Volume 2, Issue 3 (12-2019)
Iran J Health Insur 2019, 2(3): 117-124 |
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Mamikhani J A, Tabatabaie S M, Zangeneh M. The Organizational Ecosystem for Insurer-Hospital Interaction. Iran J Health Insur 2019; 2 (3) :117-124
URL: http://journal.ihio.gov.ir/article-1-108-en.html
URL: http://journal.ihio.gov.ir/article-1-108-en.html
1- Lecturer and Consultant in Management Systems, Managing Director of Behin Pouyan Hooten Institute, Tehran, Iran
2- Expert in Economics and Health Insurance, Advisor to the Deputy Minis ter of Health and Medical Education, Ministry of Health, Tehran, Iran
3- Head of Department of Economics and Health Insurance Planning, Minis try of Health and Medical Education, Tehran, Iran , zanganeh@health.gov.ir
2- Expert in Economics and Health Insurance, Advisor to the Deputy Minis ter of Health and Medical Education, Ministry of Health, Tehran, Iran
3- Head of Department of Economics and Health Insurance Planning, Minis try of Health and Medical Education, Tehran, Iran , zanganeh@health.gov.ir
Abstract: (5653 Views)
Introduction: Health insurance organizations are the main purchasers in Iran health system. Ordinarily, financial documents are delivered to the health insurers by the hospitals. It is possible there be other processes according to circumstances. Both these offices protect their own organizations' benefits, so there may occur some conflicts, which may harm patients. This study was conducted with a systemic approach employing organizational ecosystem technique for demonstrating the space of decisions and behaviors much better, in order to achieve better management in the interaction between hospitals and insurers.
Methods: This is a model building study, conducted in four phases. Initially a literature review study was performed for gathering higher national and institutional level documents, and for situational analysis of processes and functions. Then an FGD was performed according to Harris framework of ecosystems, the elements were identified under four domains, i.e. community, public policy, organizational, and interpersonal. In the third phase employing tables of program evaluation model of CDC, revealed the key stakeholders of the interaction, continued by explaining their functions and roles in the interaction. In the last phase, graphical model showing the direct effects among the elements of interaction was depicted and in the last step finalized by the experts in an FGD.
Results: In the insurer-hospital interaction ecosystem there were 30 elements identified in domains of community, public policy, organizational, and interpersonal; containing 11, 8, 4 and 7 elements respectively. The key stakeholder analysis for the interaction program, revealed the number of stakeholders which were dropped in these distinctive groups: who are affected by the program, who perform the program, and who benefit the results of the program, 2, 6, and 7 respectively. The graphical model was drawn using these findings.
Conclusion: In the organizational ecosystem of insurer-hospital interaction more than 63 percent of elements belong to community and public policy domains; less than 23 percent are related to organizational and interpersonal domains. This emphasizes that insurer-hospital interaction is more affected by community and public policy rather internal factors of insure organizations and hospitals.
Methods: This is a model building study, conducted in four phases. Initially a literature review study was performed for gathering higher national and institutional level documents, and for situational analysis of processes and functions. Then an FGD was performed according to Harris framework of ecosystems, the elements were identified under four domains, i.e. community, public policy, organizational, and interpersonal. In the third phase employing tables of program evaluation model of CDC, revealed the key stakeholders of the interaction, continued by explaining their functions and roles in the interaction. In the last phase, graphical model showing the direct effects among the elements of interaction was depicted and in the last step finalized by the experts in an FGD.
Results: In the insurer-hospital interaction ecosystem there were 30 elements identified in domains of community, public policy, organizational, and interpersonal; containing 11, 8, 4 and 7 elements respectively. The key stakeholder analysis for the interaction program, revealed the number of stakeholders which were dropped in these distinctive groups: who are affected by the program, who perform the program, and who benefit the results of the program, 2, 6, and 7 respectively. The graphical model was drawn using these findings.
Conclusion: In the organizational ecosystem of insurer-hospital interaction more than 63 percent of elements belong to community and public policy domains; less than 23 percent are related to organizational and interpersonal domains. This emphasizes that insurer-hospital interaction is more affected by community and public policy rather internal factors of insure organizations and hospitals.
Type of Study: Research |
Subject:
General
Received: 2019/11/24 | Revised: 2019/12/14 | Accepted: 2019/11/25 | ePublished: 2019/12/10
Received: 2019/11/24 | Revised: 2019/12/14 | Accepted: 2019/11/25 | ePublished: 2019/12/10
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