Abstract of Dissertation

Agency : Health Insurance, Third Party Administrator, Consumer Perspective, TPA

Objective : The objectives of the study was to understand the issues TPAs have to face within their functioning and their perspective on the comparison between the public and private market based health insurance providers and to understand the consumer’s demands, their expectations and issues in health insurance industry.

Background : The health insurance industry is in infantile stage, rather an experimental phase, wherein it is trying to do demand analysis and consumer need assessment to be able to provide consumers with the right products and options that would suit their needs. The Third Party Administrators (TPA) form a critical linkage between the health insurance provider, the consumer and the hospital network. Thus understanding their perspectives and stand point is equally important.

Methodology : The type of study was exploratory qualitative study with certain elements of quantitative data in it. The location of study was Mumbai. The study subjects were Third Party Administrators and beneficiaries who availed health insurance in last one year. The sample size undertaken was Beneficiaries-50 respondents. The list of Third Party Administrators (TPA’s) was taken by the website of IRDA and those functioning in Mumbai. The Sampling method undertaken was Non probability convenient sampling for selection of beneficiaries. The Data collection method was face to face interview for TPA’s while for the beneficiaries survey method was undertaken

Findings : There is a good level of general awareness about health insurance. Almost all the respondents understood what health insurance is and many cited the benefits of having a health insurance as a protection cover against rising health costs in case of any medical emergencies. The market is highly disorganized and Indian consumes do not conduct any type of research while buying any product. TPA perspective: The officials who were interviewed had in-depth knowledge of current issues in health insurance. The TPA’s did not give due importance to arranging or attending 39 conferences. As per the opinion of TPA spokespersons, public sector is perceived to be more dominant in the market. Major problems faced by consumers according to TPA are lack of clarity on insurance policies, service providers spread and problems in documentation. Conclusions: There is a casual attitude of the consumers towards health insurance as far as reading into the fine prints of the policy document or doing any market research for buying the health insurance is concerned. The environment is extremely challenging for the TPAs as they face issues from all the ends, the insurance companies, the customers and the health care providers end.