Annexure I: Basic Design School Model
246
Annexure II: Hospital Survey Questionniare
HOSPITAL SURVEY QUESTIONNAIRE
(DELHI & NCR)
Rohit Kumar , PhD Scholar, IIFT (Indian Institute of Foreign Trade )
(2008)
I am conducting a survey to get your valuable feedback on health insurance product, process and
services. The name of the respondent will be kept confidential.
INTRODUCTION
1. Hospital Name:_______________________________________________________________
2. Location: ________________3. No. of Beds: __________ 4. Bed occupancy (percent)
____________
5. Year of establishment __________________ 6. Hospital contact No._____________________
-------------------------------------------------------------------------------------------------------------
7 . Please put the check mark on the appropriate numbers for all the statements.
Number 1= Strongly Disagree 2= Somewhat Disagree 3= Neither Agree nor Disagree
4= Somewhat Agree 5= Strongly Agree
1 2 3 4 5
More than 10 percent of the patients who are admitted in the hospital have
a. mediclaim policy
Patients having the mediclaim policy are fully aware of the terms and
b. conditions
c. Patients with cashless TPA card are more demanding
d. Hospital gives more importance to cashless patients
e. A patient with cashless card doesn’t care for cost of treatment
f. The payments by the TPA’s are done within 20 days
g. The TPA model is a successful model for health insurance
h. In cashless cases the cost of treatment is higher due to many reasons
8. How many TPA’s are empanelled with you for cashless services?
247
a. less than 5 b. More than 5 but less than 10
c. more than 10 d. None
9. With how many TPA’s you have agreed for discounts rates?
a. All b. Few of them
c. Most of them d. None
10. With which TPA you have agreed for maximum discount? What is the discount
percent and why?
TPA Name __________________________Discount percent
________________________
Why-
________________________________________________________________________
11. Out of 10 random patients admitted in your hospital, how many patients will falls
under different income groups for corporate and retail health insurance policies?
COROPRATE CLIENTS RETAIL CLIENTS
Lower income group Lower income group
Middle income group Middle income group
Higher income group Higher income group
TOTAL 10 Patients TOTAL 10 Patients
12. Which of the income groups is preferred by the hospital in case of mediclaim
(health insurance)?
a. Low Income group b. Middle income group
c. High income group d. None
13. The hospital charges more in case of cashless cases than from cases wherein
patient pays from their own pocket?
a. Yes b. No
248
14. How frequently the hospital rates are increased?
a. Every year b. Every 2 to 3 yrs
c. Every 4 to 5 yrs d. Never being increased
15. Are you aware of any hospitals in your locality which make false bills or medical
documents or inflate the bills in case of mediclaim (health insurance)?
a. Yes b. No
c. Can‘t say d. May be
16. In your hospital most of the patient who pays from their pocket stays in which
category rooms?
a. General wards b. Semi private/ double occupancy
c. Private/ single occupancy d. Deluxe
e. Super deluxe/Suite
17. In which category room the patient wants to stay incase he/she is carrying a
cashless card?
a. General wards b. Semi private/ double occupancy
c. Private/ single occupancy d. Deluxe
e. Super deluxe/Suite
18. Is the total cost of treatment more in case of cashless cases than from cases
wherein patient pays from their own pocket? and why?
a. Yes b. No
Why?
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________
19. Does the hospital prefer any specific insurance company? and why?
a. Yes b. No
249
Why?
_________________________________________________________________________
_________________________________________________________________________
20. What can be done by the Insurance companies to reduce the cost of treatment?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
-------------------------------------------------------------------------------------------------------------
Name of the respondent: _______________________________
Designation: _________________________________________
Signature of respondent:________________________________
Date:__________________
*** Thank you***
250
Annexure III (a): Semi-Structured Questionnaire (Stakeholder Interview)
Insurer Insured Provider
Business How you see the current Have you read the policy How you see the current
Environment health insurance market terms and conditions while health insurance market in
in India? What are the buying mediclaim policy? India? What are the major
major forces driving Why? forces driving changes in the
changes in the health health insurance industry?
insurance industry?
Strengths & What you think is your NA What you think is your
weakness organization current organization current strength
strength and weakness and weakness towards
towards serving this serving this market segment?
market segment?
Competition What is the current level Tell us the names of What is the current level of
of competition in the insurance company who competition in the health care
health insurance sell health insurance? market?
market?
Service What is the importance Have your received the What is the importance of
of services in the health policy and card in time? Do services in the health
insurance market and you know the process for insurance market and what
what are the different availing cashless and are the different value added
value added services reimbursement services? services currently offered?
currently offered? Have you availed of any
services? What was your
experience?
Cost Do you feel hospital Will you pay more premium Do you feel hospital charges
charges more in if you get more benefits? more in cashless cases than
cashless cases than Do you feel the hospitals reimbursement? Why?
reimbursement? Why? charges more when a
person has cashless card?
Why?
Opportunities What are the current NA What are the current
& threat opportunities and threat opportunities and threat you
you see in this market see in this market segment?
segment?
Way forward What are your options Will you re-new you What are your options for
for growing your health mediclaim policy? Will you growing your health
insurance business in recommend your family insurance business in the
the next 5 yrs? and friends to buy such next 5 yrs?
policies?
251
Annexure III (b): Semi-Structured Questionnaire (Stakeholder Interview)
TPA Broker Regulator
Business How you see the current How you see the current How you see the current
Environment health insurance market in health insurance market in health insurance market
India? What are the major India? What are the major in India? What are the
forces driving changes in forces driving changes in the major forces driving
the health insurance health insurance industry? changes in the health
industry? insurance industry?
Strengths & What you think is your What you think is your What do you think are
weakness organization current organization current strength the current industry
strength and weakness and weakness towards strength & weakness
towards serving this serving this market segment?
market segment?
Competition What is the current level of What is the current level of How many players are
competition in the TPA's competition in the Broker's waiting to enter this
market? market? market segment?
Service What is the importance of What is the importance of Do you feel the
services in the health services in the health customers of health
insurance market and what insurance market and what insurance are treated
are the different value are the different value added fairly by insurers, TPA's
added services currently services currently offered? and brokers?
offered?
Cost Do you feel hospital Do you feel hospital charges Are we going to have
charges more in cashless more in cashless cases than any regulation for
cases than reimbursement? Why? standardization of health
reimbursement? Why? cost? If yes, then when?
Opportunities What are the current What are the current What are the current
& threat opportunities and threat opportunities and threat you opportunities and threat
you see in this market see in this market segment? you see in this market
segment? segment?
Way forward What are your options for What are your options for What is going to be the
growing your health growing your health focus of the regulator for
insurance business in the insurance business in the next 5 years for this
next 5 yrs? next 5 yrs? segment of insurance?
252
Annexure V: Identified Factors for Synergy & Research Method Used
253
Annexure VI: Correlations Matrix
254
Annexure VII: Expert Opinion (E-Mail)
Dear Sir/Madame,
I am a PhD Scholar at the Indian Institute of Foreign Trade, New Delhi. My area of
research is in ―Health Insurance‖. Since, you are a known expert in the field, I would like
to share the findings of my research study and seek you expert opinion.
As a part of my research and after extensive field study we had come up with a list of
factors that could help either help develop or destroy synergy among insurers and network
hospitals (providers). The list of factors is clubbed under different broad categories.
I would request you to please complete the attached one page ‗Expert Opinion
Questionnaire‘. The questionnaire should not take more than 30 minutes of your valuable
time. I am also attaching a brief summary of my findings and hope that it would be
insightful.
I can assure you that your valuable inputs will go a long way in our efforts to contribute
towards this sector. It is also going to be beneficial to the future research students.
Do let me know in case you have any questions or query. The findings of this study will be
used for my thesis and for academic purpose only. I also intend to share the findings of this
study with you on a later date.
I am looking forward for your kind support. Please complete the questionnaire and send it
back to me on the below e-mail address. Thanks.
Best Regards,
Rohit Kumar
FIII, ACII (UK), C-RIM
PhD Scholar
IIFT, New Delhi
M-08802112967
rohit_phd@[Link]
rohit_iihmr@[Link]
255
Annexure VIII: Expert Opinion Questionnaire
Name: Designation:
Total Years of Experience (in Yrs): Age (in Yrs):
Organization Name:
Address: State:
Instruction: Rate the below listed factors between 1 to 5 on their ability to either develop or
destroy synergy among insurers and network hospitals (where, 1= minimum affect and 5=
maximum affect). These factors are being identified based on extensive field investigations
undertaken by me and is an outcome of both qualitative and quantitative analysis.
Note: for brief details on the below listed factors please refer to the separate document titled-
Factor Description. The name of the respondent shall be kept confidential.
INSURED POINTS NEED (Care & Cover) POINTS
Awareness Referral system
Ownership Existing Infrastructure
Value creation Underwriting and enrollment
Access Inadequate cover & product
innovation
Over and Under insurance
STANDARDIZATION POINTS EXISTING RELATIONHSIP POINTS
Selection of providers Provider Tariffs and business volume
Service Level Agreement Trust and transparency
Standard treatment guidelines Provider payment
Standard forms and format Relationship with Intermediaries
Grievance handling mechanism
CLAIM & COST POINTS TECHNOLOGY & TRAINING POINTS
Co-payment and deductibles Training issues
Health insurance fraud and Specialized training institutions and
misuse courses
Selection of room category Use of information technology
Outcome based payment system Efficiency and Effectiveness
TPA Vs In-house claim Communication between parties
processing
Remarks (If any):
Signature: Location:
256
Annexure IX: Expert Opinion Questionnaire
Rank
within
Q. Total Avg. synergy
No. Factors Factor Group Score Score bucket
1 Awareness 176 4.19 1
2 Ownership 135 3.21 4
INSURED
3 Value Creation 139 3.31 3
4 Access 149 3.55 2
5 Referral System 145 3.45 2
6 Existing infrastructure 153 3.64 1
7 Underwriting and enrollment NEED (Care & 140 3.33 4
Inadequate cover & product Cover)
8 innovation 144 3.43 3
9 Over and under insurance 135 3.21 5
10 Selection of providers 149 3.55 3
11 Service level agreement 146 3.48 4
STANDARDIZATION
12 Standard treatment guidelines 164 3.90 1
13 Standard forms and format 160 3.81 2
Provider tariff and business
14 volume 158 3.76 4
15 Provider Payment EXISTING 176 4.19 1
16 Relationship with intermediaries RELATIONSHIP 171 4.07 2
17 Grievance handling mechanism 129 3.07 5
18 Trust and transparency 162 3.86 3
19 Co-payment and deductibles 148 3.52 4
Health insurance fraud and
20 misuse 171 4.07 1
21 Selection of room category CLAIM & COST 153 3.64 3
22 Outcome based payment system 141 3.36 5
TPA Vs In-house claim
23 processing 157 3.74 2
24 Training issues 158 3.76 3
Specialized training institution
25 and courses TECHNOLOGY & 144 3.43 5
26 Use of information technology TRAINIING 187 4.45 1
27 efficiency & effectiveness 147 3.50 4
28 Communication between parties 171 4.07 2
257