The Effect of Health Insurance Disparities on the Health Care System

Background:The expansion of outpatient services and the desire to provide more outpatient care than inpatient care create some problems such as the overcrowding in the outpatient clinics. Given the importance of overcrowding in the outpatient clinics, this qualitative study aimed to determine the factors influencing the overcrowding in the specialty and subspecialty clinic of a teaching hospital.Materials and Methods:This was a qualitative study conducted in the specialty and subspecialty clinic of a hospital using content analysis method in the period of January to March 2014. The study population was all managers and heads of the outpatient wards. The studied sample consisted of 22 managers of the clinic wards who were selected using the purposive sampling method. The required data was collected using semi-structured interviews. The collected data was analyzed using conventional content analysis and the MAXQDA 10.0 software.Results:Three themes were identified as the main factors affecting the overcrowding including the internal positive factors, internal negative factors, and external factors.Conclusions:Despite the efforts made to eliminate overcrowding, and reduce waiting times and increase access to the services for patients, the problem of overcrowding still has remained unresolved. In addition, the use of some strategies such as clarifying the working processes of the clinic for staff and patients and the relationships between the clinic and other wards especially emergency department, as well as using a simple triage system on the patients’ arrival at the clinic are recommended.

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“…Therefore, in order to improve the coverage, eliminating or reducing overcrowding should be considered. [22]…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the overcrowding in outpatient healthcare

Bahadori

Teymourzadeh

Ravangard

et al. 2017

J Edu Health Promot

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“…The last benefit is specific to the health insurance sector. The psychological benefits are linked to the risk transfer process and to good health, which is necessary in order to work, live, and play (Thompson and Lee, 2007; Keane and Stavrunova, 2016). Health can be seen as a basic necessity that, according to Maslow (1943), has a direct effect on individuals’ well‐being.…”

Section: Introductionmentioning

confidence: 99%

“…Access to healthcare services is another specific benefit of health insurance. This benefit can be seen in three different ways: (a) access to healthcare, (b) the use of conventional healthcare, and (c) an incentive to practice preventive healthcare (Thompson and Lee, 2007; Kasule, 2012). Not having health insurance can be a barrier to healthcare, especially in countries without a national health system (Keane and Stavrunova, 2016).…”

Section: Introductionmentioning

confidence: 99%

Health insurance risk assessment using cognitive mapping and multiple‐criteria decision analysis

Fernandes¹,

Ferreira

2020

Int Trans Operational Res

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Health insurance risk analysis is crucial to the development of the insurance industry, allowing insurance companies to anticipate potential losses in health insurance's inverted product life cycle. The health insurance risk evaluation process is, however, carried out in various ways, which limits the application of transparency, fairness, and justice principles in the calculation of risk rewards. By combining cognitive mapping and measuring attractiveness by a categorical-based evaluation technique (i.e., MACBETH, a multiple-criteria decision analysis technique), this study sought to create a nonparametric and distinctive decision support system for individual private health insurance risk analysis. The proposed system facilitates greater transparency in the calculation of health insurance risk rewards. The results of a real-world application of this system were analyzed and discussed in face-to-face group meetings with independent experts who work for two of the largest insurance companies in Portugal, thereby incorporating realism into the proposed evaluation mechanism. The advantages and limitations of this assessment framework are also discussed.

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