IMPACT OF HEALTH INSURANCE ON PATIENT ACCESS TO HEALTHCARE SERVICES: ADMINISTRATIVE PERSPECTIVES AND MEDICO-LEGAL IMPLICATIONS
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Keywords
Health insurance; Hospital administration; Healthcare access; Medico-legal implications; Healthcare management
Abstract
Background: In general, access to affordable healthcare remains a major challenge in many healthcare systems, particularly in developing countries. Health insurance has become an important means of improving access to healthcare by reducing out-of-pocket expenditure and providing financial protection against illness. It also plays an increasingly important role in hospital administration by influencing claims management, reimbursement, financial sustainability, and service delivery. Despite these benefits, administrative processes related to health insurance may delay access to healthcare and have important medico-legal implications, especially in emergency situations.
Objective: To evaluate the impact of health insurance on patient access to healthcare services from hospital administrative perspectives and to discuss its medico-legal implications.
Materials & Methods: A descriptive cross-sectional analytical study was conducted among 100 respondents from six hospitals in Chennai, Tamil Nadu, India, between January and March 2025. Data were collected using a structured questionnaire and analyzed using Microsoft Excel and SPSS with descriptive statistics.
Results: Most respondents reported that health insurance improved patient access to healthcare services, with 75% indicating a significant or moderate positive impact. Regular reimbursement was considered the main benefit of partnerships with insurance providers, while financial management was identified as the hospital function most influenced by health insurance. Delays in reimbursement, claim rejection, and complex documentation were the most frequently reported administrative challenges. Respondents also recommended digital claims management, simplified administrative procedures, and better coordination between hospitals and insurance providers to improve healthcare delivery.
Conclusion: Overall, health insurance plays an important role in improving healthcare accessibility while supporting efficient hospital administration. Effective health insurance administration is essential not only for improving patient access to healthcare services but also for strengthening hospital administration and ensuring compliance with medico-legal responsibilities in the delivery of quality healthcare.
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Dr. S. Valliappan
Associate Professor, Department of Forensic Medicine, SSJGIMS&R, Almora, Uttarakhand
Dr Gerard Pradeep Devnath
2Assistant Professor, Department of Forensic Medicine, AIIMS, Madurai, India
Dr Alagammai AL
Assistant Professor, Department of Pathology, SSJGIMS&R, Almora, Uttarakhand.
Dr.Sapeco SD
Former Professor and Head, Department of Forensic Medicine, JIPMER Karaikal.
