using descriptive statistics at a significant level of 0.05. Then, they were categorized based on their main referral cause. Results: About 1.2 percent of the people insured by the IHIO in Isfahan province are among the health service over users. Participants' mean age was 50.7 ± 15.8 years. Among them, 56.6 percent were female. Mean frequency of physicians’ visits were 16.3 ± 11.7 (more than 10 times greater than others) and the mean of paraclinical services usage was 19 ± 13.08 (more than 12 times greater than others) in the first 8 months of 2017. Mean of all physicians’ visits among females was 18.47 ± 14.7 and means of paraclinical services usage among them was 20.63 ± 14.83. The most common causes of health services over utilization among the insured included complicated medical problems (chronic disease 47.42 percent, being elderly 17.14 percent and pregnancy 6.28 percent), health anxiety disorder (HAD) (24 percent), and administrative causes (breaking or missing papers) 2.9 percent. Conclusions: According to the findings, people with complicated and chronic illness account for the majority of the over users. Others with health anxiety are in the next category. Then, identifying the over user group, their demographic characteristics, and their causative categorization can lead to a variety of solutions to suit each category. This study recommends insurance organizations to pay more attention to the service-seeking behaviors of different population groups and to consider utilization review studies as an important research approach.

Overcoming the challenges encountered by construction industry SMEs in using insurance

The construction industry is arguably one that exposes the most people to uncertainty and danger, while insurance is considered to be the backbone of risk mitigation for many other industries. Insurance itself is a very subjective and complex method of risk management which has its own flaws but can turn out to be very useful in appropriate circumstances. The aim of this research study is to evaluate the ways of overcoming the challenges encountered in using insurance schemes by small and medium enterprises in the construction industry. Quantitative research design was adopted for this research study and the questionnaire was well structured to retrieve the necessary information from respondents. Factors obtained from reviewed literatures were structured into the questionnaire for respondents to rank using a 5-point Likert scale. Government construction officials, Consultants, Contractors and insurance organisations were chosen as respondents for this study based on their familiarity with insurance administration in the construction industry. Analysis of data retrieved was done using mean item score and Kruskal-Wallis H-test. Findings showed that SMEs needs continuous training, paying attention to details of the insurance policies and thorough risk assessment in order to overcome the challenges encountered with the use of insurance schemes. The study concludes that SME’s are faced with the challenge of having leadership with little or no education concerning insurance policies thereby resulting in not knowing how best to minimize chances of risk fruition or how to get the best insurance policy covers.

Development of a French ecosystem to support cohorts

Abstract For a long time, the usual research funding mechanisms in France limited the development of very large databases (funding too low or too short for example). Over the past decade, new measures provided unprecedented momentum in our country to structure large cohorts. Due to their very broad scope, cohorts are one of the reference instruments for epidemiological and public health research. Cohorts also help to inform decision-making on risk prevention action, enhance the health system or patient care. For these reasons, the French Ministry of Research identified in 2008 cohort as research infrastructures. With this decision, the Ministry recognizes their usefulness for the public health research community, and more broadly for biomedical research. To fund this ambition, a call for proposal was launch in 2010 by the government as part of the ‘Investments for the Future &amp;gt;&amp;gt;. A dozen patient or general population cohorts are funded through this process, such as Constances, E4N or others. The creation of the National Health Data System in 2017 also reinforces the strategic aspect of cohorts. This system is unique in Europe. He allows cohort data to be linked with data from health insurance, hospital data, causes of death, disability data and supplementary health insurance organizations. The challenge of artificial intelligence also follow the analysis of this data flow. This model is part of a national strategy with several initiatives: joint coordination, shared services (France Cohortes), the France Médecine Génomique plan and the Health Data Hub, as well as the recently announced launch of 4 Institutes for Artificial Intelligence, three out of them having exploitation of health data at the heart of their development strategy. The objective of this intervention will be to present this french integrated model, and mechanisms developed, in terms of tools, resources or staff, at the service of cohorts and researchers.

Factors Affecting Motivation in the Public Sector under the Context of Self-Determination Theory and Public Service Motivation: The Case of the Hellenic Agricultural Insurance Organization (H.A.I.O.)

Purpose: The main aim of this study is to develop and test a conceptual framework that explores the factors that motivate employees in public services. The study is based on two theories, the Self Determination Theory (SDT), and the Public Service Motivation (PSM). Design/methodology/approach: The empirical testing of the proposed conceptual framework was conducted using a structured questionnaire that was distributed to 390 employees of a Greek public sector organization, namely the Hellenic Agricultural Insurance Organization (Η.Α.Ι.Ο.). The population of the study consists of 489 public servants. Exploratory factor analysis, confirmatory factor analysis and the structural equation modeling (SEM) technique were used to test the research hypotheses. Findings: Results highlight, among others, the importance of work autonomy and job satisfaction and their impact on employees’ intrinsic motivation. Moreover, empirical results emphasize the need for building a supportive work environment that contributes on employee satisfaction, autonomy and relatedness. Results also confirm the existence of a positive relationship among intrinsic motivation, public service motivation and job performance. Practical implications: The findings suggest that in cases where external incentives are significantly limited (e.g., in the public sector), it is crucial to consider the importance of promoting and supporting intrinsic motivation and support public service incentives. Originality/value: Self-determination theory seems to be poorly explored in the Greek public sector, and moreover, in economies and countries with similar characteristics. Therefore, it seems crucial to increase the knowledge about the real value of self-determination theory as a work motivation approach, especially in the public sector. Finally, research results may help supervisors and business leaders to implement appropriate systems and practices that promote a supportive environment in the workplace.

Unpacking the Associations Between Perceived Cultural Support and Employee Health: The Approach of Social Capital.

The aim of this study was to examine the associations between workplace culture supporting health and self-rated health through social capital and stress. Structural equation modeling analysis was performed on data from employees of an insurance organization (N = 725). Significant associations were found among participation of sports events, social capital, workplace culture of health, occupational perceived stress, and self-rated health (P < 0.001). The relationship between stress and self-rated health was stronger for employees at lower hierarchical levels than the ones at higher hierarchical levels (P < 0.001). Findings show that social capital and stress are mediators in the association between perceived cultural support and self-rated health. Strong support for health in the culture is associated with positive self-rated health. Well-being strategies focusing on social capital and encouraging healthy behaviors are likely to have increased effectiveness.

Research of trends of development of the health insurance market in the conditions of socio-economic crisis in Ukraine

Aim: to analyze the development trends of the health insurance market in the context of the socio-economic crisis in Ukraine.Materials and methods. The studies used data from the National Commission for State Regulation of Financial Services Markets and the League of Insurance Organizations of Ukraine on the results of the activities of insurers (number of concluded contracts, gross, net premiums and payments) for 2014–2018. Financial indicators were standardized in accordance with macroeconomic standards that were established in state budgets for different years (minimum wage, minimum wage per person, NBU rate of 1 US dollar, minimum cost of a consumer basket). We used historical, analytical, comparative, systemic, logical, hypothetical-deductive, mathematical and statistical methods.Results. The significance of the relationship between all indicators is mathematically proven. In addition, all data for 2014–2018 showed positive growth dynamics. This cannot be argued after their normalization by macroeconomic indicators. According to the normalized data on the minimum wage, in 2017 there was a significant decrease in indicators with a slight increase compared to 2018. A positive fact is the growth of financial indicators during 2014-2018, which were normalized to the subsistence level for the working population. In 2015, there was a sharp decrease in the values of all financial indicators normalized at the dollar exchange rate, which is the result of fundamental changes in the monetary policy in the country. The indicated indicators reached the minimum value in 2016. The indicators normalized by the value of the minimum food basket showed a zigzag pattern of changes in all indicators with a sharp drop in data in 2016 and their subsequent increase in 2017. All indicators that were normalized by the minimum wage, the NBU dollar exchange rate, the value of the minimum food basket in 2018, did not reach the initial values typical for 2014.Conclusions. The health insurance market was characterized by complexity of development and dependence on the main macroeconomic indicators used in the calculation of many socially significant indicators of the development of society. Negative trends in the development of the segment of the health insurance market were due to the direct or delayed influence of changes observed in the macroeconomic environment during the socio-economic crisis

Combining Life and Health Insurance*

Abstract We estimate the benefit of life-extending medical treatments to life insurance companies. Our main insight is that life insurance companies have a direct benefit from such treatments because they lower the insurer’s liabilities by pushing the death benefit further into the future and raising future premium income. We apply this insight to immunotherapy, treatments associated with durable gains in survival rates for a growing number of cancer patients. We estimate that the life insurance sector’s aggregate benefit from FDA-approved immunotherapies is $9.8 billion a year. Such life-extending treatments are often prohibitively expensive for patients and governments alike. Exploiting this value creation, we explore various ways life insurers could improve stress-free access to treatment. We discuss potential barriers to integration and the long-run implications for the industrial organization of life and health insurance markets, as well as the broader implications for medical innovation and long-term care insurance markets.

Role of Brand Awareness, Brand Loyalty and Advertisements towards Consumer Buying Behaviour in Insurance Industry

In the era of competition companies do face tough competitions in selling their products and services. The insurance industry too is not an exception to this. It is important that organizations do follow proper marketing strategies to grab the attention of the consumers. This paper has tried to research and reveal the best strategies that would help the insurance organizations to sell their insurance products to the consumers. Independent variables like Brand Awareness, Brand Loyalty and Advertisements. The dependent variable is Consumer Buying Behaviour was chosen for the study Data was collected from 100 insurance buying consumers on convenience basis. The results reveal, that brand awareness alone contribute towards insurance buying behavior but brand loyalty and advertisement contribution towards consumer buying behavior has not proved to be significant. Even though they do not contribute, these two variables are like pepper and salt required for pushing the insurance products.

An assessment of forerunners for customer loyalty in the selected financial sector by SEM approach toward their effect on business

PurposeThe purpose of this paper is to identify and describe the relationship between the precursors and consequences of customer loyalty (CL) in the Indian financial sector, specially banking and insurance context, taking a sample of individual customers as respondents from the Indian State of Punjab.Design/methodology/approachThe collected data have been analyzed using univariate, bivariate and multivariate analysis techniques. Specifically, descriptive statistics have been assessed to examine the basic characteristics of the sample data. Confirmatory factor analysis with maximum likelihood criteria has been adopted for the measurement and validation of various constructs. Independent samples t-test has been used to compare the CL of public and private firms, banks and insurance firms, and for some of the demographic variables like gender, marital status, etc. One-way ANOVA has been used to compare the CL for variables having more than two groups. Structural equation modeling (SEM) has been used to measure the impact of CL on the BP of financial services firms.FindingsThe result shows that BP is a higher-order construct measured in terms of word-of-mouth, repurchase intention, price premium and share of wallet. Though each of the four measures of CL is special and unique in nature, yet a high level of positive correlation has been seen among these dimensions. The study reveals that CL is not significantly different for the banking firms and insurance firms in Punjab.Research limitations/implicationsThe authors consider this work as one of the foundational elements that will enable further advances toward the governance of multi-layer business impact modeling systems. Extensive usability tests would enable to further confirm the findings of the paper. This study contributes to the customer relationship management and services marketing literature by providing empirical support for CL and BP relationship in the Indian context.Practical implicationsThe approach described here should improve the maintainability, reuse and clarity of business process models and in extension improve data for CL in large banking and insurance organizations. The approaches described here should improve the maintainability, reuse and clarity of loyalty and relationship of the customer with that of organizations. This can improve data for customer relationship and loyalty in banking and insurance sector.Originality/valueThis paper fulfills an identified gap to enabling SEM enabled models for data regarding customer relationship and loyalty. Loyalty revolves around the concept of relationship. CL is not a new concept, but recent years have demonstrated a developing interest to fabricate CL because of customer-oriented techniques or strategies. Over the previous era, CL has been broadly inspected inside marketing, trades and transactions. It can be concluded that the CL significantly influences BP.

Multiple Criteria Decision Analysis for HTA across four EU Member States: Piloting the Advance Value Framework

Multiple Criteria Decision Analysis (MCDA) has emerged as a methodology for Health Technology Assessment (HTA). However, limited empirical evidence is available on its use by decision-makers; where available, it only comes from single-setting exercises, while cross-country comparative studies are unavailable. This study applies the Advance Value Framework (AVF), an MCDA methodology for HTA based on multi-attribute value theory, through a series of case studies with decision-makers in four countries, to explore its feasibility and compare decision-makers' value preferences and results.The AVF was applied in the evaluation of three drugs for metastatic, castrate resistant, prostate cancer (abiraterone, cabazitaxel and enzalutamide) in the post-chemotherapy indication. Decision conferences were organised in four European countries in collaboration with their HTA or health insurance organisations by involving relevant assessors and experts: Sweden (TLV), Andalusia/Spain (AETSA), Poland (AOTMiT) and Belgium (INAMI-RIZIV). Participants' value preferences, including performance scoring and criteria weighting, were elicited through a facilitated decision-analysis modelling approach using the MACBETH technique.Between 6 and 11 criteria were included in each jurisdiction's value model, allocated across four criteria domains; Therapeutic Benefit criteria consistently ranked first in relative importance across all countries. Consistent drug rankings were observed in all settings, with enzalutamide generating the highest overall weighted preference value (WPV) score, followed by abiraterone and cabazitaxel. Dividing drugs' overall WPV scores by their costs produced the lowest “cost per unit of value” for enzalutamide, followed by abiraterone and cabazitaxel. These results come in contrast with the actual country HTA recommendations and pricing decisions.Overall, although some differences in value preferences were observed between countries, drug rankings remained the same. The MCDA methodology employed could act as a decision support tool in HTA, due to the transparency in the construction of value preferences in a collaborative manner.

The Effect of Health Insurance on the Utilization of Health Services: A Systematic Review and Meta-Analysis.

Insurance organizations are among the most influential organizations in the health system, which can lead to healthcare efficiency and patient satisfaction in case they are increasingly accessed. The main purpose of the present systematic review was to examine the effect of health insurance on the utilization of health services and also to examine the factors affecting it. The present study was a systematic review that aimed to examine the effect of health insurance on the utilization of health care services. The study was conducted in 2016 using Scopus, PubMed, Web of Science, Science Direct, and ProQuest databases. We examined the utilization rate of health insurance in insured people. The inclusion and exclusion criteria were included based on review and meta-analysis purposes. The utilization of health services increased for inpatient and outpatient services. The utilization rate of inpatient services increased by 0.51% whereas the utilization rate of outpatient services increased by 1.26%. We classified the variables affecting the utilization rate of insurance into three main categories and sub-categories: demographic variables of the household, socioeconomic status, and health status. Our study showed that insured people increased the utilization rate of health services, depending on the type of health services. Thus, health policymakers should consider the community’s health insurance as a priority for health programs. For now, implementing universal health insurance is a good solution.

The Effect of Health Insurance on the Utilization of Health Services: A Systematic Review and Meta-Analysis

Insurance organizations are among the most influential organizations in the health system, which can lead to healthcare efficiency and patient satisfaction in case they are increasingly accessed. The main purpose of the present systematic review was to examine the effect of health insurance on the utilization of health services and also to examine the factors affecting it. The present study was a systematic review that aimed to examine the effect of health insurance on the utilization of health care services. The study was conducted in 2016 using Scopus, PubMed, Web of Science, Science Direct, and ProQuest databases. We examined the utilization rate of health insurance in insured people. The inclusion and exclusion criteria were included based on review and meta-analysis purposes. The utilization of health services increased for inpatient and outpatient services. The utilization rate of inpatient services increased by 0.51% whereas the utilization rate of outpatient services increased by 1.26%. We classified the variables affecting the utilization rate of insurance into three main categories and sub-categories: demographic variables of the household, socioeconomic status, and health status. Our study showed that insured people increased the utilization rate of health services, depending on the type of health services. Thus, health policymakers should consider the community’s health insurance as a priority for health programs. For now, implementing universal health insurance is a good solution. [GMJ.2019;8:e1411]

Empowering the insured under health insurance: a case study in center of Iran

PurposeCurrently, the health system is a treatment-oriented system focused on service providers. In this system, the main focus is on the health market, with little attention on insured. One way to get out of existing conditions is to empower the insured in order to involve them actively in maintaining and improving health. The paper aims to discuss these issues.Design/methodology/approachThis qualitative study was done using the content analysis method. Based on the purposive sampling method and theoretical saturation criterion, 24 individuals including 12 health insurance experts and 12 insured participated in the study in 2018. The semi-structured interview method was used to collect data. Data were analyzed using MAXQDA10 software.FindingsHaving analyzed the interviews, 750 codes were obtained. These codes were categorized into two categories of “insurance experts” and “insured” and ten subcategories of “informing and educating, cost reduction, intersectional activities, expectations from the insured, services package, access to services, inability to pay costs, participation, and expectations from the insurance organization.”Originality/valueThis qualitative study was conducted to assess and determine the effective strategies for empowering the insured under health insurance. The results of this study are helpful to the health insurance organizations and health decision makers to detect the effective ways to develop the quality of insurance services, improve the status of insured, and increase access to health care goods and services.

Shared Value Creation in Australian Insurance Industry: The Qualitative Case Studies of IAG and AIA

This study explores the societal and economic value creation by large Australian insurance organisations, which integrate ‘shared value’ business model into their core business. The research objective of this paper is to explore the adoption of three value-enhancing thematic components of the applied shared value model, which are reconceiving products and markets, redefining productivity in the value chain and enabling local cluster development, by two Australian insurance organisations. Using case study design, the thematic analysis of primary interview data reflects how Insurance Australia Group (IAG) and American International Assurance (AIA Australia) have utilised the shared value model to create social value while generating economic value. The secondary findings also identify a fundamental shift in the customer value propositions within the conventional insurance industry, demonstrating successful utilisation of shared value model. The findings will help future academic researchers and practice managers to understand the evolving thematic components of value creation operating within the Australian insurance industry. Keywords : Shared Value, Australian Insurance Industry, Qualitative Case Study DOI : 10.7176/EJBM/11-30-09 Publication date :October 31 st 2019