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This qualitative study explores how individuals understand health insurance concepts and make health insurance purchase decisions. The study sought to develop a model of the health insurance decision-making process.

This study used semi-structured interview questions and the micro-moment time-line interview technique with newly hired employees to discuss the steps that individuals follow when making health insurance decisions. The researcher used an open coding approach to analyze the steps listed by each participant, and emergent themes were used to code all interview transcripts in Atlas.ti.

This study identified information tactics used by individuals when evaluating health insurance documentation. The findings also shed light on the personal reflection individuals undertake when making their health insurance choices.

The information needs and preferred information sources identified in this study will be of interest to information professionals and human resources officers providing assistance with health insurance enrolment.

The findings demonstrating that participants characterized their health insurance choice as a shared decision is a novel contribution of this study.

Health insurance is one of the major contributors of growth of general insurance industry in India. It alone accounts for around 29% of total general insurance premium income earned in India. The growth of this sector is important from the perspective of overall growth of general insurance Industry. At the same time, problems in this sector are also many which are affecting its performance.

The paper provides an understanding on performance of health insurance sector in India. This study attempts to find out how much claims and commission and management expenses it has to incur to earn certain amount of premium. Methodology used for the study is regression analysis to establish relationship between dependent variable (Profit/Loss) and independent variable (Health Insurance Premium earned).

Findings of the study indicate that there is significant relationship between earned premium and underwriting loss. There has been increase of premium earnings which instead of increasing profit for the sector in fact has increased underwriting loss over the years. The earnings of the sector is growing at compounded annual growth rate of 27% still it is unable to earn underwriting profit.

This study is self-driven based on secondary data obtained from insurance regulatory and development authority site.

The purpose of this study is to understand how risk attitudes drive demand for different types of insurance amongst Ghanaians.

This study uses data from a nationally representative survey of Ghanaian households (Ghana Living Standards Survey Round 7). Risk aversion is measured following the approach of Holt and Laury (2002) in the use of hypothetical questions about investment. Probit regressions are used to estimate the effect of risk aversion on insurance outcomes.

The paper finds evidence that supports the theory that risk attitudes influence insurance demand. Specifically, risk aversion is positively related to the uptake of insurance in general and in particular, public health insurance. Unlike previous literature, the authors do not find the sex of the respondent to affect the relationship between risk aversion and insurance demand except for private health insurance. Socio-economic factors such as wealth, age and education were found to strongly predict insurance demand.

The findings confirm that risk attitude influence the demand for insurance in developing countries but socio-economic factors play a strong role in explaining low insurance penetration in such contexts.

Theoretically, attitudes towards risk have been strongly linked with insurance demand. Yet, empirical evidence on this relationship is limited in developing countries where insurance penetration is very low. This study is among the first to document the influence of risk attitude on the demand of a range of insurance products using a large nationally representative sample of individuals in a developing country.

The purpose of this study is to explain the need for the implementation of decentralization of Indonesia social health insurance (INA-Medicare), with particular emphasis for Aceh Province. First, it discusses the inconsistency of Act on National Social Security System (ANSSS) to the 1945 Constitution, because certain rules in ANSSS are contrary to the 1945 Constitution. This weakens the practice of broader regional autonomy, lessens the importance of public service quality in health care and ignores specific cultural and religious values of the regional people. Then, it explains provisions on central and regional government authority in the 1945 Constitution, Act on Regional Autonomy and Act on Governing of Aceh. Later, it explores current law and practice of INA-Medicare under the national social security system and the centralized administering body. Finally, it provides reasons for decentralization of INA-Medicare, as the solution.

This study uses doctrinal legal research. It relies on both primary and secondary legal authorities. In additions, it also uses sociolegal research by relying on non-legal materials, including empirical data from books, journals and newspapers. Analysis of legal authorities is by legal reasoning process, whereas analysis of non-legal materials is by qualitative approach.

This study argues that the decentralization of INA-Medicare is more suitable for Aceh Province because of several reasons, including implementing broader regional autonomy, improving public service quality in health care and implementing the principle of sharia social health insurance.

The study is original because it focuses on a specific regional area of Aceh Province, Indonesia. It concentrates on specific legal issues and provides unique reasons for argumentation. Therefore, it provides important specific information for journal readers.

Since 1999, China has undergone reform of its healthcare system. City‐based social health insurance (SHI) is the primary form of current health insurance, supplemented by various commercial health insurance programs. The rural new cooperative medical system (NCMS) was introduced in 1993 and extended to cover the whole of rural China in 2003.

The paper developed a theoretical model for consumer demand of medical services and health insurance based on an expected utility framework with a two‐stage decision under uncertainty. The model is then applied to current health insurance systems in China for urban citizens and rural residents separately. Least square and logistic regressions are employed.

The major results are that although the factors driving the decisions on health insurance participation are basically the same for rural and urban citizens, the participation levels are quite different. The major difference is that urban SHI has higher coverage and urban citizens have higher income, resulting in a much larger urban medical expenditure.

The empirical analysis reveals that health insurance programs have played an important role in the healthcare expenditure for urban residents, while the NCMS has not made a significant impact towards increasing the ability of rural residents to seek more medical services, based on data at 2004.

This is the first paper employing a health production theory on China's new urban and rural healthcare programs.

Health insurance in India has shown little development. It has not been able to evoke enthusiasm among Indian insurers. Consequently, several reports on Indian health care insurance have been produced. The purpose of this paper is to offer a review of this matter.

Critical review of related published and grey literature.

Almost 79 per cent of health expenditure is borne by private bodies and the rest by the public. Authors argue that to stimulate private health insurance growth, the Indian government should recognize health insurance as a separate line of business and distinguish it from other non‐life insurance. Particular emphasis is placed on the present health care scenario in India and international field generally. A global comparison of selected Asian countries, regarding their national incomes and health expenditure in public and private sectors, generates insights. Third party administrators (TPAs) facilitate a cashless health services for their customers and offer back‐up services to the insurance companies. Desired strategies and ways of furthering the role of the Insurance Regulatory and Development Authority in acting as a regulator for the purpose of ensuring the industry's smooth functioning is an issue for India's health services.

Information about the present complexities in the health insurance market has been gathered from various sources and summarized.

The purpose of this paper is to examine the relationship between consumers' satisfaction with their health insurance and quality of life (QoL), the mediating role of perceived financial burden in this relationship, as well as the moderating effect of external locus of control (LoC) on the relationship between perceived financial burden and QoL among cancer patients.

A cross-sectional design was employed in order to collect quantitative data by means of a self-administrated questionnaire. Participants consisted of 387 conveniently selected consumers diagnosed with cancer in Iran. Furthermore, the questionnaire was translated into Persian using a forward–backward method. The model was tested using partial least squares structural equation modeling (PLS-SEM).

The results indicate that the more satisfied patients are with their health insurance, the higher QoL they experience, and this relationship is explained through reducing perceived financial burden in terms of direct and indirect costs of the disease. Although external LoC belief is negatively related to QoL, it buffers the negative association between financial burden and QoL.

Reducing the disparity between consumers' expectation and perception of the comprehensiveness of health insurance policies may relieve consumers' anxiety stemming from financial worries.

This paper fills a gap in the literature where consumers' perception about quality of insurance and its relationship with their QoL has received little attention so far.

Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated.

This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization.

Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of “health.” Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations.

This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable counterpart, are prime challenges in any health care reform initiative, especially as it adapts to the changing demographic and socio-economic characteristics of the insured population and regulatory landscape of health insurance in the USA.

Research has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing world, Rwanda still faces formidable challenges in provision certain key maternal health services, leading to higher levels of maternal morbidity and mortality. To understand this paradox, this study will examine the association between maternal health services and insurance coverage, utilizing the latest data from the Rwanda Demographic Health Survey.

Using a sample of 6,167 childbearing women aged 15–49 years, a bivariate and multivariate analysis was conducted to examine the paradoxical relationship between health insurance and maternal health services, such as antenatal care, in Rwanda.

The results reveal significant differences in ANC4+ and the timing of the first ANC, which remain low in Rwanda. Despite significant improvements in delivery factors and skilled ANC providers, ANC4+ rates in the country remain the lowest. However, this study found a positive and significant association between ANC4+ and insurance coverage (AOR = 1.64, p < 0.001).

Rwanda has implemented an effective health insurance policy, but there has been minimal progress in the utilization of maternal health services. Therefore, there is a strong need for policy interventions to reduce barriers to healthcare utilization. Additionally, supply-side factors such as transportation, socio-cultural factors and other logistic barriers should be examined in greater detail. These factors may overshadow the impact of health insurance on the utilization of healthcare services in Rwanda.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0059

Wearable technology and mobile commerce have significant applications for both enterprises and customers, but few studies explore purchase behavior regarding wearable technology combined mobile device with the spillover-effect health insurance. The purpose of this study is to investigate customers’ purchase behavior on the spillover-effect insurance products, provide health insurers input for their marketing strategies and enhance policy sales volumes.

This study assessed consumers’ purchase behavior regarding spillover-effect health insurance in Taiwan, using the purposive sampling method to collect questionnaire survey of 233 respondents. The data are using analysis of variance, multiple regression and hierarchical regression to analyze and test the hypotheses.

The results indicated that all extended technology acceptance model (TAM) variables significantly and positively affected consumer’s attitude toward using spillover-effect health insurance. In addition, consumers’ subjective norms and usage attitudes positively affect their intention to purchase spillover-effect insurance products. However, hierarchical regression analysis result that trust has no moderating effect between usage attitudes and purchase intentions.

This study examines the understanding of customers’ attitude toward using and intention to purchase spillover-effect in health insurance, by integrating the extended TAM theory. The results have practical implications for customers’ intention to purchase spillover-effect health insurance, and provides innovative services to reduce losses in the health insurance, improves customer health management and contributes to fulfilling the need for marketing evidence in an emerging market of insurance.