Page 118 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

7.4.1 EXPLAIN THE RELATIONSHIP BETWEEN INSURERS AND HEALTH CARE PROVIDERS

Both insurers and healthcare rely on each other in providing services to the Insured.

Insurers require the knowledge of the types and costs of services provided, to

adequately price their products as well as for allowing their Insured access to their

panel hospitals. The product marketing department, in determining the panel listing,
would want the providers to be:

 aware which the charges must be fair and reasonable

 ethical in their jurisdiction of care

 co-operative with the insurer in the event of claims

 not likely to cause difficulties for the Insured

 able to influence potential customers positively for the need of getting cover.

7.4.2 ELABORATE THE ROLE PLAYED BY THE HEALTH CARE PROVIDERS

Healthcare providers are the hospitals, specialists, and medical practitioners that
provide healthcare services to the people at large, regardless of ownership of PMI

policies. Usually, they are professionals and are guided by their code of ethics to treat

the patient in their best practice. Hence, the role played by healthcare providers is

vital for maintaining a good relationship between insurers, providers and the Insured
or patient.

7.5 ANALYZE THE MARKETING SIZE AND GROWTH

In total, general insurers and general takaful operators have generated a Gross Direct

Premium (GDP) of RM1,005 million for the period January to December 2014, an

increase of 13.23% (RM887.6 million) as per the ISM report for the year 2014.

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