| 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 |