Performance of Third Party Administrators in Indian Healthcare

• Published in: Journal of health management Vol. 24; no. 4; pp. 652 - 661
• Main Authors: Shetty, Sham Ranjan, Chatterjee, Debmallya, Pai, Yogesh P
• Format: Journal Article
• Language: English
• Published: New Delhi, India SAGE Publications 01.12.2022
• Subjects: Indian health insurance market segments; third party administrator (TPA); health insurance claims management; analytical hierarchy process (AHP); performance measurement
• ISSN: 0972-0634; 0973-0729
• DOI: 10.1177/09720634221128385

Health insurance companies, healthcare service providers and third party administrators (TPAs) play an important role in health system performance. Our study develops performance metrics for TPAs in the Indian healthcare setting. Further, we examine the relative importance of these metrics among the market segments that TPAs service. Auditing of TPAs on performance measures is not prevalent practice in the industry. This evaluation will enable critical assessment of both efficiency and quality of health insurance claims processing and provide insights on required modifications thus resulting in better performance and enhanced customer satisfaction. This study’s motivation stems from the possible impact that the objective performance evaluation of TPAs has on healthcare delivery, control and costs. Analytical Hierarchy Process was used to formulate a hierarchy of factors to determine TPA performance and to assess their relative importance among the market segments serviced. The findings suggest that the relative importance of performance metrics for TPAs vary across market segments. This study is limited to TPA performance. Studies can be undertaken to understand the performance metrics of other members in the healthcare system, such as clinics, hospitals and insured members.