Abstract of Dissertation

Keyword : TPA: Cash-less; Policyholders

Objective : The main objective of study was to: • To understand the perception of healthcare providers about the performance of cash-less services in hospital. • To ascertain the experiences and challenges perceived by provider and policyholders in availing services of cashless reimbursement

Background : The advent of cashless by a hospital is expected to play an important role in health insurance market in ensuring better services to policyholders. However, the hospitals and insurance sector still faces challenge of effectively institutionalizing the services of the cashless. A lot need to be done in this direction. Towards this the study describes the findings, which was carried out with the objective to ascertain the experiences and challenges perceived by hospital administrators and its policyholders in availing services of cashless.

Methodology : Type of study: Descriptive Data and fact collection: Questionnaire and In-depth interview Study duration: 2 Months

Findings : The proliferation of various healthcare technologies and increase in cost of care has necessitated the exploration of health financing options to manage problem arising out of increasing healthcare costs. Post-liberalization of the Indian healthcare insurance sector, some companies have been licensed as third party administrators (TPAs) of health services with the aims of bringing more professionalism into claims management, and facilitating cashless payment. Managing large numbers of clients and a large claims volume necessitates a highly efficient administration system capable of speedy and accurate response to clients’ hospitalization needs. The major findings from the study were: (1) low awareness among policyholders about their policy. (2) Policyholders mostly rely on their insurance agents. (3) Healthcare providers do experience substantial delays in settling of their claims by the insurance provider. (4) Hospital administrators perceive significant burden in terms of effort also. There is a clear indication from the study that the regulatory body needs to focus on developing mechanisms, which would help TPAs to strengthen and ensure smooth delivery of cashless services in emerging health insurance market.

Recommendations : TPAs should devote more attention on care management issues related with policyholders rather than focusing on financial issues. TPAs must settle the claim to the hospital on time so as to build a strong relationship with hospitals Policyholders should be made more aware about the TPA and the services it provide. Also policyholders should contact directly with insurance company rather than depending on insurance agent.