ACKNOWLEDGEMENT

It is my pleasant duty to acknowledge my sincere gratitude and heart felt thanks to all those who have encouraged, guided and helped me in the completion of this project. I wish to put on record my cordial thanks to Mr. Shivoham Singh (Asst.professor), for allowing me to carry out this project study on health Insurance. I also express my thanks to all staff member for providing the facilities and encouragement to me in making this success. I extend my kind acknowledgement to my faculty member and our director Prof.B.P.Sharma sir for giving me this precious and useful opportunity to improve my practical knowledge. Last but not least, the silent support received from my parents who stood behind all my even or odds situations to convert any distress into delight, deserves unconditional recognition

PREFACE
This live research project is due during the fourth semester of M.B.A programme. Although this project is not direct interface with the industry but a deep one. It was a quite interesting and knowledge too. This project has been prepared by me after doing a study for project during 2011-12 sessions and has been produced for partial fulfillment of the degree of Master of Business Administrative (M.B.A.) from faculty of management studies, pacific university, Udaipur. The project was related to the analysis of the satisfaction level of the customer and to know about their expectations. A satisfied customer is the asset of the company. The satisfied customer promotes the business. For in health insurance sector it is very must to know the satisfaction level of their customer because there are lots of companies those are providing the close substitutes that is why there is a tough competition in this sector. The chapter 1 presents the overview of the project profile which is related to the needs & satisfaction of the customer. Chapter 2 overview about insurance industry & about health insurance. Chapter 3 shows an overview of review of literature. Chapter 4 it includes the research objectives, sample design. Chapter 5 present data interpretation which includes the analytical view on the customer satisfaction. Chapter 6 conclusion Chapter 7 suggestion Chapter 8 questionnaire

EXECUTIVE SUMMERY
Studies of patient satisfaction have typically been conducted in general patient populations with little attention to patients suffering from specific illnesses. The purpose of the study expectation and raise issues relevant to the satisfaction of patients with chronic arthritis. Individuals suffering from a chronic illness such as arthritis may be different from others who seek medical care in their expectations, what they expect from care, and preferences, what they want from care. These differences may occur because patients with chronic arthritis have greater experience with care seeking and increasing recognition of the potential for poor disease outcomes in spite of adequate care. Literature from marketing research and health care which suggests that both expectations and preferences influence satisfaction with care will be reviewed. Then specific hypotheses about expectations and preferences of patients with chronic arthritis will be proposed. Recommendations for future studies of arthritis patient expectations and preferences will be made. Keywords: Marketing, Market Information System, Market Research, Patient Expectation, Patient Satisfaction, Consumer Satisfaction Model

TABLE OF CONTENTS
CHAPTER TOPIC ACKNOWLEDGEMENT PREFACE EXECUTIVE SUMMERY 1 2 3 4 5 6 7 8 9 10 11 INTRODUCTION THEOROTOCAL FRAMEWORK REVIEW OF LITERATURE RESEARCH METHODOLOGY DATA ANALYSE OBJECTIVE OF THE STUDY SCOPE OF THE STUDY CONCLUSION SUGGESTION BIBILOGRAPHY QUESTIONNARE PAGE NO. I II III 5-

CHAPTER-1
INTRODUCTION
What is health insurance You must have read about life insurance but do you also know what health insurance is? Health insurance, like life insurance, is a form of insurance in which people collectively pool their risk, in this case the risk of incurring medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by an individual. In each case, the covered groups or individuals pay premiums to help protect themselves from unexpected healthcare expenses. The Need for health insurance Now that you know what is health insurance you must be wondering what the need for health insurance is. Most of us today, lead very hectic lives, trying to juggle between work and home. All the stress, travelling, long hours and irregular eating habits make our lifestyle very susceptible to illnesses. With a lifestyle where we do not get enough exercise and face the problems of pollution and stress, the number of people suffering from health problems is on the rise. Health care has also become very expensive and as such, it becomes difficult to bear the increasing costs of the doctors fee and hospital charges. A medical insurance or health insurance policy is a way to safeguard our health from the impact of illnesses as it helps reduce the financial impact as well as the mental stress associated with an illness. Hope this illustration gives u a clear picture. Assume A (25 yrs) has a salary of Rs 4 lakhs. He drives to office on a bike every day. His yearly savings come to around 1.5 lakhs. In a span of 3 years he saves 6 lakhs. He has not availed any medical cover. The possibility that A is hospitalized once in these three years due an accident or illness is very likely. The likely expenses for a three day admit along with cost of the diagnosis and operation (minor) would come to around 18,000. Had he

had a medical cover the premium paid by him in these three years for a cover of Rs 1, 00,000 would be 1250*3 = 3750 Rs. This cover would have saved him the expenses of Rs 18,000 (thus resulting in a net savings of almost Rs 14000). I hope this illustration makes it clear why we need health insurance. Whats a good health plan With numerous companies offering health insurance and with a variety of health insurance plans on the offer its hard to decide which plan you should go for. How do you define if a health policy is a good health plan? Following some of components of a good health plan: Hospitalization cover: This ensures that medical expenses incurred on hospitalization for more than 24 hours are covered by the insurance company. This may include room charges as well as the money spent towards the surgeon, medicines and other tests. Cashless claims: In a cashless claim, the hospitalization expenses are directly settled between the hospital and the insurance company. Tax benefits: An insured person can receive a tax exemption on the premium paid, up to a significant amount each financial year. This means that while he is safeguarding himself, he is also reducing his tax deductions and saving money on a portion of his income. Pre & Post-hospitalization expenses: Daily cash allowance and payment for treatments received prior to hospitalization and during the recovery period are extremely beneficial, as the insured might not have an alternate source of income during those trying times. Floater plans: Floater plans cover the entire family under one policy and allow the coverage of the medical insurance policy to be shared among the family members. Here are some key changes coming into effect:

Coverage expansion for adult dependents until age 26. Employers will have to provide coverage for dependents of workers who don't have access to other employer-

based health care coverage 'till age 26. Some states already mandate this coverage until age 28 or 29. This new provision could also push companies to look for ways to restrict the number of new people added to their health plans. [Employers get tough on insuring 'family' ]

Children no longer denied coverage for pre-existing conditions: Insurance plans can't deny coverage due to a pre-existing condition to children under age 19. For adults, the same provision goes into effect in 2014.

Prohibit insurers from rescinding coverage: It's illegal for insurers to drop a customer when they become sick or search for an error on a customer's insurance application and then deny payment for service when the person gets sick.

Free Preventive Care: All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. If individuals keep their existing plans or if a group plan doesn't make major changes, the provisions won't kick in until the plans get changed. [Health reform: What you're not getting]

No lifetime limits on coverage: Insurers no longer can impose lifetime dollar limits on essential benefits, like hospital stays or expensive treatments.

Unrestricted

doctor

choice:

Plans

must

allow

pediatricians

and

obstetrician/gynecologists to get primary care physician status. This eliminates the requirement for patients to get prior-authorization from their insurer or a doctor's referral to see a pediatrician or OB/GYN.

Level charges for emergency services: Insurers must remove prior authorizations for ER services. Also, insurers can't charge higher co-payments or co-insurance for out-of-network ER providers.

Patient-friendly appeals process: Insurers will have to establish new internal and external appeals processes for claims. This means that while a claim is under appeal, your insurer has to continue to pay your claims, and continue paying for subsequent treatment, until the matter is resolved.

Small business impact: The changes that kick in on Sept. 23 also apply to small businesses with 50 employees or more that already offered insurance coverage prior to reform. Companies that didn't offer coverage pre-reform and have no more than 25 workers will be given incentives such as tax credits and grants to encourage them to offer insurance coverage, said Dorothy Miraglia, director of benefits with Alpha Staff, a firm that manages employee benefits programs for small businesses.[Tax change for small businesses] The government estimates that 4 million small businesses will be eligible for health insurance tax credits. These include a credit of up to 35% of the premiums employers pay on worker plans. For small non-profit companies, the credit is up to a 25%. Also, the 35% maximum credit is given to employers with 10 or fewer full-time employees, said Miraglia. If you buy insurance yourself: For consumers who buy health insurance directly from insurers, some of the same key changes go into effect this month. Most importantly, insurers can't drop you when you get sick or because you made a mistake on your coverage application. Insurers also can't set annual or lifetime limits. If you have children under age 26, you can insure them if your policy allows for dependent coverage. Individual plans can't deny or exclude coverage to any child under age 19 for pre-existing conditions. If you're a senior citizen: If you have Medicare prescription drug coverage and are affected by the donut hole, this year you will get a one-time tax-free $250 rebate to help pay for prescriptions. The prescription drug coverage gap that develops when Medicare stops paying for drug coverage and patients can't afford to pay for drugs out-of-pocket is called the "donut hole."

In 2011, if high prescription drug costs put you in the donut hole, you'll get a 50% discount on covered brand-name drugs while you're in the donut hole. Healthcare Issues Malnutrition 42% of Indias children below the age of three are malnourished, almost twice the statistics of sub-Saharan African region of 28%. World Bank estimates this figure to be 60 million children out of a global estimated total of 146 million. Although Indias economy grew 50% from 20012006, its child-malnutrition rate only dropped 1%, lagging behind countries of similar growth rate. Malnutrition impedes the social and cognitive development of a child, reducing his educational attainment and income as an adult. These irreversible damages result in lower productivity. High infant mortality rate Approximately 1.72 million children die each year before turning one. The under five mortality rate and infant mortality rate indicators have been declining, from 202 and 190 deaths per thousand live births respectively in 1970 to 64 and 50 deaths per thousand live births in 2009. However, this rate of decline is slowing. Reduced funding for immunization leaves only 43.5% of the young fully immunized. Infrastructures like hospitals, roads, water and sanitation are lacking in rural areas. Shortages of healthcare providers, poor intra-partum and newborn care, diarrheal diseases and acute respiratory infections, also contribute to the high infant mortality rate. Diseases Diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs. And in 2011, India finally developed a totally drug-resistant form of tuberculosis India is ranked 3rd among the countries with the most number of HIV-infected Diarrheal diseases are the primary causes of early childhood mortality. These diseases can be attributed to poor sanitation and inadequate safe drinking water in India. However in 2012, India was polio free for the first time in its history.

Indians are also at particularly high risk for atherosclerosis and coronary artery disease. This may be attributed to a genetic predisposition to metabolic syndrome and changes in coronary artery vasodilatation. NGOs such as the Indian Heart Foundation and the Medwin Foundation have been created to raise awareness about this public health Poor sanitation As more than 122 million households have no toilets and 33% lack access to latrines, over 50% of the population (638 million) defecates in the open. his is relatively higher than Bangladesh and Brazil (7%) and China (4%).Although 211 million people gained access to improved sanitation from 19902008, only 31% uses them. 11% of the Indian rural families dispose of child stools safely whereas 80% of the population leave their stools in the open or throw them into the garbage. Open air defecation leads to the spreading of diseases and malnutrition through parasitic and bacterial infections. Healthcare infrastructure He Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2020. Rising income levels and a growing elderly population are all factors that are driving this growth. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery. In order to meet manpower shortages and reach world standards India would require investments of up to $20 billion over the next 5 years Patient-centered care and patient satisfaction are considered key dimensions of healthcare quality by the Institute of Medicine. Achieving a high level of patient satisfaction is important to the quality of care. Moreover higher patient satisfaction has been shown to be associated with improved outcomes. Expectations represent an important part of satisfaction. Meeting patient expectations correlates with higher satisfaction and results in better health outcomes. Consistent with this notion, studies have shown the importance of both identifying and addressing patient expectations. Although failure to identify patient expectations can lead to dissatisfaction, physicians and nurses often neglect to solicit patients expectations, and consequently may not be able to fulfill them. Despite interest

in patient satisfaction and widespread use of patient satisfaction surveys to assess quality of care relatively little research has focused on clinicians attention to addressing patient expectations. Therefore, we undertook a study to examine clinician attitudes, performance and major determinants of their behavior with respect to managing patient expectations, and did so in multiple countries to determine whether approaches differ across cultures. The social sciences have become increasingly involved in exploring patients' satisfaction with the health care that they receive. Serious theoretical and methodological reservations have been expressed about the validity of results.' One review expresses the limitations of current knowledge of' the process whereby consumers arrive at assessments of the services they receive. While expressions of satisfaction and dissatisfaction are the end product of such a process, we know little as yet of the procedures, criteria and standards consumers employ." This paper attempts to draw out some of the salient assumptions and explicit images of the patient sustained by patient satisfaction research, and then to explore their applicability to patients encountering one particular health-care setting. An investigation of the perspectives of a series of patients attending neurological outpatient clinics for headache is used to suggest some important limitations of conventional concepts from satisfaction research and an alternative approach is outlined. Survey research into patient satisfaction has been responsible for developing a number of related concepts concerning the ways in which patients evaluate the health care that they receive. Recently doubts have been expressed as to the adequacy of this approach for understanding how patients anticipate and respond to medical encounters. This paper reports a study of patients attending neurological outpatient clinics. The results suggest that the conceptual framework deriving from patient satisfaction research provides only partial and sometimes misleading insights into the perspectives of the patients studied. The paper concludes that patients' varying concerns with regard to their illness need to be more directly considered in explaining different responses to medical consultations. This approach enables a more sensitive evaluation of health care from the patient's point of view.

CHAPTER-2
THEOROTICAL FRAMEWORK OF HEALTH INSURACE
About Insurance Industry "Insurance is a contract between two parties whereby one party called Insurer undertakes in exchange for a fixed sum called premiums, to pay the other party called insured a fixed amount of money on the happening of a certain event."Insurance is a protection against financial loss arising on the happening of an unexpected event. Insurance companies collect premiums to provide for this protection. A loss is paid out of the premiums collected from the insuring public and the Insurance Companies act as trustees to the amount collected. For Example, in a Life Policy, by paying a premium to the Insurer, the family of the insured person receives a fixed compensation on the death of the insured. Similarly, in car insurance, in the event of the car meeting with an accident, the insured receives the compensation to the extent of damage. It is a system by which the losses suffered by a few are spread over many, exposed to similar risks.

Logic of insurance It is a system by which the losses suffered by a few are spread over many, exposed to similar risks. Insurance is a protection against financial loss arising on the happening of an unexpected event. Insurance companies collect premiums to provide for this Protection. A loss is paid out of the amount premiums collected from the insuring public and the Insurance Companies act as trustees to the collected.

Need of insurance Insurance is desired to safeguard oneself and one's family against possible losses on Account of risks and perils. It provides financial compensation for the losses suffered due to the happening of any unforeseen events. By taking life insurance a person can have peace of mind and need not worry about the financial consequences in case of any untimely death. Certain Insurance contracts are also made compulsory by legislation. For example, Motor Vehicles Act 1988, stipulates that a person driving a vehicle in a public place should hold a valid insurance policy covering Act" risks. Another example of compulsory insurance pertains the Environmental Protection Act, wherein a person using

or to carrying hazardous substances (as defined in the Act) must hold a valid public liability (Act) policy. Insurance in India Insurance is a federal subject in India and has a history dating back to 1818. Life and General insurance in India is still a nascent sector with huge potential for various global players with the life insurance premiums accounting to 2.5% of the country's GDP while general insurance premiums to 0.65% of India's GDP. The Insurance sector in India has gone through a number of phases and changes, particularly in the recent years when the Govt. of India in 1999 opened up the insurance sector by allowing private companies to solicit insurance and also allowing FDI up to 26%. Ever since, the Indian insurance sector is considered as a booming market with every other global insurance company wanting to have a lion's share. Currently, the largest life insurance company in India is still owned by the government. History of Insurance in India. Insurance in India has its history dating back till 1818, when Oriental Life Insurance Company was started by Europeans in Kolkata to cater to the needs of European community. Pre-independent era in India saw discrimination among the life of foreigners and Indians with higher premiums being charged for the latter. It was only in the year 1870, Bombay Mutual Life Assurance Society, the first Indian Insurance company covered Indian lives at normal rates. At the dawn of the twentieth Century, insurance companies started mushrooming up. In the year 1912, the Life Insurance Companies Act, and the Provident Fund Act were passed to regulate the Insurance business. The Life Insurance Companies Act, 1912 made it necessary that the premium rate tables and periodical valuations of companies should be certified by an actuary. However, the disparage still existed as discrimination between Indian and Foreign companies. The oldest existing insurance company in India is National Insurance Company Ltd, which was founded in 1906 and is doing business even today. The Insurance industry earlier consisted of only two state insurers: Life Insurers i.e. Life Insurance Corporation of India (LIC) and General Insurers i.e. General Insurance Corporation of India (GIC). GIC had four subsidiary companies. With effect from December 2000, these subsidiaries have been de-linked from parent company and made as independent insurance companies:

Oriental Insurance Company Limited, New India Assurance Company Limited, National Insurance Company Limited and United India Insurance Company Limited. Life Insurance Corporation Act, 1956 Even though the first legislation was enacted in 1938, it was only in 19 January 1956, that life insurance in India was completely nationalized, through a Government Ordinance; the Life Insurance Corporation Act, 1956 effective from 1.9.1956 Was enacted in the same year to, inter-alia, form LIFE INSURANCE CORPORATION after nationalization of the 245 companies into one entity. There were 245 insurance companies of both Indian and foreign origin in 1956. Nationalization was accomplished by the govt. acquisition of the management of the companies. The Life Insurance Corporation of India was created on 1 September, 1956, as a result and has grown to be the largest insurance company in India as of 2006.

General Insurance Business (Nationalization) Act, 1972 The General Insurance Business (Nationalization) Act, 1972 was enacted to nationalize the 100 odd general insurance companies and subsequently merging them into four companies. All the companies were amalgamated into National Insurance, New India Assurance, Oriental Insurance, and United India Insurance which were headquartered in each of the four metropolitan cities.

Insurance Regulatory and Development Authority (IRDA) Act, 1999 Till 1999, there were not any private insurance companies in Indian insurance sector. The Govt. of India then introduced the Insurance Regulatory and Development Authority Act in 1999, thereby de-regulating the insurance sector and allowing private companies into the insurance. Further, foreign investment was also allowed and capped at 26% holding in the Indian insurance companies. In recent years many private players entered in the Insurance sector of India. Companies with equal strength started competing in the Indian insurance market. Currently, in India only 2 Million people (0.2 % of total population of 1 billion), are covered under Medi claim, whereas in developed nations like USA about 75 % of the total Population is covered under some insurance scheme. With more and more private Players in the sector this scenario may change at a rapid pace.

Different Insurance Companies Insurance is an upcoming sector, in India the year 2000 was a landmark year for life Insurance industry, in this year the life insurance industry was liberalized after more than fifty years. Insurance sector was once a monopoly, with LIC as the only company, a public sector enterprise. But nowadays the market opened up and there are many private players competing in the market. There are fifteen private life insurance companies has entered the industry. After the entry of these private players, the market share of LIC has been considerably reduced. In the last five years the private players is able to expand the market (growing at 30% per annum) and also has improved their market share to 18%.For the past five years private players have launched many innovations in the industry in terms of products, market channels and Advertisement of products, agent training and customer services etc. The various life Insurers entered India:1. Bajaj Allianz Life Insurance Company Limited 2. Birla Sun Life Insurance Co. Ltd 3. HDFC Standard life Insurance Co. Ltd 4. ICICI Prudential Life Insurance Co. Ltd. 5. ING Vysya Life Insurance Company Ltd. 6. Max New York Life Insurance Co. Ltd 7. Met Life India Insurance Company Ltd. 8. Kotak Mahindra Old Mutual Life Insurance Limited 9. SBI Life Insurance Co. Ltd 10. Tata AIG Life Insurance Company Limited 11. Reliance Life Insurance Company Limited. 12. Aviva Life Insurance Co. India Pvt. Ltd. 13. Sahara India Life Insurance Co, Ltd. 14. Shriram Life Insurance Co, Ltd. 15. Bharti AXA Life Insurance Company Ltd. 16. Future General Life Insurance Company Ltd. 17. IDBI Fortis Life Insurance Company Ltd. 18. Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd 19. AEGON Religare Life Insurance Company Limited. 20. DLF Pramerica Life Insurance Co. Ltd. 21. Star Union Dai-chi Life Insurance Comp. Ltd.

The various other general Insurance Companies are as under:1. National Insurance Company Limited. 2. Reliance General Insurance. 3. Star Health plus Insurance. 4. Oriental Insurance Company. 5. United India Insurance Company Ltd. 6. Bajaj Allianz General Insurance Company Ltd. 7. Future General Insurance Company Ltd. 8. ICICI Lombard General Insurance Ltd.

ABOUT HEALTH INSURANCE How many accident you need to realize that you need Health Cover? It takes just one visit to a hospital to make us realize how vulnerable we are, every passing second. For the rich as well as poor, male as well as female and young as well as old, being diagnosed with an illness and having the need to be hospitalized can be a tough ordeal. Heart problems, diabetes, stroke, renal failure, cancer the list of lifestyle diseases just seem to get longer and more common these days. Thankfully there are more specialty hospitals and specialist doctors but all that comes at a cost. The super rich can afford such costs, but what about an average middle class person. For an illness that requires hospitalization/ surgery, costs can easily run into five digit bills. A Health insurance policy can cover such expenses to a large extent. Health Insurance continues to be one of the most rapidly growing sectors in the Indian insurance industry with premium to the tune of `11,480 crore underwritten in 2010-11, reporting growth of 38.22 per cent over the premium written in 2009-10 (`8,305 crore).

Health Insurance Co. Ltd., Star Health and Allied Insurance Co. Ltd. and Max Bupa Health Insurance Co.Ltd. Contributed to Health insurance business. The total premium underwritten by the standalone Health insurers stood at `1,536 crore in 2010-11 (`1,072 crore in 2009-10).

Types of Health Insurance

There are mainly three types of Health Insurance covers:

Individual Mediclaim: The simplest form of health insurance is the Individual Mediclaim policy. It covers the hospitalization expenses for an individual for up to the sum assured limit. The insurance premium is dependent on the sum assured value. Example: If you have 3 family members you can get an individual cover of Rs 2 lacs each. In this case each of you are covered for 2 lacs, if 3 members face a need for hospitalization, all 3 of them can get expenses recovered up to Rs 2 lacs. All the 3 policies are independent.

Family Floater policy: Family Floater Policies are enhanced version of the Mediclaim policy. The sum assured value floats among the family members. I.e. each opted family member comes under the policy, and it covers expenses for the entire family up to the sum assured limit. The premium for family floater plans is typically less than that for separate insurance cover for each family member. Example: In this case if suppose there are 3 family members, you can take a Family floater policy for Rs 6 lacs in total. Now anyone can claim up to 6 lacs in expenses, but then the cover will go down by that much amount for that year. So if one of the family members is hospitalized and the expenses are 4.5 lacs. It will be paid and then the cover will be reduced to 1.5 lacs for that particular year. Next year again it will start from fresh 6 lacs. Family floater makes sense for a family because that way each one in family gets a big cover and probability of more than 1 getting hospitalized in same year is too low until and unless whole family is travelling together most of the times in a year.

Unit Linked Health Plans: Taking the ULIP route, health insurance companies too have introduced Unit Linked Health Plans. Such plans combine health insurance with investment and pay back an amount at the end of the insurance term. The returns of course are dependent on market performance. These plans are very new and still in development phase. This is only recommended for people who can handle market linked products like ULIP and ULPP.

For a number of reasons, it is advisable to steer clear of unit linked health plans. The best way is to treat insurance purely as an expense. So if you are single, opt for an Individual Mediclaim policy and if you have family, opt for a Family Floater policy. The amount paid (by cheque or debit/ credit card) for health insurance premium provides tax exemption under section 80D for a maximum of Rs.15, 000. What is the Ideal Cover for Health Insurance As mentioned earlier, the cost of Health Insurance depends on the sum assured, age, current health condition and your previous medical history. Higher the sum assured, higher the premium. So what is the ideal health insurance cover requirement? There is no standard answer or thumb rule for this. If we agree that health insurance is important, one has to look at his/ her own lifestyle, health condition, age/ life stage, family history of illnesses and affordability. Keep in mind that most insurance companies limit the sum assured to a maximum of 5 lakhs. Also note that many health insurance policies provide additional benefits such as daily allowance, ambulance charges, etc. for hospitalization. Not only are such benefits superfluous, they tend to drive the premiums higher. So it is best to avoid such plans and stick to something basic and simple. Health Insurance provided by Employer Many employers provide health cover for their employees. Isnt that sufficient? Three aspects need to be considered in such a case Is that cover sufficient? Is the insurer good enough? What happens if you change your job? Health insurance is provided as a perk to the employees. So it is important to understand the policy a bit more in detail and to check for coverage. The best way is to ask the HR Department for policy details. Get into details, what is covered, what is not covered? Many times Employees just think that they have health Insurance and are just relaxed only to find later that it does not cover X and covers Y only up to a limit . That can be a painful situation. Health Insurance for the aged Till a few years back, health insurance companies were reluctant to provide cover for the aged. But nowadays there are a lot of insurance companies providing policies for the senior citizens. Insurance cover paid for a person of age 65 years and above, can provide additional tax exemption of up to Rs.20, 000. But keep in mind that the premium rates are

higher for senior citizens. For the employed, another option is to approach the employer to negotiate with the official insurer to provide an option for additional cover to parents. Since the volumes are high, the insurer can provide such added cover at attractive premium rates. Tax Exemption from Health Insurance Premiums Sec 80D covers Health Insurance. You can get exemptions of

Up to Rs. 15,000 paid for self + spouse + children. Up to Rs 15,000 paid for Parents (Rs 20,000 if parents are senior citizens)

So in total if you pay your health insurance and your parents health Insurance premium, you can save up to maximum of 35,000. Note: If you take Health Insurance riders with Term Insurance like Critical Illness cover, the extra premium paid for that will be actually be covered under Sec 80D not sec 80C.See Tax Rules What is TPA (Third Party Administrators)? TPA stands for Third Party Administrator. TPA is a middleman between Insurer and the Customer. Customer can directly deal with TPA at the time of claim and TPA will help with all the process of claim settlement. A TPA is a specialized health service provider rendering variety of services like networking with hospitals, arranging for hospitalization and claim processing and settlement. The concept of TPA has been introduced by the IRDA (Insurance Regulatory and Development Authority of India) for the benefit of both the insured and the insurer. While the insured is benefited by quicker & better health service, insurers are benefited by reduction in their administrative costs, fraudulent claims and ultimately bringing down the claim ratios. An insurance company can have more than one TPA and a TPA can serve more than one insurance company. Some of the services TPA provides are

Maintain database of policyholders Issue of identity card to all policyholders Provide ambulance service

Provide information to policyholders about hospitals. Check various investigations Provide Cashless service Process claims

Health Insurance Claims settlement process A bit on how health insurance claims processing works. In most cases, the Insurance companies appoint a third part administrator (TPA) for claims processing. That means once the health insurance policy is sold, the insurer passes on the baton to the TPA. In case of a claim, the insured has to get in touch with the TPA for all versification and formalities. There are 2 ways by which health insurance claims are settled:

Cashless: For availing cashless treatment (only at authorized network hospitals), the TPA has to be notified in advance (for planned hospitalization) or within the stipulated time limits (for emergencies). The insurance desk at hospitals usually helps with all paper work. The claim amount need to be approved by the TPA, and the hospital settles the amount with the TPA/ Insurer. Typically there will be exclusions and such amount will have to be settled directly at the hospital.

Reimbursement: Reimbursement facility can be availed at both the network and non-network hospitals. Here the insured avails the treatment and settles the hospital bills directly at the hospital. The insured can claim reimbursement for hospitalization by submitting relevant bills/ documents for the claimed amount to the TPA.

The TPA mode of claims settling has its own problems. The TPA is incentivized to limit insurance claims and they are not the ones who sell the policy. There are many cases where the insured had a tough time to claim for his hospital expenses. So before taking health insurance it would be useful to check who the TPA is and how good are they when it comes to claims processing. Internet search and a friendly chat with the hospital staff can give you good insight on the insurer/ TPA. There are also some health insurance providers who do not employ TPAs and does claims settlement directly (this is called Inhouse TPA

Health Insurance Data Report -2010 2011

Health Insurance Data Report
The data received from TPAs/ Insurers for the year 2010-11 has been analyzed and the following reports are generated for the information of all the stake holders. HR-1: Policies, Insured Members and Claims Year Number of Policies Number Members 2003-2004* 2004-2005* 2005-2006* 2006-2007* 2007-2008* 2008-2009* 2009-2010** 2010-2011** 22,65,451 20,59,449 38,28,495 31,10,475 37,90,838 45,75,725 68,84,687 77,42,076 83,61,629 89,87,239 1,63,45,575 1,79,07,430 2,41,21,625 3,27,10,604 5,48,93,453 5,25,08,111 3,60,088 5,55,273 10,16,785 10,60,047 14,36,998 20,81,297 32,63,597 38,43,285 of Number of Claims

NB: Member - insured person(s) covered under the policy 1. * Policies serviced by TPAs only. 2. ** Figures of Policies serviced by TPAs and directly serviced by Insurers HR-2: Total Premium, Total Claim Paid and Claim Ratio Period Premium (` in Crs.) 2003-2004* 2004-2005* 2005-2006* 2006-2007* 2007-2008* 2008-2009* 2009-2010** 944 987 1,947 2,820 2,758 3,976 7,803 Claims paid (` In Crs.) 785 948 1,777 2,198 2,904 4,087 7,456 Claims Paid Ratio % 83% 96% 91% 78% 105% 103% 96%

2010-2011**

10,932

10,797

99%

1. Policies serviced by TPAs only. 2. Figures of Policies serviced by TPAs and directly serviced by Insurers

HR-3: Average Premium, Average Claim Paid and Average Person Insured per Policy and per Member Period Premium per Premium per Number Policy (in `) Insured Member (in `) 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 4,166 4,792 4,892 9,067 7,275 8,689 11,333 14,120 1,129 1,098 1,146 1,575 1,143 1,216 1,421 2,082 Persons Insured Policy 4 4 4 6 6 7 8 6 3,465 4,606 4,642 7,066 7,661 8,932 10,910 13,946 939 1,055 1,040 1,227 1,204 1,249 1,368 2,056 of Claim Paid per Policy per (in `) Claims Paid per insured

member (in `)

HR-4: Number of Claims, Claim Paid an Average Claim Paid during 2010-2011 - by Gender Gender Number of Claims Claims Paid (` in crs.) Average Claims Paid (in `) Male Female Gender not Specified Total 18,01,949 15,65,370 4,75,966 38,43,285 4,037 3,174 3,586 10,797 22,402 20,279 75,335 28,093

NB: Error records are those for which either the field is not filled up by TPAs/ Insurers or no coding was adopted by TPA/Insurers.

HR-5: Number of Claims, Claim Paid and Average Claim Paid during 2010-2011 by Age Age-band(in Years) Up to 1 Above 1 - 5 6 - 15 16 - 25 26 - 40 41 - 60 61 - 65 66 - 70 Above 70 Age Not Specified Total Number of Claims 83,800 1,25,335 2,04,237 4,09,029 10,07,898 11,06,026 2,43,676 1,69,611 1,55,990 3,37,683 38,43,285 Claim Paid (` in Crs.) 117 140 263 642 1,918 2,685 729 535 547 10,249 10,797 Average Claim Paid 13,928 11,171 12,869 15,704 19,026 24,274 29,911 31,544 35,097 3,03,519 28,093

NB: Age not specified: - Date of birth / Age field not filled in by the TPA/ Insurers HR 5.1: Numbers of Members, Amount of Sum Insured and Numbers of Claims, Amount of Claim Paid for INDIVIDUAL COVER during 2010-11 - by Age Age-Band ( in Years) Members Up to 1 2-5 6-15 16-25 26-40 41-60 61-65 66-70 Above 70 AgeNotSpecifie Total Claims 3,90,617 6,26,070 18,14,029 19,24,436 39,81,115 37,24,929 4,08,227 2,40,160 1,92,848 69,901 1,33,72,332 60,528 68,831 85,122 2,34,870 5,67,170 4,90,000 1,32,707 93,823 79,715 18,12,766 Number of Members Total amount of Claim Paid(in `) 90,77,86,693 69,54,46,359 80,96,29,195 3,51,76,86,569 11,33,91,98,178 12,11,46,14,218 4,06,34,22,352 2,96,27,86,588 2,75,04,45,139 39,16,10,15,291

Sum Insured (in `)

57,50,18,25,110 80,40,45,14,986 2,35,26,40,85,85 4,47,02,09,28,94 8,17,04,59,52,87 7,63,36,83,30,09 79,86,91,42,407 42,35,31,07,281 29,47,82,81,381 39,89,02,500 25,52,70,50,71,4

33

HR-6: Number of Claims Paid during 2010-2011 by Gender and Age Age-Band ( in Years) Male Up to 1 Above 1 - 5 6 15 16 25 26 40 41 60 61 65 66 70 Above 70 46,227 69,041 1,25,364 1,91,801 4,58,045 5,64,868 1,36,397 1,00,594 96,829 Female 30,563 46,655 74,915 2,00,634 5,04,921 4,99,277 93,268 59,231 50,876 4,93,779 15,60,340 38,43,285 Number of Claims Total 76,790 1,15,696 2,00,279 3,92,435 9,62,966 10,64,145 2,29,665 1,59,825 1,47,705

Age and Gender not provided Total 17,89,166

NB: Age and gender not specified: - Date of birth / age/ gender details not provided by the TPA/Insurers HR-7: Type of Cover, Number of Policies and Premium during 2010-2011 Type of Policy Number Policies Individual Individual Floater Group Group Floater 40,829 1,69,512 1,117 4,998 58 0.53% 2.19% 2.06% 10.22% 45.72% 0.53% 51,34,700 21,03,300 of Policy Premium Share in Total Share in Total (` in Crs. 2,979 1,521 Policies 66.32% 27.17% Premium 27.25% 13.91%

Declaration and 1,59,175 Others Not Specified Total 1,34,560 77,42,076

259 10,932

1.74% 100.00%

2.37% 100.00%

NB: Individual Policy issued to individuals includes individuals and members of the family, Group Policy issued to other than individuals, Individual Floater Individual policies having floater Sum insured for the family, Group Floater. HR-9: Number of Claims and Average Claim Paid for 2010-11 - by State NB: States have been classified on the basis of postal pin codes as given in the hospital pin code field. State Maharashtra Uttar Pradesh Karnataka Tamil Nadu Gujarat Delhi West Bengal Andhra Pradesh Kerala Haryana Bihar Madhya Pradesh Punjab Rajasthan Chhattisgarh Orissa Jharkhand Himachal Pradesh Assam States with <10000 Claims Pin codes not Provided Total Number of Claims 4,76,438 2,66,196 2,29,414 2,14,976 2,13,028 1,67,621 1,62,040 1,46,514 1,05,771 1,00,249 34,016 32,313 29,670 27,243 21,266 18,599 17,302 12,265 10,124 23,708 15,34,532 38,43,285 Average Claim Paid (in `) 28,344 9,927 24,969 23,786 21,345 29,589 25,650 26,119 11,810 21,268 7,073 16,836 18,672 17,904 6,735 16,979 7,695 3,657 10,734 15,753 37,251 28,093

HR-12: Frequency of Claims by Gender and Age-Groups (in %) during 2010-11 12.1: Male
Disease Name Up to 1 2-5 6 - 15 16 - 25 26 - 40 Age Band (in Years)/ Frequency 41 - 60 61 - 65 66 - 70 Above 70 Year Accident Arthropathies Blood diseases Circulatory Clinical findings Codes for 0.0304 0.0295 0.0838 0.0666 1.1008 0.0002 0.0246 0.0405 0.0377 0.0538 0.6796 0.0004 0.0177 0.0405 0.0156 0.0352 0.3644 0.0238 0.0823 0.0167 0.0680 0.4440 0.0000 0.0228 0.1489 0.0235 0.2235 0.4219 0.0000 0.0330 0.2674 0.0454 1.0902 0.5010 0.0001 0.0317 0.4212 0.0934 2.3903 0.6448 0.0340 0.5308 0.1181 3.1638 0.8042 0.0342 0.5266 0.1373 3.1304 0.8493 0.0004 0.0257 0.1689 0.0349 0.5566 0.4863 0.0001 Total

special purposes

Digestive Ear Endocrine Eye Health services related Infectious Injury Malformations/ deformations Mental disorders Neoplasm Nervous Respiratory Skin Urology Diseases specified Total not

0.7475 0.0203 0.0677 0.0385 0.0642

0.3887 0.0271 0.0267 0.0439 0.0194

0.3383 0.0318 0.0250 0.0308 0.0168

0.4212 0.0394 0.0267 0.0459 0.0216

0.6319 0.0507 0.0574 0.0833 0.0439

0.9053 0.0575 0.2265 0.8423 0.1055

1.2495 0.0607 0.4673 3.1268 0.2446

1.4474 0.0641 0.5700 4.5212 0.2765

1.3315 0.0594 0.5288 3.8558 0.2584

0.6655 0.0471 0.1201 0.5139 0.0662

2.2128 0.3392 0.0781

1.3226 0.4128 0.0264

1.0542 0.4291 0.0125

1.0316 0.5511 0.0146

0.9030 0.6004 0.0142

0.8125 0.7489 0.0142

0.7198 0.7897 0.0167

0.8202 0.9440 0.0265

0.8006 0.9608 0.0205

0.9569 0.6117 0.0163

0.0064

0.0143

0.0264

0.0102

0.0070

0.0094

0.0149

0.0209

0.0268

0.0118

0.0751 0.1345 2.0414 0.0786 0.3340 3.3613

0.0727 0.0933 1.1915 0.0646 0.2801 1.5295

0.0427 0.0619 0.3889 0.0510 0.1473 1.5322

0.0408 0.0454 0.2539 0.0778 0.2591 1.6120

0.0784 0.0561 0.2916 0.0926 0.4450 2.0419

0.3044 0.1219 0.4475 0.1592 0.7688 3.4526

0.8610 0.2524 0.6938 0.2303 1.6394 4.0007

1.2180 0.3658 1.0220 0.2586 1.8984 4.6950

1.1966 0.4601 1.2698 0.2396 1.8753 4.0623

0.1922 0.0947 0.4588 0.1099 0.5410 2.3953

10.911 0

6.3498

4.6622

5.0862

6.2378

10.913 7

17.949 1

22.799 5

21.624 6

8.0738

Total frequency = no. of claims in age/no of total exposure in age group*100) (Disease-wise frequency = no of claims for the disease in the age/no. of total exposure in age group*100)

12.2 Female
Disease Name Up to 1 accident arthropathies blood diseases circulatory clinical findings codes for special purposes digestive ear endocrine eye healthservicesrelat infectious injury malformations/def ormations mental disorders neoplasm nervous perinatalperiodcon pregnancy respiratory skin urology diseases specified Total 9.1118 5.0936 3.5231 7.2994 9.2659 11.337 7 18.303 1 21.554 8 21.723 6 9.1741 not 0.0039 0.0796 0.0993 1.3183 0.0957 1.6045 0.0799 0.1902 1.3279 0.0066 0.0590 0.0635 0.0665 0.0237 0.9847 0.0555 0.1463 1.1205 0.0134 0.0380 0.0506 0.0467 0.0079 0.3184 0.0421 0.1078 1.0986 0.0096 0.0909 0.0571 0.1016 1.9582 0.2708 0.0696 0.4061 1.6486 0.0093 0.2970 0.0670 0.1372 2.1013 0.2974 0.0802 0.7594 2.2308 0.0101 0.9368 0.1121 0.0776 0.0177 0.3842 0.1158 1.0757 3.0276 0.0159 1.2658 0.2015 0.1378 0.0169 0.6660 0.1558 1.2652 3.6837 0.0204 1.3185 0.2970 0.1707 0.0218 0.8628 0.1907 1.3483 3.9943 0.0239 1.0205 0.4219 0.1366 0.0414 1.2105 0.2143 1.1986 3.5504 0.0104 0.4352 0.0881 0.1247 0.9999 0.4136 0.0874 0.6887 2.2127 0.6016 0.0179 0.0716 0.0444 0.0856 1.9411 0.2758 0.0653 0.3275 0.0230 0.0234 0.0468 0.0215 1.1334 0.2833 0.0167 0.2886 0.0266 0.0251 0.0288 0.0130 0.8344 0.1824 0.0108 0.4887 0.0492 0.0426 0.0529 0.1589 0.9958 0.2414 0.0148 0.6880 0.0730 0.0802 0.0869 0.2021 0.9018 0.4260 0.0159 0.8066 0.0891 0.2280 1.0119 0.1313 0.8070 0.7595 0.0134 1.0334 0.0842 0.4504 3.8222 0.2553 0.8187 1.1141 0.0124 1.1216 0.0833 0.5353 4.9219 0.2038 0.8232 1.3669 0.0262 1.1422 0.0662 0.6456 4.1683 0.2101 1.0128 1.6981 0.0167 0.6387 0.0641 0.1285 0.5568 0.1427 0.9142 0.4945 0.0155 0.0203 0.0286 0.0614 0.0575 1.0414 0.0191 0.0285 0.0341 0.0430 0.5671 0.0001 0.0100 0.0322 0.0206 0.0314 0.2956 0.0112 0.0702 0.0356 0.0637 0.4619 0.0125 0.1513 0.0417 0.1485 0.4585 0.0180 0.4480 0.0634 0.6564 0.5475 0.0000 0.0247 0.8937 0.0934 1.6457 0.6464 0.0229 1.1350 0.1201 2.2315 0.7384 0.0004 2-5 6 - 15 16 - 25 26 - 40 Age Band (in Years)/ Frequency 41 - 60 61 - 65 66 - 70 Above 70 0.0282 1.0175 0.1503 2.8211 0.9283 0.0147 0.2411 0.0480 0.3594 0.4954 0.0000 Total

Total frequency = no. of claims in age/no of total exposure in age group*100) (Disease-wise frequency = no of claims for the disease in the age/no. of total exposure in age group*100)

CHAPTER-3
REVIEW OF LITERATURE
Several researchers have considered the concept of patient satisfaction. After reviewing some of the earlier (pre-1975) literature in the area of patient satisfaction in general, Luft (1981) characterized satisfaction as being related to access, availability of resources, and continuity of care, information transfer, humaneness, and quality. Higgins et al. (1991) suggest ten dimensions of quality that are specific to Health Maintenance Organizations (HMOs): reliability, responsiveness, competence, access, courtesy, communication, credibility, security, knowing the customer, and tangibles, such as written communications and billing procedures. Researchers who empirically examined consumer satisfaction with health care in general have suggested that satisfaction is influenced by aspects of care that are specific to the health care experience (Abramowitz, Cote, and Berry 1987; Cleary and McNeil 1988; de Ruyter and Scholl 1994; Doering 1983; Meterko, Nelson, and Rubin 1990; Russell 1990; Strasser, Aharony, and Greenberger 1993; Ware and Snyder 1975; Woodside, Frey, and Daly 1980) and that consumers are able to form summary measures of their satisfaction based on their satisfaction with components of care (Aharony and Strasser 1993; Luft 1981; Strasser, Aharony, and Greenberger 1993). Quality of care, access to care, availability of resources, and continuity of care accounted for 72 percent of the variance in satisfaction in a study by Ware and Snyder (1975), while Russell (1990) found that quality of care and accessibility accounted for 64 percent of the variance in satisfaction. Ward (1990) focused on age as an input into satisfaction with HMOs. These findings indicate that age, increases in acceptance of providers other than the primary care physician, ability to see the primary care physician, and familiarity with the plan all positively influence consumer satisfaction with HMO services. Some researchers have focused specifically on the process of health care delivery (distinct from the physical outcome) as being a major influence on consumer perceptions of satisfaction with medical services (Buller and Buller 1987; Street and Wiemann 1987; Woolley, Kane, Hughes, and Wright 1978). Swan (1992) has suggested that the formation of patient satisfaction perceptions is based on a reciprocal process that is influenced by both the consumer and provider of medical services. This view of satisfaction is an extension of the expectation/disconfirmation model (Cardozo 1965;

Oliver 1980) and is complementary to the work of Woodruff et al. (1983) and Oliver (1989) who assert that consumers develop a set of experience-based norms on which they judge whether their expectations are confirmed or disconfirmed. It is Swan's (1992) proposition that "patient expectations and standards for performance are negotiated as health care providers attempt to change unrealistic patient expectations/performance standards" This idea is of potentially great importance when examining consumer satisfaction with managed care, as consumers may have preconceived perceptions. The creation of a new customer is often the result of promotional efforts and word-of mouth communications which are responsible for initial expectation formation and service trial. The ability to "keep" a customer depends on consumer satisfaction. Organizations attempt to develop consumer loyalty and repeat patronage by insuring that customers are satisfied with the service experience. In general terms, consumer satisfaction is posited to result if the consumer experiences consistent delivery of expected levels of service quality and has their psycho-social needs met in the service encounter. Many successful services marketers tend to "under promise and over deliver," thereby creating lowered consumer expectations which can be easily exceeded by the service provider (Davidow and Uttal 1989; Zeithaml, Bitner, and Grimler 2006).

However, as the "under promised - over delivered" axiom implies, less successful service firms may "over promise and under deliver." This condition suggests that some firms may not comprehend the importance of "managing" consumer expectations.

Consumers now expect firms to deliver unprecedented levels of quality (Leonard and Sasser 1982; Olson and Johnson 2003; Takeuchi and Quelch 1983). Many manufacturing firms have lost market share to higher quality imported products and there now exists a perceived threat from abroad to the dominance of U.S. firms in the service sector (Quinn and Gagnon 1986). Consequently, the quest for quality is one of the dominant issues facing most industries. Managers have become obsessed with the challenge of further understanding how to enhance the organizations ability to produce high-quality goods and services.

The strategic benefits accruing to organizations that achieve consistent levels of quality are based on attaining profitable differentiation in the marketplace (Garvin 1987; Porter 1980). Unlike other elements of marketing strategy (i.e., product, price, promotion, and place) which cane more readily imitated, quality is much more difficult to achieve and maintain (Crosby 1979).Therefore, competing on the basis of quality not only creates a differential position for the firm in the marketplace, but may also pose a significant barrier to competitive entry.

Several studies based on PIMS (Profit Impact of Marketing Strategy) data support the Strategic role of quality in creating and maintaining competitive advantage (Jacobson and Aaker1987; Phillips, Chang, and Buzzell 1983). These research findings suggest that the specific benefits an organization may expect from the pursuit of a quality-focused market strategy include:(1) positive effects on market share and return-on-investment (Anderson and Zeithaml 1984; Jacobson and Aaker 1987; Phillips et al.1983); (2) reduced production costs and the ability to charge a higher price (Jacobson and Aaker 1987; Phillips et al. 1983); and (3) improved productivity (Garvin 1983). The opportunity for achieving such strategic benefits has resulted in increased attention to and investment in quality improvement efforts by both product and service producing organizations.

On an individual consumer level, the result of a strategic quality emphasis is customer Satisfaction. Indeed, satisfying consumer needs is the cornerstone of the marketing concept (Kotler and Keller 2006). Most practitioners and academicians generally agree that satisfaction is an important concept because it is thought to be a major determinant of: (1) product/service acceptance; (2) repeat sales; (3) word-of-mouth communications; and (4) consumer loyalty (Bearden and Teel 1983; Boulding et al. 1993; Churchill and Surprenant 1982; Zeithaml et al. 1993). These four factors are critical to the long-term survival of both product and service-based organizations. Thus, issues related to quality and consumer satisfaction are of primary importance to marketing practitioners.

Nowhere is the need for quality-focused strategy more apparent than in the service sector. One reason is that many service firms have great difficulty producing consistent levels of service quality (Quinn and Gagnon 1986; Schlesinger and Heskett 1991). A related issue concerns the fact that despite tremendous growth among most service industries in

recent years, service providers are facing major environmental challenges. Overcapacity in service industries (e.g., airline, legal, and financial), changes in professional standards (e.g., medical and legal advertising), competition from non-traditional service providers (e.g., chiropractors, retailers in financial services, and industrial firms in insurance/credit markets), deregulation, and rapid innovation in-service delivery technology are making strategic and tactical decision-making more difficult. Managers are seeking sustainable strategies that are difficult to duplicate in order to survive in a chaotic marketplace (Heskett 1986; Roach 1991). The historical performance of many U.S. manufacturing firms serves as testimony to the fact that an organizations inability to meet consumer expectations could foreshadow major losses of market share and profitability.

The health care industry, the specific context for the present study, now represents almost 20 percent of domestic GNP and is one of the single largest segments of the economy. Recently, payers (i.e., corporation, insurance companies, and government) have attempted to control rampant price inflation by becoming more diligent in regulating and reducing reimbursement for health care services. This has led to intense competition among health care providers for market share. Indeed, because of these factors and other concerns, healthcare has emerged as an issue of national import. The most widely discussed model guiding health care reform efforts at the federal level (i.e., managed competition) promises even more competition between providers as well as increased emphasis on cost-effective services and continuous improvement in outcomes.

The strategic importance of service quality and patient satisfaction in health care has been receiving increasing attention in the literature. Research suggests that consumer perceptions of service quality are an important determinant in attitudes toward health care providers (Crane and Lynch 1988; Lane and Linquist 1988; Leebov and Afriat 1988; Lim and Zallocco 1988; MacStravic 1987; Rahtz and Moore 1988; Woodside and Shinn 1988). Despite consensus that patient satisfaction and service quality are critical to competitive advantage in health care markets, the literature suggests that health care services are perceived by consumers as the most dissatisfying of all professional services (Quelch and Ash 1981) and malpractice litigation against health care providers is becoming more widespread (Brown and Swartz 1989). These observations suggest that the health care industry is doing a poor job in understanding and meeting consumer expectations.

Several scholars have noted the importance of expectations in consumer evaluation of health care. In a hospital based empirical study of in-patient, out-patient, and emergency room services, Reidenbach and Sandifer-Smallwood (1990) found that "patient confidence" was the single most important factor in explaining variability in ratings of service quality, patient satisfaction, and willingness to recommend. The patient confidence construct included traditional measures of attribute expectations. Similarly, in a study of primary care clinics, Brown and Swartz (1989) found that inconsistent perceptions of expectations and experiences between patients and providers negatively impact consumer perceptions of service quality.

Hospital satisfaction studies (Romano 2005) have shown that most patients are either. Delighted. (33%) or .pleased. (41%). On the surface this result appears positive until it is viewed through the lens of recent satisfaction research. Several studies have found that just satisfying or .pleasing. The customer does not result in brand loyalty (Oliver ET al.1997; Ganesh et al. 2000). This research suggests that many .satisfied. Customers are prone to .switching. Behavior. Therefore, in the hospital context almost 70% of the patients are .at risk.

Changes in the availability of standardized hospital quality and patient satisfaction Information reinforce the importance of the developing greater insight into the expectation formation process in the health care context. As such, researchers in the services marketing and health care literature have called for further theoretical and methodological investigation of psycho-social influences on expectation formation processes (Bandura 2005; Brown and Swartz 1989; Ross et al. 1987).

EXPECTATION FORMATION "Great service providers inform customers about what to expect and then exceed the Promise." - Davidow and Uttal (1989) despite widespread support for the importance of expectations in service quality and consumer satisfaction processes, few models of expectation formation have appeared in the literature (Oliver and Winer 1987; Zeithaml et al.1993). Indeed, Zeithaml and her colleagues (1993, p.2) remark that "one relatively unexplored area of research involves the sources of consumer expectations." In discussing

the nature of the consumer expectation formation process, Davidow and Uttal (1989) note: "Expectations are formed by many uncontrollable factors, from the experience of customers with other companies and their advertising to a customers psychological state at the time of service delivery. Strictly speaking, what customers expect is as diverse as their education, values, and experiences."

Oliver and Winer (1987) proposed a theoretical framework for consumer expectation formation which includes the myriad of consumer-related factors Davidow and Uttal (1989) allude to above.mWhile this framework has not been empirically investigated, these researchers suggest that scholarly effort in the areas of economics, psychology/sociology, and marketing all contribute to the theoretical development of the expectation construct. Gives an overview of the

Oliver and Winer framework. Included are (1) the dimensions of service expectations role, process, outcome, and service quality; and (2) psychosocial and behavioral antecedents and mediators of expectation formation - locus of control, perceived risk, past experience, perceived social support and information search.

Conceptual Definition of Expectations A number of definitions have been suggested in the various literatures for the expectation construct. One of the earliest is the economist Shackles (1952) notion that the formation of an expectation involves the creation of mental images of a situation (i.e., scripts or schemas),m associating the images with a future time, and developing scaled measures as to the degree of belief that the situation will indeed occur. Another economist, Georgescu-Roegen (1958, p.12), defines expectations as "... the state of mind of a given individual with respect to an assertion, a coming event, or any other matter on which absolute knowledge does not necessarily exist." Vroom (1964, p.15), building upon Skinners (1953) stimulus-response learning model, Suggests that expectations are "... a momentary belief concerning the likelihood that a particular act will be followed by a particular outcome." Psychologists Fishbein and Ajzen (1975, pp.23-24) note that an expectation is:

"...a belief about an object (e.g., medical treatment) and an attribute of that object (e.g. reduces pain). Beliefs are cognitive, constituting the information about objects from which attitudes are developed. In general, individuals have a small number of beliefs about an object but can add beliefs by receiving new information or by using past experience in combination with new information to create new, inferential beliefs.. Oliver and Winer (1987, p.487) define expectations of a product attribute as: "A consumers subjective evaluation of the value of that attribute at a particular point in Time. Value, in turn, is a function of ones evaluation of the subjective level of the Attribute, and further evaluations of the attributes uncertainty, ambiguity, and knowability."

Several implications arise from the various definitions presented above. Of primary concern is the fact that these definitions were generally developed in the context of understanding cognition and behavior from an object or product perspective. As a consequence, these definitions focus on expectations about "product attributes." Because many service offerings are intangible, inseparable, and heterogeneous, defining expectations in terms of "attributes" in the product sense may be an oversimplification. Various authors (Boulding et al. 1993; Ross et al. 1987; Smith and Houston 1983, 1986; Solomon et al. 1985; Surprenant and Solomon 1987 Zeithaml et al. 1993) point out that service expectations are multi-dimensional in nature and include expectations about: (1) consumer and provider roles in the service encounter; (2) the process of service delivery; (3) alternatives/outcomes associated with the service encounter; and (4) service quality attributes.

CHAPTER-4
RESEARCH METHODOLOGY
Research methodology is a very important part of any research of survey. Basically it is a technique & methods. Which we use in our project to get efficient results we should adopt an appropriate research methodology. In this project which is resulted for getting information about the customer satisfaction for health insurance in Rajasthan and to become aware about expectation of customers for health insurance, I have chosen a certain research methodology that is most appropriate for getting good. Efficient and complete result. Basically my project is related to survey of getting customer satisfaction about the health insurance. So I have taken all customers universe or population of survey that I have selected them as health insurance customers. According to different areas of Rajasthan I have conveniently selected 91 customers from all survey area. For project or survey my sample size was 91 customers. After selecting appropriate sample size I have prepare a good questionnaire to interview with customer and the interview was totally structured. My basic aim was to judge the satisfaction level of all customers and expectation about the health insurance. Data of health insurance were restricted to some information from the internet and company it so I relied more on primary information

Objective: The main objective to identify the factors of customer satisfaction & expectation and to analyze the response of customers towards health insurance.

Sample size Sampling unit Sampling procedure Research design Data collection method Data source Research instrument Type of questionnaire Type of question Area covered

174 customers customer of Rajasthan Purposive exploratory survey primary data questionnaire structured close ended & open ended Rajasthan

CHAPTER-5
DATA ANALYSIS 1. Gender
GENDER MALE FEMALE RESPONDENT 75 16 TABLE NO.1.1

16

MALE FEMALE

75

CHART NO.1.1

Interpretation-: In the above diagram, we found that majority of the respondent were male which constitute 82% of the sample population.

2. Age

S.NO. 1 2 3 4

AGE <25 YEARS 25YEARS-40YEARS 40YEARS-50YEARS >50 YEARS TABLE NO.1.2

1

RESPONDENT 49 38 3 1

38 49

<25 YEARS 25YEARS-40YEARS 40YEARS-50YEARS >50 YEARS

CHART NO. 1.2 Interpretation-: In the above diagram we found that majority of the respondent belongs to the age group of less than 25 years. More over 42% of the respondent were from the age group 25-30 years of age. Since the working force is maximum in India there for the sample will also contain respondent of age group 25-40.

3. Family annual income? S.NO INCOME RS.) 1 2 3 4 . <RS100000 RS.100000-RS.150000 RS.150000-RS.300000 . RS.300000-RS.600000 2 23 48 12 (INLAKH RESPONDENT

>RS.600000

TABLE NO.1.3

6 12

2 23 1 <RS.100000 2 RS.100000-RS.150000 3 RS.150000-RS.300000 4 RS.300000-RS.600000 5 RS.>600000

48

CHART NO. 1.3 Interpretation-: In the above diagram we found that the respondent has a annual income of RS.150000300000 there were also a few respondent who had an annual salary of more than 6, 00000, which constitute 7% of the sample size.

4. OCCUPATION?
S.NO 1 2 3 4 5 OCCUPATION PRIVATE EMPLOYEE PROFESSIONALS GOVERMENT EMPOLYEE BUSNIESS OTHER TABLE NO.1.4 RESPONDENT 33 7 12 26 13

occupation

13

33 PRIVARE EMPLOYEE PROFESSIONAL GOVT EMPLOYEE BUSNIESS 26 OTHERS

7 12

Interpretation-:

CHART NO.1.4

In the above diagram, the majority of respondent were private employee which constitute 36% of sample size. 12 respondents were government employee while 26 respondents had business of their own.

5. Are you insured? If yes go ahead S.NO 1 2 INSURED YES NO TABLE NO.1.5 RESPONDENT 128 46

46

YES NO

128

CHART NO. 1.5 Interpretation-: In the above diagram we found that 74% of the respondents were insured. Majority of them had life insurance & health insurance policy. Non insured constitute 26% of the sample size.

6. Which type of insurance do you have?

S.NO 1 2 3 4 TYPE OF INS. LIFE INSURANCE PERSONAL ACCIDENT INS. HEALTH INSURANCE ANY OTHER SPECIFY TABLE NO.1.6 RESPONDENT 128 18 91 8

91 128

18

CHART NO. 1.6

Interpretation-: In the above diagram we found that majority of the respondent were protected against life. 37% were insured again health policy 35 respondent had other policy.

7. Which type of health insurance plan do you have?

S.NO 1 2 3 4 5 6 Name of plan individual health ins. comprehensive major health ins. special indiviual ins. disability health ins. overseas health ins. any other specify TABLE NO.1.7 RESPONDENT 29 10 16 13 2 21

health plan

21, 23% 29, 32% 2, 2% 13, 14% 10, 11 %

16, 18%

CHART NO. 1.7 Interpretation-: In the above diagram we found that majority of the respondent who had policy of individual health insurance. 32% people had preferred this policy.

8. What is the level of awareness of your health insurance plans?

S. NO. 1 2 3 4 AWARENESS < 20% 20% - 40% 40% - 60% >60% TABLE NO.1.8 RESPONDENT 9 53 19 10

60 50 40 30 20 10 0 < 20% 20% - 40% 40% - 60% >60% 2 9 19 10

53

CHART NO. 1.8 Interpretation-: In the above diagram we found that majority of the respondent were having20%-40% awareness level of insurance.

9. Do you have any serious illness?

ILLNESS YES NO RESPONDENT 4 87 TABLE NO.1.9

SERIOUS ILLNESS

YES NO

87

CHART NO. 1.9 Interpretation-: In the above diagram we found that majority of the respondents were not having any serious illness.

10. Where did you obtain your health insurance form?

S. NO. 1 2 3 4 5 6 7 8 REFRENCES EMPOLYER SPOUSES EMPOLYER OTHER EMPOLYER FRIENDS OR FAMILY COLLEAGUES DIRECT INSURANCE COMPANY INSURANCE AGENT DO NOT KNOW TABLE NO.2.1 RESPONDENT 7 20 11 49 11 32 78 2

80 70 60 50 40 30 20 10 0

78 49 7 20 32 11 11 2

CHART NO. 2.1 Interpretation-: In the above diagram we found that majority of the respondent obtain health insurance policies from agent. Hence agent plays a very important role in influencing customer to take health insurance policies. Moreover people are highly influence by peer pressure. Hence people get aware about policies from friends & relatives.

CHAPTER-6

OBJECTIVES OF THE STUDY

To enquire in to the attitude of the policyholders towards the buying health insurance policy.

To ascertain the views of the policyholders on influencing factor and satisfaction level.

To offer concrete suggestion to improve the health insurance in the study area.

CHAPTER-7
SCOPE OF THE STUDY
This paper deals at length with customer satisfaction & expectation towards health insurance policy. The scope of the study is restricted to health insurance policyholders with in several area of Rajasthan with only 91 respondents. The findings of the present study are subject to the competitive enviourment created by the health insurance providers and the extent of awareness the part of the health insurance policyholders. The study also relates to the policyholders satisfaction & expectation of several responses which are analyzed on the basis of the scoring & ranking accorded by the study participants. The result is limited to the reliability of the respondents rating made.

CHAPTER- 8
CONCLUSION
In the study it has been observed that as the study was conducted for 174 out of which only 128 was insured out of which 91 have health insurance. This shows 52% of the people want to take health insurance and out of that only 26% persons have taken claim from insurance company. So by this we can concluded that the person have awareness about health insurance product & so we can analyze that health insurance companies are able to satisfied the customer needs, wants & expectation. The objective of my study fulfills here.

CHAPTER-9
SUGGESTION
The following suggestion, based on the findings of the study, is given for the growth of health insurance. 1) Customers must be made more aware of alternate channel of premium payment like credit cards, internet payment, and ATMs which will reduce the waiting time for the customer for payment of premium. 2) The policyholders can be educated to be aware of before taking health insurance policy like pre/post hospitalization, domiciliary hospitalization, waiting period, exclusion, pre-existing diseases, sub limits of various expenses and tax benefits. 3) Steps can be taken to create 100% awareness among policyholders on third party administration. 4) The health insurance policyholders should be advised to renew his policy in time to avoid losing continuity of cover. 5) the health insurance taker should select a suitable health insurance plan as per needs and affordability the first time around because switching from one insurer to other without losing the renewal and no-claim benefits is not allowed. 6) The health insurance taker should ensure that the policy provides for cashless hospitalization. He should check the number of hospitals where this facility can be availed, the location of these hospitals and the norms of cashless settlement.

CHAPTER-10
BIBILOGRAPHY
www.insuranceinformationbearu.com www.insuranceinstituteofindia.com www.irda.com Akter S.M., Upal M and Hani U (2008), Service Quality Perception and Satisfaction: A Study Over Sub-urban Public Hospitals in Bangladesh, Journal of Service Research, special Issue. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001. Jha AK, Orav EJ, Zheng J, et al. Patients perceptions of hospital care in the United States. N Engl J Med 2008; 359:1921e31.

. Glickman SW, Boulding W, Manary M, et al. Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circ

Cardiovasc Qual Outcomes 2010; 3:188e95. . Isaac T, Zaslavsky AM, Cleary PD, et al. The relationship between patients perception of care and measures of hospital quality and safety. Health Serv Res 2010; 45:1024e40.

. Oliver RL. Satisfaction: A Behavioral Perspective on the Consumer. 2nd edn. New York: M.E Sharpe, 2010.

. Ruiz-Moral R, Perula de Torres LA, Jaramillo-Martin I. The effect of patients met expectations on consultation outcomes. A study with family medicine residents. J Gen Intern Med 2007; 22:86e91.

. McKinley RK, Stevenson K, Adams S, et al. Meeting patient expectations of care: the major determinant of satisfaction with out-ofhoursprimary medical care? FAM Pract 2002; 19:333e8.

Williams S, Weinman J, and Dale J, et al. Patient expectations: what do primary care patients want from the GP and how far does meeting Expectations affect patient satisfaction? Fam Pract 1995; 12:193e201. Marvel MK, Epstein RM, Flowers K, et al. soliciting the patients agenda: have we improved? JAMA 1999; 281:283e7.

CHAPTER-11
QUESTIONNARE
CUSTOMER SATISFACTION AND EXPECTATION TOWARDS HEALTH INSURANCE

1. Name.. 2. Email address.

3. Gender

male female

4. Age

<25 years 25 years - 40 years 40 years - 50 years > 50 years

5. Please mention your family annual income?

< rs. 100000 Rs. 100000-rs.150000 rs.150000-rs.300000 rs.300000-rs.600000

rs.>600000

6.0ccupation

private employee professionals goverment employee business other

7. Are you insured?

yes no

8. Which type of insurance do you have?

life insurance personal accident insurance health insurance any other specify _______________________________

9. Do you have any health insurance plan?

yes no

10. Which type of health insurance plan do you have?

individual health insurance comprehensive major health insurance special individual health insurance disability health insurance overseas health insurance any other specify ____________________________________

11. What is the level of awareness of your health insurance plans?

<20% 20% - 40% 40% - 60% above 60%

12. Do you have any serious illness?

yes no

13. Where did you obtain your health insurance form?

empolyer spouse's empolyer other empolyer refrence of frinends or family

Reference of colleagues directly from insurance company through insurance agent don't know