Ali Mohammad Mosadeghrad; Mahya Abbasi; Sajad Ramandi
Volume 24, Issue 11 , 2022
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 ...
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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.
Ali Mohammad Mosadeghrad; Mahya Abbasi; Sajad Ramandi
Volume 24, Issue 10 , 2022
Abstract
Background: The covid-19 pandemic has affected the health insurance industry in numerous ways.
Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country.
Methods: This was a cross-sectional ...
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Background: The covid-19 pandemic has affected the health insurance industry in numerous ways.
Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country.
Methods: This was a cross-sectional descriptive study conducted on the data collected from a private insurance company. The statistical population included all insured individuals covered by the insurer in 31 provinces throughout the country who have used the services provided in hospitals and other diagnostic centers from March 21, 2019 to September 21, 2019 (1,699,930 insured people), considered as the pre-covid-19 incidence period, and from March 20, 2020 to September 20, 2020 (1,862,657 insured people), as the post-covid-19 incidence period. Data were analyzed using the SPSS and GIS statistical software.
Results: In the 2019 half-year, 10,416,591 medical expense records have been filed in the country, which decreased by 17.1% in the same period in 2020 to 8,633,613 records. The average referral times in the pre-covid-19 period was 7.02, which decreased by 32.9% during the post-covid-19 period, falling to 4.71.
Conclusion: The overall frequency of referrals to receive all services covered by the insurer, including visits, medicine, hospital services (general surgeries), and laboratory services in the post-covid-19 period decreased significantly, compared to a similar period in the previous year. It seems that in many different provinces, non-emergency patients avoided referring to healthcare centers and unnecessary visits to medical centers. Moreover, the number of general surgeries decreased because of the therapists cautiousness and the changing behaviors of the patients, making diagnostic and medical services more real.
