Skip to main content

Table 1 The final checklist of criteria to assess the performance of complementary health insurance companies in Iran

From: Criteria for the selection of complementary private health insurance: the experience of a large organisation in Iran

 

Domains

 

Criteria

Weight of each domain (weight out of 100)

Weight of each criterion out of 100, according to the results of Best-Worst Method (weight according to the consensus among experts)

1

Previous experience of the applicants

1

Experience of contraction with organizations with similar population size in the last 10 years

24.42

12.9 (9.29)

2

Experience of contraction with organizations with similar beneficiaries’ characteristics (age and gender, special medical needs, etc.) in the last 10 years

8.97 (8.07)

3

Number of current medical contracts with large organizations (over 10 thousand beneficiaries )

3.26 (7.06)

2

Communication with clients

1

Satisfaction of previous organisations which have worked with the applicants (CHICs) in the last 3 years (certificates, awards and official certificates obtained by the company)

22.68

5.82 (4.63)

2

Customer grievance management system

9.77 (6.05)

3

Comprehensive and up-to-date information system (physical or electronic manual, site, SMS, application, IVR) to inform the insured regarding the health care providers under contraction and the benefit package

5.26 (6.2)

4

Emphasizing on public health services and health education

1.82 (5.8)

3

Financial status

1

Financial strength rate in the last year

16.53

3.65 (4.47)

2

The amount of registered capital of the applicants (CHICs)

6.24 (4.58)

3

Ratio of the amount of compensation paid to the insured to the total premiums received (treatment compensation coefficient)

5.03 (4.81)

4

License to provide reinsurance contract

1.29 (2.66)

4

Health care providers’ network

1

Number of private hospitals under contraction and their distribution over the country

17.89

4.93 (2.66)

2

Number of specialist offices under contraction and their distribution over the country

2.27 (2.45)

3

Number of pharmacies under contraction and their distribution over the country

2.35 (2.61)

4

Number of laboratories under contraction and their distribution over the country

2.35 (2.61)

5

Number of radiology centres under contraction and their distribution over the country

2.35 (2.61)

6

Number of first class hospitals under contraction and their distribution over the country

1.31 (2.4)

7

Number of public and private policlinics (for outpatient health services) under contraction and their distribution over the country

2.35 (2.55)

5

Technical infrastructure and workforce

1

Number and distribution of active branches all over the country

11.42

2.59 (2.06)

2

Having an online system to check the complementary health insurance coverage status of the insured in the contracted medical centres

1.65 (2.01)

3

Having an online reporting system to provide financial reports at regular intervals (based on the requests of the FMVA)

1.37 (1.92)

4

Having a central organisational structure in the headquarters to analyse, monitor and control health care expenditures (cost management)

2.24 (1.92)

5

Adequacy of the number of personnel specialised in reviewing medical records

0.83 (1.5)

6

Possibility of establishing an electronic health record

2.75 (2.01)

 

Process of reviewing claims and reimbursement

1

Having an active application to perform all activities related to reviewing claims online and electronically (ability to send reimbursement SMS to the insured person; sending SMS to the insured person informing them about the health care services provided for them; possibility to follow the process of claims review by the insured online; possibility of announcing the amount of claim which is not payable and why; having electronic medical record)

7.38

2.08 (1.9)

2

Time duration of reviewing and reimbursing medical records delivered by the contracted medical centres (one month for hospitals and 14 days for outpatient and para clinic centres)

1.61 (1.78)

3

Time duration of reviewing and reimbursing medical records delivered by the insured (14 days)

2.12 (1.69)

4

Possibility to barter bonds, stocks, property

1.57 (2.01)

 

Total

28

  

100