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1. INTRODUCTION
Even in the healthiest of families, if one member has an accident (or falls sick) the
resulting medical expenses can affect the financial and economic stability of the whole
family. The impact depends, in part, on whether the injured person was insured, the size of
the bills, and the family’s income and other resources (Uninsurance, 2002). With Healthcare
financing still a vex issue; the burden of health care spending is passed on to the individual
concern. Financial constraint is a bottle neck for funding Universal Healthcare. Tax-payers’
money can’t pay for healthcare as life expectancy is increasing (Shetty, 2012).
Insufficient public health provision has compelled the population to turn to private
health providers pushing out of pocket (OOP) spending higher. In India OOP spending is
over four times higher than the public spending on health care (Choudhury, 2012). OOP
spending by households occupies about 72% of the total health expenditure (WHR, 2006) and
it pushes 2.2 percent of the population below the poverty line each year (Peters, A S, R S, G
N V, L H, & A, 2002). OOP expenditures aggravate poverty for those living in both rural and
urban, with more severity (though the impact is felt more) in rural areas (Garg & Karan,
2009). Alternate financing strategy through health insurance (HI) can be an effective option
(Churchill, 2007). Health insurance coverage can give a cushion to impeding financial and
economic burden of a family.
WHO (World Health Organization) considers health insurance a promising means for
achieving universal health-care coverage (WHO, 2010). In India, only 10 percent Indian has
some form of health insurance, mostly inadequate. In terms of the market share, the size of
the commercial insurance is barely 1% of the total health spending in the country. The Indian
health insurance scenario is a mix of mandatory social health insurance (SHI), voluntary
private health insurance and community-based health insurance (CBHI). Health insurance is
thus really a minor player in the health ecosystem (Dhar, 2012).
With the enactment of the Insurance Regulatory Development Authority of India
(IRDA), the industry now has a regulatory framework to protect the interests of policy
holders. Stricter regulatory framework is required as is evident in countries where Health
Insurance (HI) plays a dominant role in financing of health expenditures (IRDA, 2003). New
initiatives like Health Insurance (HI) portability can make it more users friendly. Further
reforms like increasing the FDI cap to 49% and reducing capital requirement for health
insurers from the present Rs. 100 to Rs. 50 crores may invite more players in Health
Insurance (HI) and increase the level of Health Insurance (HI) penetration (TOI, 2012).
2. PURPOSE OF THE STUDY
Consumerism, Changes in the Demographic Profile of the consumers, Changes in
Life Style etc, all these factors will have an impact on the overall demand for better health
care services including Health Insurance (HI). The ultimate burden for these health care
services will be passed on to the general public. If the general public is aware of Health
Insurance (HI), it can play a bigger role in reducing this impeding burden of Health care
expenses. In this perspective this paper “Customer perception of Health Insurance (HI)
Products: A study in Imphal City, Manipur (India)” was carried out.
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3. REVIEW OF LITERATURE
Awareness and Perception: Many studies have been carried out to understand the awareness
and perception of Health Insurance. For a consumer to be interested in an offering, the
consumer must have awareness of the offering and find it acceptable, available at the right
time and place, and affordable (J.N. Seth, R.S. Sisodia, 2008). A study conducted in Bahraich
District, Uttar Pradesh has clearly highlighted that respondent’s perception towards insurance
and savings and their understanding of the benefits are still nascent. Out of all types of
insurance, awareness for Life insurance (38 percent) is by far, the highest followed by vehicle
insurance (15%) and property insurance (10%) (Constella, 2008). It is estimated that only
about 3% to 5% of Indians are covered under any form of health insurance (Rao, 2005). In
their study found out that the need for education for rural and urban population was alike on
the concept of health information which is a crucial aspect on extending awareness about
health insurance on a large-scale (Gumber A, 2000).
Bhatt, Professor, Finance and Accounting at IIM, Ahmadabad writes that the
penetration of insurance critically depends on the availability of insurance products and
services (Bhatt & Jain, 2006). 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 (Gupta, 2007). If Parliament
approves the recent increase in FDI cap of 49%, the change in law is expected to come as a
huge boon for the health insurance business (TOI, 2012).
With entry of Private players in Insurance Industry in India, aggressive promotion has
resulted in growth of this sector. However, no one in the industry is taking responsibility to
develop knowledge and awareness of health insurance among the public nor is specific
expertise in health insurance being developed within the private sector, an expertise that is
essential to dealing effectively with providers of health care services. Because of this absence
of specific capacity, Indian companies writing health insurance seem to have focused on
controlling claims payout by following strategies designed to minimize the insured person’s
ability to collect on claims. Because of these practices health insurance has become one of the
largest litigation areas for insurers, exceeded only by motor third party cases (Mathur, Vol
VIII No. 1 January - March 2011). Spread of awareness of all information for health policies
and claim settlement procedure thereof must be ensured by service providers (USAID, 2008).
Also more knowledge about health insurance will help them in making an informed choice
about their purchase (Bhatt & Jain, 2006).
Service Industry: Health Insurance is a service industry. A person taking up a policy is
going to be a customer for 15/20 years, any good or bad experience echoes good and bad
messages to other probable customers. For most first time buyers it is the brand of the
company which acts a catalyst for buying any product/service. Blackshaw identifies six
drivers to brand credibility as trust, authenticity, transparency, listening, responsiveness and
affirmation (Blackshaw, 2008). Health Insurance (HI) falls under the ambit of Service Sector.
A glimpse of 7Ps of marketing mix for service industry is represented in the Figure below.
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Figure 2
The Marketing Mix
Product management, New product development,
Branding ,Packaging
} Product
Pricing ,Discount structures, Terms of business } Price
Advertising , Sales promotion, Public relations,
Personal selling , Merchandising
} Promotion
Channel management, Customer service,
Physical distribution
} Place
Employee selection, Employee training,
Employee motivation
} People
Layout, Décor, Ease of access, Forms of
presentation
} Physical Evidence
How customers are handled and managed from
the point of very first contact with the
organization through to the point of very last
contact
} Process Management
Source: Adapted from (Wilson & Gilligan, 2001)
Agents: Private Health Insurance (HI) in India is based on the partner – agent model and
insurance agents are important stakeholder between the Insurer and the Clients. Insurance
agents are the main source of information about HI schemes (Vellakkal, 2009).
4. OBJECTIVE OF THE STUDY
The main objective of this study is to determine the customer perception of Health
Insurance (HI) Products in Imphal City. In doing so, the article aims to study
(i) The major source of money to finance the bill in case a family member falls ill.
(ii). The choice of Company from which Health Insurance (HI) policies are bought.
(iii).Whether agents are actively selling Health Insurance (HI) products.
(iv). Major reasons why people who are aware of Health Insurance (HI) intends to stay
away from buying a Health Insurance (HI) Product.
Under these objectives following null hypotheses are framed.
Null Hypotheses:
(i). H01: There is no relationship between Occupation and Source of Money to finance
the bill for treatment.
(ii). H02: There is no difference in the awareness level of Health Insurance (HI) between
males and females (Gender), Age, Education Qualification, Income and Occupation.
(iii).H03: There is no difference in opinion among respondents with different Gender,
Educational Qualification and Occupation that agents are actively selling Health
Insurance (HI) products.
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5. RESEARCH METHODOLOGY
5.1 Methods of Data Collection, Sample Size and Statistical tools used
Population could not be determined conclusively. Initially, random sampling sizes of
280 respondents are taken for this study. Out of these 16 samples are rejected. So, Random
sampling size of 264 is taken for the final analysis. Information is collected by using
questionnaire.
5.2 Schematic Representation of all steps of how the analysis has been done:
Figure 1: Flow Chart showing the schematic stepwise analysis of the questionnaire
Source: Primary Data
5.3 Data Analysis
Data collected through structured questionnaire were analyzed using SPSS. The
statistical techniques namely descriptive statistics that is mean, standard deviation, percentage
and Chi Square test are mainly used to test the hypotheses.
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6. Data Analysis and Discussion
6.1 Demographic profile of the Sample
Table 1
Profile of Sample
Personal information No. of respondents Percent
Gender
Female 100 37.9
Male 164 62.1
Age
<20 36 13.6
20-40 148 56.1
40-60 64 24.2
>60 16 6.1
Educational
Qualification
Undergraduate 44 16.7
Graduate 80 30.3
Post-graduate 100 37.9
Professional degrees 40 15.2
Monthly
Income
Below Rs. 15000 64 24.2
Rs. 15000 to 30000 120 45.5
30000 to 45000 52 19.7
45000 and above 28 10.6
Occupation
Private employee 60 22.7
Govt. employee 92 34.8
Own business 60 22.7
Others 52 19.7
Source: Primary Data
The above Table No. 1 indicates the overall profile of the Sample. It consists of a
Sample size consists of 37.9% Females and the remaining 62.1% Males. 56.1% of
Respondents belong to the Age Group (20 – 40) years, where 24.2% belongs (40-60) years
and 6.1% belongs to above 60 years of Age. In case of Educational Qualification 37.9% of
the Sample were Post Graduate, 30.3% were Graduate and 15.2% were Professional Degree
Holders. 45.5% of the Sample belongs to the Monthly Income Group of Rs. (15,000 –
30,000), 24.2% were below Rs. 15,000 and 10.6% were Rs. 45,000 and above. 34.8% of the
Respondents were Government Employee and 22.7% were Private Employees & Own
Business. The Remaining 19.7% of the Respondents belongs to Others Group.
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6.2 Data Analysis on Family Member falling sick, Expense incurred in Treatment
and Source of Money:
Table 2
Percentage of Sickness, Expense incurred in Treatment and Source of Money
Personal information No. of Percentage
Family member (s)
falling sick
No 60 22.7
Yes 204 77.3
Expense incurred
in treatment
Below Rs. 5000 12 4.5
Rs.5000 to Rs. 10000 20 7.6
Rs.10000 to Rs. 15000 100 37.9
Above Rs.15000 72 27.3
Mean(SD) 10189(6590)
Source of money
Out of pocket 88 33.3
Reimbursement from 96 36.4
Insurance 16 6.1
Others 4 1.5
Source: Primary Data
From the above Table 2, it is observed that 77.3 % of respondents agree with the
statement that in the past one year a family member (within the family) had fallen sick.
37.9% of those who falls sick spend Rs. 10,000 to Rs. 15000 in a year for treatment. Every
family spends on an average of Rs. 10189 for treatment with standard deviation Rs. 6590.
Majority (36.4%) of the Respondents reimburse their expense for the treatment from service.
33.3% of the respondents met the expenses from their pocket (Out of Pocket) while a meager
6.l% and 1.5% through Insurance and Others respectively.
6.3 Data Analysis on Occupation and Source of Money to finance treatment
Table 3
Occupation and Source of Money to finance treatment
Source of money Total Chi -
Square
P-
Value
Occcupation
Out of Reimburs. Insurance Other
Pvt.
Empl.
16(28.6) 24(42.8) 4(7.2) 0(0) 44(100)
36.825 <0.001Govt.
Empl.
4(5.6) 68(94.4) 0(0) 0(0) 72(100)
Own
Busi.
44(78.6) 0(0) 8(14.3) 0(0) 52(100)
Others 24(50) 4(8.3) 4(8.3) 4(8.3) 36(100)
Total 88(37.9) 96(41.4) 16(6.9) 4(1.7) 204(100)
N.B. – Figures in brackets indicate percentage Source: Primary Data
In the Table above, majority of the respondents (94.4%) employed in Government and
42.8% in Private sectors reimbursed their expenses for treatment. While maximum (78.6%)
of Business Owners and 50% Others financed though Out of Pocket (OOP) for treatment. It is
statistically tested that the relation between Occupation and Source of Money for treatment is
highly significant with p-value less than 0.001(i.e. <0.001). Null Hypothesis (H01) is rejected.
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6.3 Awareness of Health Insurance (HI)
Table 3
Awareness of Health Insurance (HI)
N.B. – Figures in brackets indicate percentage Source: Primary Data
Table 3 above indicates that 57.6 % of the respondents are not aware of Health
Insurance (HI). Higher percentages, i.e., 53.7% of the male respondents are aware of Heath
Insurance (HI) in contrast to 24% for Females. And, it is statistically tested that there is a
significant difference in the level of awareness of Health Insurance (HI) between male and
female with p-value 0.018. It is observed that a significant percentage, 54.1% of the
Respondents in the age group (20 – 40) years are aware about Health Insurance (HI). But it
is statistically tested that there is no significant difference in the level of awareness of Health
Insurance (HI) between different age groups with p-value 0.097. It is also observed that 100%
of the Respondents with Professional Degrees are aware of Health Insurance (HI). It is
statistically tested and observed that there exists a highly significant difference in the level of
Personal
information
Awareness of HI
Total
Chi-
square
P-
valueNo (%) Yes
Gender
Female 76 (76.0) 24 (24.0) 100
5.593 0.018
Male 76 (46.3) 88 (53.7) 164
Total
152
(57.6)
112 (42.4) 264
Age in Year
<20 32 (88.9) 4 (11.1) 36
6.318 0.097
20-40 68 (45.9) 80 (54.1) 148
40-60 40 (62.5) 24 (37.5) 64
>60 12 (75.0) 4 (25.0) 16
Total
152
(57.6)
112 (42.4) 264
Educational
Qualification
Undergraduate 40 (90.9) 4 (9.1) 44
19.865 <0.001
Graduate 56 (70.0) 24 (30.0) 80
Post-graduate 56 (56.0) 44 (44.0) 100
Professional
degrees
0 (0.0) 40 (100.0) 40
Total
152
(57.6)
112(42.4) 264
Monthly
Income
Below Rs. 15000 52 (81.3) 12 (18.8) 64
14.273 0.003
Rs.15000 to 30000 76 (63.3) 44 (36.7) 120
30000 to 45000 24 (46.2) 28 (53.8) 52
45000 and above 0 (0.0) 28 (100.0) 28
Total 152(57.6) 112(42.4) 264
Occupation
Private employee 20 (33.3) 40 (66.7) 60
7.410 0.060
Govt. employee 48 (52.2) 44 (47.8) 92
Own business 44 (73.3) 16 (26.7) 60
Others 40 (76.9) 12 (23.1) 52
Total
152
(57.6)
112(42.4) 264
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awareness of Health Insurance (HI) among individuals with different Education Qualification
with p-value less than 0.001. 100 % of the Respondents with monthly income Rs. 45,000 and
above are aware of Health Insurance (HI). And, it is statistically tested that there is significant
difference in the level of awareness of Health Insurance (HI) among respondents belonging to
different income groups (monthly income) with p-value 0.003. Higher percentage, 66.7% of
the Respondents with Occupation in Private Sector are aware of Health Insurance (HI) as
against other sectors. But it is statistically tested that there is no significant difference in the
level of awareness of Health Insurance (HI) among respondents belonging to different
occupation with p-value 0.060.
6.4 Data Analysis on Reason for not aware, Willingness to buy, Purchase Percentage
and Source of Information about Health Insurance (HI)
Table 4
Reason for not aware, Willingness to buy, Purchase of HI and Information
Source for HI
No. of respondent Percentage
Reason for
not aware
Never heard about it 132 86.8
Not aware about the benefit 12 7.9
Nobody approach 4 2.6
Others 4 2.6
Total 152 100.0
Willingness to
buy
No 4 2.6
Yes 148 97.4
Total 152 100
Purchase HI
No 60 53.6
Yes 52 46.4
Total 112 100
Information
about HI
comes from
Agent 44 84.6
Friend 4 7.7
Others 4 7.7
Total 52 100
Source: Primary Data
From the table above, it is observed that 86.8% of the Respondents cited “Never heard
about it” as the reason for ‘not aware’ of Health Insurance (HI). 97.4% of the Respondents
say that they are willing to buy Health Insurance (HI). But only 46.4% of the Respondents
have purchased a Health Insurance (HI) policy. Main (84.6%) source of Information about
Health Insurance (HI) comes from Agents (Insurance Agents).
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6.5 Data Analysis on Agents activity in Selling Health Insurance (HI)
Table 5
Agents Actively Selling Health Insurance (HI)
Actively selling Chi-
square
P-
valueDisagreed Neutral Agreed
Gender
Female 4 16.7 16 66.7 4 16.7
4.176 0.124Male 36 40.9 20 22.7 32 36.4
Total 40 35.8 36 32.1 36 32.1
Educational
Qualification
Undergraduate 0 0.0 0 0.0 4 100.0
13.089 0.042
Graduate 8 33.3 4 16.7 12 50.0
Post-graduate 4 9.1 20 45.5 20 45.5
Professional
degrees
28 70.0 12 30.0 0 0.0
Total 40 35.8 36 32.1 36 32.1
Occupation
Private employee 20 50.0 4 10.0 16 40.0
15.105 0.019
Govt. employee 16 36.4 28 63.6 0 0.0
Own business 4 25.0 0 0.0 12 75.0
Others 0 0.0 4 33.3 8 66.7
Total 40 35.8 36 32.1 36 32.1
Source: Primary Data
From the Table above it is statistically tested that there is no significant difference in
opinion among respondents with different Gender (male and female) that agents are actively
selling Health Insurance (HI) with p-value 0.124. Whereas statistically there is significant
difference in the opinion among respondents with different Educational Qualification (p-
value at 0.042) and Occupation (p-value at 0.019) that agents are actively selling Health
Insurance (HI).
6.6 Data Analysis on Reasons for not purchasing Health Insurance (HI)
Table 6
Reason for not purchasing Health Insurance (HI)
Reason for not purchase Frequency Percentage
I do not need it 0 0.0
No return from investment 60 25.9
High premium charge 52 22.4
Poor service provider 56 24.1
Alternate sources to fund health related cost 8 3.4
No empanelled hospitals in Imphal 56 24.1
Others 0 0.0
Multiple response tabulated Source: Primary Data
From the Table above, it is observed that “No return from Investment”, “Poor Service
Provider”, and “No empanelled Hospitals in Imphal” as the reason for not purchasing Health
Insurance (HI).
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6.7 Choice of Company from which Health Insurance (HI) policies are bought
Table 7
Company from which Health Insurance (HI) are bought
Parameter Analyzed Name of the Company Frequency Percent
Company from which HI
policies are bought
ICICI Prudential 14 26.9
NIC 4 7.7
LICI 8 15.4
Bajaj Allianz 4 7.7
Amsure (Max Life) 7 13.5
Birla Sunlife 2 3.8
HDFC Life 2 3.8
Metlife 0 0.0
SBI Life 3 5.8
TATA AIA 1 1.9
Reliance 3 5.8
IDBI Fortis 1 1.9
ICICI Lombard 3 5.8
Others 0 0
Source: Primary Data
From the above Table, respondents say ICICI Prudential Life, LICI and Amsure (Max
Life) are the top three companies; respondents bought Health Insurance (HI) policies from.
6.8 Analysis of awareness of Health Insurance (HI), Scheme, Diseases not covered,
Premium and Claim Procedure
Table 8
Awareness of Health Insurance (HI), Scheme, Diseases not covered, Premium and
Claim Procedure
No. of respondents %
Awareness of HI
Medium 44 84.6
Highly aware 8 15.4
Total 52 100
Awareness of scheme
Medium 48 92.3
Highly aware 4 7.7
Total 52 100
Awareness of disease not cover by
HI
Less aware 24 46.2
Medium 24 46.2
Highly aware 4 7.7
Total 52 100
Awareness of HI premium
Less aware 4 7.7
Medium 44 84.6
Highly aware 4 7.7
Total 52 100
Aware of claim procedure
Less aware 32 61.5
Medium 16 30.8
Highly aware 4 7.7
Total 52 100
Source: Primary Data
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From the above Table, the awareness level of Health Insurance, Awareness of
Scheme, Premium in Imphal are ‘medium’ with a score of 84.6% , 92.3% and 84.6%
respectively. In case of Awareness of diseases not covered by Health Insurance (HI),
respondents awareness level is in ‘medium’ and ‘less aware’ with a score of 46.2%. The
awareness of Claim procedure for Health Insurance in Imphal is “less aware” having score of
61.5% out of the Total Respondents.
6.8 Analysis on the reason for the purchase of Health Insurance (HI)
Table 9
Reason for the purchase of Health Insurance (HI)
Reason for the purchase of HI No. of respondents %
Attractive schemes 36 22.0
Tax benefit 32 19.5
Expecting health problems 8 4.9
Better health care to family 12 7.3
To protect from rising cost of health care 44 26.8
Cover big expenses 32 19.5
Total 164 100
*Multiple responses tabulated Source: Primary Data
From the Table above, 26.8% attributes “To protect from rising cost of Health Care”
as the major reason for purchasing Health Insurance. “Attractive schemes”, “Tax benefit”
and “Cover big expenses” are also important reasons for purchase of Health Insurance (HI).
6.9 Analysis on factors that influence purchase of Health Insurance (HI)
Table 10
Factors that influence purchase of Health Insurance (HI)
Factors that influence in purchase of HI
No. of
respondents*
%
Trust worthiness of company 52 17.1
Better Schemes Offer 32 10.5
Existing insurance with the Company 8 2.6
Personal Relationship 32 10.5
Easy claim settlement 28 9.2
More Coverage of Diseases 24 7.9
Low Premium Cost 20 6.6
Better marketing by Agent 44 14.5
Tax Saving 28 9.2
Advertisement 36 11.8
Total 304 100
*Multiple responses tabulated Source: Primary Data
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From the Table above, Trust worthiness of company, Better marketing by Agent and
Advertisement are the three important factors that influence purchase of Health Insurance
(HI).
7. CONCLUSION
One important observation is people intend to take up HI if they are explained
explicitly about it. But in contrast majority of people who know about health insurance does
not own a HI policy. So, there seems to be a gap. And all stakeholders in Health Insurance
(HI); Insurance companies, insurance agents, probable customers, existing clients etc. have a
major role to play in increasing enrolment for Health Insurance (HI) policies. For a society
like ours, level of unemployment is very high. Since major chunk of the population are
unemployed, financing for treatment through Out Of Pocket (OOP), which occupies a
sizeable section of respondents, will have a dent on the socio-economic pattern of the masses.
Overall increase in the enrolment of Health Insurance (HI) therefore will be a “win win” for
all stakeholders.
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