Summary of: Performance of Third Party Administrators in Indian Healthcare

Document Type

Article

Abstract

Study Background: Health insurance companies, healthcare service providers and third party administrators (TPAs) play an important role in health system performance. Auditing of TPAs on performance measures is not prevalent practice in the industry. This evaluation will enable critical assessment of both efficiency and quality of health insurance claims processing and provide insights on required modifications thus resulting in better performance and enhanced customer satisfaction. This study’s motivation stems from the possible impact that the objective performance evaluation of TPAs has on healthcare delivery, control and costs.

Research Goals: Our study develops performance metrics for TPAs in the Indian healthcare setting. Further, we examine the relative importance of these metrics among the market segments that TPAs service.

Methodological Approach: The framework and the relevant metrics for performance measurement of TPAs were identified from extant literature on health insurance and claims processing. Content analysis of 10 expert interviews gave a deeper understanding of the factors for the performance measurement of TPAs. Analytical Hierarchy Process was used to formulate a hierarchy of factors to determine TPA performance and to assess their relative importance among the market segments serviced.

Results and Discoveries: This study has established that the relative importance of the performance metrics for TPAs change depending on the market segments and the type of claim. In order to provide quality care at affordable costs, there is a need to understand the requirements of the different segments.

Citation to the base paper: Shetty, S. R., Chatterjee, D., & Pai, Y. P. (2022). Performance of Third Party Administrators in Indian Healthcare. Journal of Health Management, 24(4), 652-661.

Publication Date: 2022

Publication Date

2022

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