| Abstract: |
The advent of Third Party Administrators (TPAs) is expected to play an
important role in health insurance market in ensuring better services to
policyholders. In addition, their presence is expected to address the cost and
quality issues of the vast private healthcare providers in India. However, the
insurance sector still faces challenge of effectively institutionalising the
services of the TPA. A lot needs to be done in this direction. Towards this
the present paper describes the findings of a survey study, which was carried
out with the objective to ascertain the experiences and challenges perceived
by hospitals and policyholders in availing services of TPA in Ahmedabad,
Gujarat. The major findings from the study are: (i) low awareness among
policyholders about the existence of TPA; policyholders mostly rely on their
insurance agents; (ii) policyholders have very little knowledge about the
empanelled hospitals for cashless hospitalisation services; (iii) TPAs insist
on standardisation of fee structure of medical services/procedures across
providers; (iv) healthcare providers do experience substantial delays in
settling of their claims by the TPAs; (v) hospital administrators perceive
significant burden in terms of effort and expenditure after introduction of
TPA and (vi) no substantial increase in patient turnover after empanelling
with TPAs. However, there is an indication that hospital administrators
foresee business potential in their association with TPA in the long-run.
There is a clear indication from the study that the regulatory body need to
focus on developing mechanisms, which would help TPAs to strengthen their
human capital and ensure smooth delivery of TPA services in emerging health
insurance market. |