Summary of: Managed Care Models in India: An Investigation on the Ownership and Performance of Health Claims Management

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Article

Abstract

Study Background: Third-party administrators (TPAs), an important member of the managed care model in India, service health insurance claims and intermediate between health insurance companies, service providers and customers. Auditing TPA performance is not a prevalent industry practice because of a lack of regulation.

Research Goals: Our study examines the impact of ownership of TPA activities and attempts to analyse the context and impact of bringing TPA services in-house on performance and customer satisfaction

Methodological Approach: Analytic Hierarchy Process (AHP) is adopted for structuring the problem of rating the performance indicators of TPAs. Hierarchy of the factors and sub-factors was formulated using AHP. Based on the identified performance metrics and expert interviews, the performance measurement problem was structured as a series of hierarchies.

Results and Discoveries: The results show that both internal and external TPAs have their own efficiencies and advantages due to their operational models. This study has established that the relative importance of performance metrics for TPAs change based on the TPA being internal or external and type of the claim.

Citation to the base paper: Shetty, S. R., Chatterjee, D., & Pai, Y. P. (2023). Managed Care Models in India: An Investigation on the Ownership and Performance of Health Claims Management. Journal of Health Management, 25(4), 918-926.

Publication Date: 2023

Publication Date

2023

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