Challenges and Solutions of Insured Participation in Reducing the Loss Ratio in HealthInsurance

Introduction: Health insurance interface with many problems including a lot of public polices inhealth insurance, multiple laws, and high household share of Health expenses, inadequatepopulation coverage and lack of cost-effective interventions, high rate of induced Demand, highinflation rate and high tariff. The main purpose of the present study was to determine the challengesand provide solutions to increase people's participation and reduce the Loss ratio of healthinsurance portfolio in Iran and countries with a similar situation.Methods: The current research was applied with a descriptive method, which was carried out in acomparative way in ۲۰۲۱. The research environment of health insurance organizations includesPrivate health service insurance Companies, social service insurance organizations, non-licensedhealth service insurance organizations, higher social research institute and Iranian insuranceresearch Center, some universities of Health sciences and library studies.Results: Effective factors in increasing the use of Complimentary and supplementary Healthinsurances, management of Health insurance risks and Loss Ratio reduction in Complimentary andsupplementary Health insurances have been presented in three areas. The results of the ADF testshow that the consumption series of Complimentary and supplementary Health insurance, withindicators of per ca pita income, inflation and unemployment rate with the first order differenceand premium insurance rate with the second order difference. According to the descriptivestatistics, ۹ factors of the approval effect based on Health insurances and supplementary treatmentincluding age, gender, weight, education level, type Health history, income and place of residencehave been confirmed. The risks of insurer, including government values, Environmental risk andinsured risk have been identified.Conclusions: Considering the fact that there is a positive relationship between national incomeper capita and the use of complimentary and supplementary Health insurance and since there is adirect relationship between the economic development and trade of the country and nationalincome per capita, therefore with development of economy, Financial empowerment of individualsthrough the formation of mutual takaful funds and the establishment of Health managed caresystems and the formation of international cooperatives' funds for the health of the internationalcommunity and the use of the relative advantages of each country's investment can consequentlyimprove Complimentary and supplementary Health insurance.

کلیدواژه ها:

Insured Participation ، Health insurance ، Loss Ratio