EFFECT OF CLAIM SETTLEMENT ON THE

CUSTOMER SATISFACTION OF THE MEDI-CLAIM

INSURANCE POLICY:
A STUDY OF SOUTHERN ODISHA

Presented by
PRASANJIT BISWAS
Department of Business Management, Central University of Odisha.
Under the Guidance of
SRINIVAS RAO K
Faculty, Dept. of Business Management, Central University of Odisha.
 Research Intuition
• Health Insurance is one of the untapped market of
Insurance segment.
• General Insurance companies mostly focus on
Motor Insurance Leaving Health Insurance
Potential
• Health Expenditure has tremendously increased
both for the Govt. and Individual
• Some companies failed to settle disputes in
Health Insurance segment.
Research Problem
“What are the factors that affect the Health Insurance subscription”
and “Will Claim settlement act as an important factor for satisfaction
in Health insurance”.
Research Objective
1. To find the Factors effecting Health Insurance subscription
2. To study the effectiveness of factors that affect the subscription
decision of customer towards health insurance
3. To suggest the effectiveness of pro active claim settlement that
will help in the marketability of health Insurance.

Hypothesis of the study

H1- There is a significant effect of factors that affect the
purchasing decision of Health Insurance.
H2- Pro Active Claim settlement plays an important role in the
Satisfaction level and subscription of Health Insurance plans.
Research Design & Methodology Continued.
a.The study followed the casual research design
b.Type of research: The study followed the casual research to find out
the factors effecting both health insurance subscription and satisfaction.
c. Data collection: Stratified Random sampling technique will be used to
find out samples will be collected from 4 district of southern Odisha, i.e.
Koraput ,Kalahandi, Malkanigiri and Rayagada. A total of 113 samples
will be collected from 4 districts Data will be collected through a self
structure questionnaire.
d. The scale of the questionnaire is measured by Cronbach’s alpha.
e. The data adequacy is tested through KMO statistics.
f. The factors analysis is used to extract the factors behind customer
satisfaction of health insurance holder.
g. The multiple linear regressions is used to find out the effect of factors
behind customer satisfaction of health insurance holder on their
satisfaction..
h. Literatures are studied from Elsevier and Emerald Inslight.
Literature Review
• Mohan.D.M (2020) found that Health Insurance sector is
growing but unable to earn Underwriting profit.
• Nayak.B, Sekhar.B.S, Krishnamoorthy.B (2009) found three
key themes for technology in social health, Analytics of Risk
Mangement, Cost Optimization for Operations and
Enhancement of Customer Experience.
• Subhashini.R (2016) found that India’s growth is slowing
down due to the absence of a well laid out public policy for
the Health care.
• Gupta.S (2017) explains that almost all the public schemes are
not fully made aware to the public, Even the Rastriya
Swasthiya Bima Yojana.
 Results and Discussion
Scale statistics and Scale Reliability

Scale Statistics

Mean Variance Std. Deviation N of Items

116.19 321.497 17.930 28

A total number of 113 fully filled and qualified responses are taken for
the study.
Reliability Statistics

Cronbach's Alpha Based on

Cronbach's Alpha Standardized Items N of Items
.972 .972 28

, the scale (questionnaire) is optimally reliable, i.e. 97%.

 Factor Analysis to find out Factors Affecting the
Subscription of Health Insurance
KMO and Bartlett's Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .943
Bartlett's Test of Sphericity Approx. Chi-Square 2514.986
Df 325
Sig. .000
KMO measure of sample adequacy is 94% which is significant
(0.000), so explorative factor analysis is applicable here.
Total Variance Explained
Extraction Sums of Squared Rotation Sums of Squared
Initial Eigenvalues Loadings Loadings

% of Cumulative
Component Total % of Variance Cumulative % Total % of Variance Cumulative % Total Variance %
1 14.980 57.615 57.615 14.980 57.615 57.615 7.429 28.574 28.574
2 1.376 5.291 62.906 1.376 5.291 62.906 4.404 16.937 45.511
3 1.281 4.928 67.834 1.281 4.928 67.834 4.324 16.632 62.144
4 1.028 3.955 71.790 1.028 3.955 71.790 2.508 9.646 71.790
 Rotated Component Matrixa
Component
1 2 3 4
Both offline and online subscription and
renewal of policy must be available for .796
people
Regular health check up facility must be
provided to the subscriber and medical .780
advices must be given time to time
The behaviour of the agent must be good
.744
while explaining the policy regulation
Terms and condition, rules and regulation
must be properly communication to the .734
knowledge level of individual
The agent and staff must be cordial while
.708
insurance claim settlement
Less paper work must be there in the network
hospital if cashless facility is provided .706
Ease in subscription and Dispute Settlement
Queries must be handle with suitability of the
.703
clients
Dispute settlement must be easy in case of
.679
claim settlement procedure
The health insurance claim related to
.616
COVID-19 must be covered.
The insurance premium must be affordable .610
The reimburse facility of the health insurance
.537
schemes must be easy
Health Insurer provide Reimbursement
facility while settling claims in network and .494
non-network hospitals
The claim receiving period must be less
Claim settlement must be made online for
.790
convenience
There should be some discount give to the
subscriber in case making investment in the .712
same product of same HI company.

The tie-up network and non-network

hospitals must located in the nearby area of .658
residence
Proactive Claim
Health Insurer uses digital technology in
tracking your health time to time .642 Settlements
Health Insurer must provide cashless
facility option while settling claims in .613
network hospitals
Health insurance premium must be given
less if done for more than 1 person in the .598
family or entire family members

Will prefer insurances, where procedure of

.793
registration is easy
The COVID 19 pandemic has shown the
importance of Health Insurance (HI) policy .725

Health insurance must cover modern day

Modern Sickness .655
critical illness
In the uncertain world, the health insurance Coverage
policy is immensely important for any .558
middle class and lower income family

Deduction to the claim must be less to

reduce the burden on the subscriber .490
Agent counter must be
.806
present to resolve the
issues at hospitals
Easy accessibility of services
Private hospitals must be
given more focus in the
.589
list of network hospitals
rather than government
hospitals

Extraction Method: Principal Component Analysis.

Rotation Method: Varimax with Kaiser Normalization.

a. Rotation converged in 8 iterations.

 Regression Analysis to find the effect of factors relating to Health
Insurance affecting the Subscription of Health Insurance
ANOVAa

Model Sum of df Mean Square F Sig.

Squares
1 Regression 68.889 4 17.222 53.844 .000b

Residual 34.544 108 .320

Total 103.434 112

a. Dependent Variable: I am satisfied with the present health insurance policy

b. Predictors: (Constant), Easy Accessibility of Service, Modern Sickness Coverage, Proactive

Claim Settlements, Ease in subscription and Dispute Settlement
The above ANOVA table shows that the multiple linear regression is
significant for analysis F statistics
(53.844) is significant (p=.000). so we can proceed for the regression model.
 
 Model Summaryb
Change Statistics

Std. R
Error of Square F Sig. F
R Adjusted the Chang Chan df Chang Durbin-
Model R Square R Square Estimate e ge 1 df2 e Watson
1
.816a .666 .654 .566 .666 53.84
4 4 108 .000 1.553

a. Predictors: (Constant), Easy Accessibility of Service, Modern Sickness

Coverage, Proactive Claim Settlements, Ease in subscription and Dispute
Settlement
b. Dependent Variable: I am satisfied with the present health insurance policy

The factors affecting the customer satisfaction with their present health
insurance effect their satisfaction level by 65% is significant (p=.000)
 Coefficientsa
Standar
dized Correlations Collinearity Statistics
Unstandardized Coeffici
Coefficients ents
Std. Zero-
Model B Error Beta t Sig. order Partial Part ToleranceVIF
1 (Constant) 4.071 .053 76.514 .000
Ease in
subscription
.490 .053 .510 9.166 .000 .510 .661 .510 1.000 1.000
and Dispute
Settlement
Proactive
Claim .379 .053 .395 7.101 .000 .395 .564 .395 1.000 1.000
Settlements
Modern
Sickness .215 .053 .224 4.022 .000 .224 .361 .224 1.000 1.000
Coverage
Easy
Accessibilit .430 .053 .448 8.048 .000 .448 .612 .448 1.000 1.000
y of Service
a. Dependent Variable: I am satisfied with the present health insurance policy
Summary Findings

 The factors that affect the Health Insurance subscription are

Ease in Subscription and Dispute Settlement, Proactive Claim
Settlements, Modern Sickness, Easy accessibility of Services.
 The factors in combination affect the Purchasing attitude or
satisfaction level by 65%.
 Out of the 4 factors all the four factors have significant
impact with the lowest being the Modern sickness Coverage.
The most important factor is Ease in Subscription and Claim
settlement.
Conclusion
 Health Insurance is the 4th Basic Necessity since the Pandemic.
 Govt. should upgrade the existing coverage of people in its
Health schemes
 Insurance companies should focus on Ease of Subscription and
Dispute settlement, Easy accessibility of Services to the
customers, Including modern day illness and most importantly
pro active claim settlements to grab the rising demand for
Health Insurance Post Pandemic started.
 Companies should also focus on the satisfaction level of
customer by regularly getting in touch with them.
Reference:

Nayak, B., Bhattacharyya, S. S., & Krishnamoorthy, B. (2019). Integrating

wearable technology products and big data analytics in business strategy: A
study of health insurance firms. Journal of Systems and Information
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Subhashini, R. (2012). National health policy, the need of the hour: An

analysis in Indian perspective. Leadership in Health Services, 25(3), 232–248.
https://doi.org/10.1108/17 511871211247660

Gupta, S. (2017). Awareness and utilization of Rashtriya Swasthaya Bima

Yojana and its implications for access to health care by the poor in slum areas
of Delhi. Health Systems, 6(3), 242–259.
https://doi.org/10.1057/s41306-017-0022-y