Article

Application of digital technologies in health insurance for social good of bottom of pyramid customers in India

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Abstract

Purpose Social health insurance framework of any country is the national identifier of the country’s policy for taking care of its population which cannot access or afford quality healthcare. The purpose of this paper is to highlight the strategic imperatives of digital technology for the inclusive social health models for the BoP customers. Design/methodology/approach A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance CXOs was conducted with a semi-structured questionnaire. Using MaxQDA software, the interview transcripts were analyzed by means of thematic content analysis technique and patterns identified based on the expert opinions. Findings A framework for the strategic imperatives of digital technology in social health insurance emerged from the study highlighting three key themes for technology implementation in the social health insurance sector – analytics for risk management, cost optimization for operations and enhancement of customer experience. The study results provide key insights about how insurers can enhance the coverage of BoP population by leveraging technology. Social implications The framework would help health insurers and policymakers to select strategic choices related to technology that would enable creation of inclusive health insurance models for BoP customers. Originality/value The absence of specific studies highlighting the strategic digital imperatives in social health insurance creates a unique value proposition for this framework which can help health insurers in developing a convergence in their risk management and customer delight objectives and assist the government in the formulation of a sustainable social health insurance framework.

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... Several studies in the context of India have discussed the challenges in digitising the insurance sector (Nayak, Bhattacharyya, & Krishnamoorthy, 2019;Revathi, 2020). They aim to adopt FinTech to gain advantages (Aruna & Acharya, 2019;Hartmut, 2018). ...
... • Privacy and security issues (Nayak et al., 2019) • Lack of collaboration among stakeholders (Nayak et al., 2019) • Lack of skilled human resource (Aruna & Acharya, 2019) • Lack of awareness (Aruna & Acharya, 2019;Revathi, 2020) • Huge investment in R&D (Aruna & Acharya, 2019) • Infrastructure implementation costs (Aruna & Acharya, 2019) Source: Authors' compilation. (Revathi, 2020) • Change in organizational culture to adopt new technology (Revathi, 2020) • Alignment of IT strategy with business strategy • Technology adoption for privacy and security issue Source: Authors' compilation. ...
... • Privacy and security issues (Nayak et al., 2019) • Lack of collaboration among stakeholders (Nayak et al., 2019) • Lack of skilled human resource (Aruna & Acharya, 2019) • Lack of awareness (Aruna & Acharya, 2019;Revathi, 2020) • Huge investment in R&D (Aruna & Acharya, 2019) • Infrastructure implementation costs (Aruna & Acharya, 2019) Source: Authors' compilation. (Revathi, 2020) • Change in organizational culture to adopt new technology (Revathi, 2020) • Alignment of IT strategy with business strategy • Technology adoption for privacy and security issue Source: Authors' compilation. ...
... Moreover, this influence was stronger when IET mediated the path between ISD and KMP than the impact observed between OPO and KMP. This outcome entailed that while managers believed that IET was an important constituent of the strategic social advantage framework, those with a higher experience perceived that IET emerging from ISD can drive higher knowledge creation than IET emerging from OPO. Technologymediated services encourage the participation of customers in the service delivery process, thereby increasing the social acceptance of the services (Nayak, Bhattacharyya and Krishnamoorthy, 2019b;Schumann et al., 2012). Vargo (2018) advocated that technology and humans are inseparable, and service is a result of technology being used beneficially for value creation. ...
... While the public health policies strive to enhance financial inclusion and reduce social inequality (Narain, 2016), the health insurance industry needs to adopt business strategies to support this policy. A certain section of the population can afford to buy high levels of health insurance coverage while the bottom of pyramid population does not have adequate access to basic healthcare (Nayak, Bhattacharyya and Krishnamoorthy, 2019b). This study lays down a framework for health insurance firms to formulate business strategies for all economic sections and balance its social and economic goals. ...
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Strategic social advantage in firms has emerged as a concept that balances the social and fiscal goals of firms. Towards this end, restructuring organizational designs to reduce societal inequalities is gaining prominence. Disruptive technologies are transforming the social and economic context of businesses. Given this background of altered technological, social and economic contexts, a strategic social advantage framework, based on managerial perceptions, has been proposed in this study by integrating the theories of competitive advantage and social orientation of firms. The goal of this study was to develop a social strategic advantage model for firms in the context of micro health insurance business in India. Using Structural Equation Modeling supported by Hayes' multiple mediation model a socially embedded strategic advantage framework was developed. The study methodology was based on the perceptions of 565 managers in health insurance services. The results indicated that inclusive emerging technologies, product innovation, knowledge management practices, and socio-technical expertise formed the multiple mediators that connected inclusive service delivery and people orientation in firms to strategic social advantage of firms. Managerial experience had a moderating effect on the relationship between management of inclusive emerging technologies and knowledge management practices of firms. This finding implied that with higher experience, firm managers perceived that effective management of inclusive emerging technologies leads to robust knowledge management practices in firms. While younger managers were expected to be passionate about modern-day technologies, this counterintuitive outcome entailed that with more experience regarding market dynamics, managers would ardently drive implementation of emerging technologies to achieve strategic social advantage.
... Since the size of most of the insurance companies is sufficiently big, it can be expected from the companies that they should offer their services through digital mode (Liberatore and Breem, 1997). Besides, India is a country where a vast population lives below the poverty line and digital technology has the potential to cover those living below the poverty line (Nayak et al., 2019). However, it is expected that the regulator should play an active role in this respect (Niraula and Kautish, 2019). ...
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... Present day insurance market has great potential compared to the scenario that existed before a decade. The scenario has changed today with more informed customers who used digital and social media to compare and understand insurance benefits before making a purchase (Nayak et al., 2019a). The outcome of this study is expected to help in developing a framework for health insurance firms to become more stable and contribute to societal benefits. ...
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... Planned human resource deployments and activities intended to enable an organization to achieve its goals (Wright & McMahan, 2011). Methodology and system of setting a firm's strategy should be the driving force in the organization or all HR policies, Programs and practices (Nayak & Bhattacharyya, 2019). A strategic approach towards HR entails an organization with three critical contributions creates (1) facilitates the development of a high quality workforce through its focus on the types of people and skills needed. ...
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This article explores how Multi-Method qualitative research supports in-depth qualitative research, the positive and negative implications of the Multi-Method qualitative process in research and discusses the advantages, challenges, and limitations. Furthermore, this article has used a systemic literature review to show the triangulation of the data to validate and provide credibility by complementing the research results. These article further offers insights to the researchers who plan to conduct a Multi-Method qualitative study despite the critics in this field. For the Literature review, the researcher referred to 25 existing journal articles available digitally in the related area and carefully analysed them using descriptive research to develop this article with available data collected. This study concluded that the multi-method approach is a worthwhile procedure to overcome barriers in Mono-Method qualitative study, which mainly comprises analysing only one area of an issue. Therefore, Multi-Method enhances the validity of qualitative research on a management discipline research work. Keywords: Multi-Method Approach, Qualitative Study, Triangulation
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... Among healthcare professionals in emerging economies too, technology adoption has been stressed, like Web 2.0 adoption (Singh et al., 2018) or mobile technology for even community healthcare services (Fletcher-Brown et al., 2020). This has also been advocated for the services such as health insurance (Nayak et al., 2019a(Nayak et al., , 2019b. Manpower in this case consists of doctors, nurses, paramedics, and such others. ...
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... A set of close-ended questions were asked next. Qualitative research methods, specifically semi-structured interviews, have been extensively used (e.g., Chmielewski et al., 2020;Khare & Varman, 2016;Nayak et al., 2019) and are appropriate for several reasons. First, our respondents had low levels of formal education, and a semi-structured interview format makes the process inclusive and supportive for gathering information. ...
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... Rubbio et al. (2019) show that digital medical technologies strengthen sustainable behavior of people in society. Nayak et al. (2019) prove the perspectives of applying digital technologies in medical insurance for consumers' social benefit in India. Andersen et al. (2019) outlines the necessity to use and barriers in the form of high cost and the digital (infrastructural) gap in online healthcare (by the example of modern Denmark). ...
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... Employees will feel included under such practices, which will further facilitate long-term orientation practices. These employees evaluated their organization based upon the degree of technology usage prevalent in the organization (Nayak et al., 2019;Olson & Bakke, 2001;Turner, 2015). ...
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Chapter
Healthcare has been a principal theme of social engagement by Indian firms. This has been done as a part of both core business activities as well as a part of Corporate Social Responsibility (CSR) initiatives. India has been home to a substantial section of Bottom of Pyramid (BoP) customers. Healthcare for BoP customers had thus become a dominant theme in the conversation of Indian healthcare system. The vision for healthcare engagements for such customers has been to provide quality healthcare at affordable price points. This has been done by firms both through technological as well as business model innovation in healthcare services.
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Purpose The purpose of this study was to ascertain how real options investment perspective could be applied towards monetization of customer futures through the deployment of machine learning (ML) and artificial intelligence (AI)-based persuasive technologies. Design/methodology/approach The authors embarked on a theoretical treatise as advocated by scholars (Cornelissen, 2019; Barney, 2018; Cornelissen, 2017; Smithey Fulmer, 2012; Bacharach, 1989; Whetten, 1989; Weick,1989). Towards this end, theoretical argumentative logic was incrementally used to build an integrated perspective on the deployment of learning and AI-based persuasive technologies. This was carried out with strategic real options investment perspective to secure customer futures on m-commerce apps and e-commerce sites. Findings M-commerce apps and e-commerce sites have been deploying ML and AI-based tools (referred to as persuasive technologies), to nudge customers for increased and quicker purchase. The primary objective was to increase engagement time of customers (at an individual level), grow the number of customers (at market level) and increase firm revenue (at an organizational level). The deployment of any persuasive technology entailed increased investment (cash outflow) but was also expected to increase the level of revenue and margin (cash inflow). Given the dynamics of market and the emergent nature of persuasive technologies, ascertaining favourable cash flow was challenging. Real options strategy provided a robust theoretical perspective to time the persuasive technology-related investment in stages. This helped managers to be on time with loading customer purchase with increased temporal immediacy. A real options investment space involving six spaces has also been developed in this conceptual work. These were Never Invest, Immediately Investment, Present-day Investment Possibility, Possibly Invest Later, Invest Probably Later and Possibly Never Invest. Research limitations/implications The foundations of this study domain encompassed work done by an eclectic mix of scholars like from technology management (Siggelkow and Terwiesch, 2019a; Porter and Heppelmann, 2014), real options (Trigeorgis and Reuer, 2017; Luehrman, 1998a, 1998b), marketing intelligence and planning (Appel et al. , 2020; Thaichon et al. , 2019; Thaichon et al. , 2020; Ye et al. , 2019) and strategy from a demand positioning school of thought (Adner and Zemsky, 2006). Practical implications The findings would help managers to comprehend what level of investments need to be done in a staggered manner. The phased way of investing towards the deployment of ML and AI-based persuasive technologies would enable better monetization of customer futures. This would aid marketing managers for increased customer engagement at the individual level, fast monetization of customer futures and increased number of customers and consumption on m-commerce apps and e-commerce sites. Originality/value This was one of the first studies to apply real options investment perspective towards the deployment of ML and AI-based persuasive technologies for monetizing customer futures.
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Thesis
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La doctrine dominante de la connaissance suppose une connaissance a priori, indépendante de l’expérience sensible et logiquement antérieure. Inversement, l’empirisme considère l'expérience comme source d’une connaissance a posteriori. Le pragmatisme fait de l'expérience son concept central, et ne dissocie pas la connaissance de la situation. Dans les sciences informatiques la connaissance a priori est un objet central et l’expérience est limitée à la représentation du vécu d’un agent. Les recherches sur le calcul de situations sont limitées. La gestion de l’expérience client des organisations hérite de cet état qui limite le concept d’expérience. Or les données concrètes (a posteriori) sont aussi importantes que les relations d'idées (a priori). A. N. Whitehead propose un modèle dit « organique » de l’expérience, basé sur un calcul méréotopologique d’événements spatio-temporels intra-reliés. À partir de données vidéo en entrée, cette thèse propose un calcul d’expérience basée sur la méréotopologie whiteheadienne ; le Multiple Objects Tracking pour accéder aux régions spatio-temporelles des vidéos ; un algorithme de calcul des relations méréotopologiques entre régions avec le référentiel RCC8 ; l’utilisation de la méthode Louvain (graph clustering) pour obtenir les événements dans le graphe ; les complexes simpliciaux pour dégager les associations d’événements. Les données obtenues ne sont pas sémantisées et révèlent la structure spatio-temporelle de l’expérience. Elles sont réutilisables par des systèmes plus complexes (interprétation ou reconnaissance) pour la gestion de l’expérience client.
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The purpose of the presented paper is to discuss on the factors that influence the satisfaction of the insured persons with the assistance centre (AC) of the investigated health insurance company. In the empirical part of the research the factors which are important for the satisfaction of the insured with the AC were investigated with the questionnaire for insured persons. The factor that is the most statistically positively related to user satisfaction is the ‘understanding the needs and requirements of policyholders’. Based on the findings from empirical research (questionnaire for insured persons and interview with AC’s employees), improvement proposals were defined which should increase the satisfaction of policyholders with the AC’s service. Recognized findings and suggestions should be considered and reasonably implemented by the insurance policy designers.
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COVID-19 pandemic, the associated economic lockdown and the norms of social distancing have disrupted the business world. Most managers have struggled to make sense of the chaos and complexity around. Health insurance industry mangers are at the forefront of this challenge as new products and services covering COVID-19 had to be launched fast. This was both a market as well as the societal requirement. In the COVID-19 world, in different countries like United States of America (USA), United Kingdom (UK), Germany and India, attempts are being made to develop mobile applications for tracking COVID-19 patients. Emerging technologies have been altering the business landscape in most industries. The health insurance industry has also been witnessing the effects of technologies such as wearables technology, big data analytics, cloud technologies, blockchain, machine learning and such others. The advent of these technologies is fundamentally changing the health insurance industry. Given the realities of the COVID-19 world, the health insurance industry is poised at a crossroad of evolution where the industry would become data-intensive and data-driven. Health insurance firms have to enter into interfirm collaboration with wearable technology firms in the conversation on tracking social distancing from COVID-19 positive and potential cases. Health insurance firms might develop a service mechanism which could while maintaining the anonymity of COVID-19 positive or potential cases, ensure that customers who are using the wearable technology products and following social distancing norms are provided favourable premium for COVID-19 related health insurance products in case they were infected. This would be a novel addition to COVID-19 related products of health insurance firms. Deliberating on these aspects in this article, the authors propose a fundamental shift in the strategic orientation of health insurance firms.
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Purpose The purpose of the paper is to develop the scientific and methodological provision for measuring and managing the social effectiveness of the market economy and its approbation. Design/methodology/approach With foundation on the classical idea of effectiveness as a ratio of results to costs, and with acknowledgment of incompatibility and inequality of the elements of social effectiveness and the necessity of their ranking, the authors' formula for its evaluation is presented, and the methodology of its application is offered. Findings It is substantiated that the economic component of effectiveness of the market economy might have no connection with its social component, moreover, these two components could enter a vivid contradiction. This contradiction is especially vivid in countries with developed market economy. As the example of the USA shows despite the high global economy its market economy shows average statistical social effectiveness. While the experience of Russia shows that even with moderate global competitiveness of the market economy, it is possible to achieve its high social effectiveness. Advantages are achieved due to other social effects – active development of human potential and using the opportunities of the digital economy for social purposes. Social effectiveness of the Russian economy is assessed at 1.602. Originality/value The determined differences in the level of social effectiveness of developed and developing market economy predetermined the necessity for applying different measures to manage this effectiveness. A cyclic algorithm for managing the social effectiveness of developed and developing markets has been developed from the examples of the USA and Russia in 2019. It shows that perspectives of increasing the social effectiveness of certain market economies and leveling the disproportions of social effectiveness in the modern global economic system are connected to change of the measures of management with results and costs and for avoiding their mutual neutralization, the authors offer scientific and practical recommendations.
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Purpose: This article explores innovations in customer experience at the intersection of the digital, physical, and social realms. It explicitly considers experiences involving new technology-enabled services, such as digital twins and automated social presence (i.e., virtual assistants, service robots). The challenges and opportunities facing service organizations are significant and substantial because customer experiences arise at the intersection of the digital, physical, and social realms for each customer. Design: This paper reviews what we know, and don’t yet know, about customer experience, with a focus on connections among the digital, physical, and social realms. We view the customer experience as encompassing customers’ cognitive, emotional, social, sensory and value responses to the organization’s offerings over time, including pre- and post-consumption (Kranzbühler et al., 2017; Lemon and Verhoef, 2016; Voorhees et al., 2017). We bring together recent research concerning value co-creation and interactive services, digital and social media (augmented and virtual reality), multi-channel marketing (e.g., store beacons), service operations (e.g., leveraging AI in business processes), and technology (e.g., the Internet of Things). In doing so, our paper addresses managerial questions such as: • How do digital, physical and social elements interact to form the customer experience? • How might organizations integrate digital, physical and social realms to create consistently superior customer experiences in the future? • How do customer experiences at the intersection of digital, physical and social realms influence outcomes for individuals, service providers and society? • What are the opportunities, challenges and emerging issues in the digital, physical and social realms for organizations managing the customer experience?Future customer experiences are conceptualized within a three dimensional space −low to high, low to high physical complexity, and low to high social presence − yielding eight octants. Findings: Our paper offers a conceptual framework for analyzing the formation of customer experiences that incorporates the digital, physical, and social realms and explicitly considers new technology-enabled services. Customer experiences are conceptualized within a three dimensional space − low to high digital density, low to high physical complexity and low to high social presence − yielding eight octants. This framework leads to a discussion of specific opportunities and challenges connected with transitioning from low to high digital density and from low to high social presence environments for both B2B and B2C services. It also reveals eight “dualities” – opposing strategic options – that organizations face in co-creating customer experiences in each of the eight octants of the framework. We review relevant conceptual work about the antecedents and consequences of customer experiences that can guide managers in designing and managing customer experiences. Moreover, we identify possible future conditions that can significantly impact customer experiences identifying heretofore unanswered questions about customer experiences at the intersection of the digital, physical, and social realms, thereby outlining a research agenda. Research Implications: A review of theory demonstrates that little research has been conducted at the intersection of the digital, physical and social realms. Most studies focus on one realm, with occasional reference to another. This article suggests an agenda for future research and gives examples of fruitful ways to study connections among the three realms rather than in a single realm. Practical Implications: This paper provides guidance for managers in designing and managing customer experiences that we believe will need to be addressed by the year 2050. Social Implications: This paper discusses important societal issues, such as individual and societal needs for privacy, security, and transparency. It sets out potential avenues for service innovation in these areas.
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In the process of conducting everyday business, organizations generate and gather a large number of information about their customers, suppliers, competitors, processes, operations, routines and procedures. They also capture communication data from mobile devices, instruments, tools, machines and transmissions. Much of this data possesses an enormous amount of valuable knowledge, exploitation of which could yield economic benefit. Many organizations are taking advantage of business analytics and intelligence solutions to help them find new insights in their business processes and performance. For companies, however, it is still a nascent area, and many of them understand that there are more knowledge and insights that can be extracted from available big data using creativity, recombination and innovative methods, apply it to new knowledge creation and produce substantial value. This has created a need for finding a suitable approach in the firm’s big data related strategy. In this paper, the authors concur that big data is indeed a source of firm’s competitive advantage and consider that it is essential to have the right combination of people, tool and data along with management support and data‐oriented culture to gain competitiveness from big data. However, the authors also argue that organizations should consider the knowledge hidden in the big data as tacit knowledge and they should take advantage of the cumulative experience garnered by the companies and studies done so far by the scholars in this sphere from knowledge management perspective. Based on this idea, a big data oriented framework of organizational knowledge‐based strategy is proposed here.
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Background Universal health coverage has become a policy goal in most developing economies. We assess the association of health insurance (HI) schemes in general, and RSBY (National Health Insurance Scheme) in particular, on extent and pattern of healthcare utilization. Secondly, we assess the relationship of HI and RSBY on out-of-pocket (OOP) expenditures and financial risk protection (FRP). Methods A cross-sectional study was undertaken to interview 62335 individuals among 12,134 households in 8 districts of three states in India i.e. Gujarat, Haryana and Uttar Pradesh (UP). Data on socio-demographic characteristics, assets, education, occupation, consumption expenditure, illness in last 15 days or hospitalization during last 365 days, treatment sought and its OOP expenditure was collected. We computed catastrophic health expenditures (CHE) as indicator for FRP. Hospitalization rate, choice of care provider and CHE were regressed to assess their association with insurance status and type of insurance scheme, after adjusting for other covariates. Results Mean OOP expenditures for outpatient care among insured and uninsured were INR 961 (USD 16) and INR 840 (USD 14); and INR 32573 (USD 543) and INR 24788 (USD 413) for an episode of hospitalization respectively. The prevalence of CHE for hospitalization was 28% and 26% among the insured and uninsured population respectively. No significant association was observed in multivariate analysis between hospitalization rate, choice of care provider or CHE with insurance status or RSBY in particular. Conclusion Health insurance in its present form does not seem to provide requisite improvement in access to care or financial risk protection.
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Background: There are various complex reasons that influence sustainable adoption of innovations in health care systems. Low adoption can be caused by a lack of support from one or more stakeholders because their needs and expectations are not always considered or aligned. Objective: This study aimed to identify stakeholders' perceptions of barriers and facilitators toward the sustainable adoption of digital health innovations. Methods: A stakeholder workshop was attended by 12 participants with a range of backgrounds on August 25, 2017, including people representing the views from patients, carers, local hospitals, pharmacy retailers, health insurers, health services researchers, engineers, and technology and pharmaceutical companies in Switzerland. On the basis of adoption of innovation frameworks, we asked participants to interview each other about 3 factors influencing the adoption of digitally delivered health interventions: (1) Facilitators and barriers in the external system, (2) Needs and expectations of stakeholders, and (3) Safety, quality, and usability of innovations. The worksheets and videos generated from the workshop were qualitatively analyzed and summarized. Results: Facilitators for adoption mentioned were high levels of income and education, and digital health is a high priority to stakeholders. Main common interests of different stakeholders were patient satisfaction and job protection. Health care spending was a misaligned interest: although some stakeholders were keen on spending more to obtain or provide the highest quality of care, others were focused on reducing health care spending to provide cost-effective services. Switzerland's diversity and complexity, in terms of its organization with 26 cantons (administrative divisions), were barriers as these made it harder to ensure interoperability of interventions. A culture of innovation was considered a push factor, but adoption was inhibited by persistent paper-based systems, a fear of change, and unwillingness to share data. The sustainability of interventions can be promoted by making them patient-centered, meaning that patients should be involved throughout their development. Conclusions: Promoting sustainable adoption of digital health remains challenging despite various push factors being in place. Barriers related to fragmentation, patient-centeredness, data security, privacy, trust, and job security need to be addressed. A strength is that people from a wide range of backgrounds attended the workshop. A limitation is that the findings are focused on the macro level. In-depth case studies of specific issues need to be conducted in different settings.
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Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers’ decision-making process leading to specific healthcare choices in slum settings, and the relative balance of socio-cultural and socio-economic factors underpinning patients’ preferences. This article adopts a mixed-method approach to investigate the determinants of BOP patients’ choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than top-of-the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed.
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Background India recently launched the largest universal health coverage scheme in the world to address the gaps in providing healthcare to its population. Health technology assessment (HTA) has been recognised as a tool for setting priorities as the government seeks to increase public health expenditure. This study aims to understand the current situation for healthcare decision-making in India and deliberate on the opportunities for introducing HTA in the country. Methods A paper-based questionnaire, adapted from a survey developed by the International Decision Support Initiative (iDSI), was administered on the second day of the Topic Selection Workshop that was conducted as part of the HTA Awareness Raising Workshop held in New Delhi on 25–27 July, 2016. Participants were invited to respond to questions covering the need, demand and supply for HTA in their context as well as the role of their organisation vis-à-vis HTA. The response rate for the survey was about 68% with 41 participants having completed the survey. Results Three quarters of the respondents (71%) stated that the government allocated healthcare resources on the basis of expert opinion. Most respondents indicated reimbursement of individual health technologies and designing a basic health benefit package (93% each) were important health policy areas while medical devices and screening programmes were cited as important technologies (98% and 92%, respectively). More than half of the respondents noted that relevant local data was either not available or was limited. Finally, technical capacity was seen as a strength and a constraint facing organisations. Conclusion The findings from this study shed light on the current situation, the opportunities, including potential topics, and challenges in conducting HTA in India. There are limitations to the study and further studies may need to be conducted to inform the role that HTA will play in the design or implementation of universal health coverage in India. Electronic supplementary material The online version of this article (10.1186/s12961-018-0378-x) contains supplementary material, which is available to authorized users.
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India is poised on a renewed growth path and several new initiatives are a brainchild of this vision. Programs such as Skill India, Digital India, and Make in India are certain key strategies for driving growth and sustainable socio economic development. The base of the pyramid sector is predominantly characterized by people with very low incomes; it is known that the bottom of the pyramid is the largest but poorest socio-economic group in the world. The current usage of the term ‘bottom of the pyramid’ refers to the four billion people living on less than $ 2 per day, the definition was familiarized and became widely known in 1998 through the works of C. K. Prahalad and Stuart L. Hart. The wealth and revenue generation capabilities at the base of the pyramid, especially in emerging markets have been the topic of many studies and research in recent years. The potential of the customers, who live on less than $ 2 per day, is immense. It is estimated that India accounts for close to 300 million adults and is a significant percentage of the population. If there has to be inclusive and all round growth and development it has to be aimed at empowering the poorest of the poor. This is a conceptual paper and looks at the sustained growth of India during India 2.0 period (1992 onwards) and further fuelled by PM Modi Government, aimed by the various initiatives and explores avenues to create sustained development from the BOP perspective with special focus on Economic development, Social development, Environmental protection, and Industry development.
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The personal health information (PHI) is an activity among the health-care providers and the patients in terms of managing the data which is sensitive to the parties. The PHI data have been maintained by multiple health-care providers, thus resulting in separated data. Moreover, the PHI data are stored in the provider’s database, hence the patients have no authority to manage their own information. Therefore, in this article, we propose a conceptual model for managing the PHI data which is derived from several health-care providers by relying on the blockchain technology in the peer-to-peer overlay network. In addition, we elaborate the security analysis that might be occurring in the proposed model. By leveraging on our model, it allows the patients and the providers to collect effectively the PHI data onto a single view as well guarantee of data integrity. The blockchain offers an immutable of the data record without having to trust a third party. The experimental results show that the proposed approach is promising to be developed due to the high success rate in terms of data dissemination.
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Background Network society is creating new opportunities for value generation in all areas of our lives: new collaborative methods and tools are increasingly available for use by closely connected individuals and organizations. The stakeholders of the health ecosystem are potential winners of this networking process as a consequence of the increase in knowledge about health value generation supported by teamwork and collaborative approaches in this field. Case Presentation In this paper, we focus on the transactional nature of health value generation networks. First, we analyze the transactions in the networks. We then propose a design structure—the Community Health Experience Model—for effective person-centered health value generation networks. In the second phase of the work, we describe how the system design of the complete transaction network was tested in a real-life pilot environment focusing on fall prevention in individuals with osteoporosis. As a result of the network-based collaborative service approach, fall risk decreased by 11.8% and the number of falls decreased by 4.5% within 3 months. Regarding the major health experience outcomes, self-evaluated condition-specific health literacy improved from 7.85 to 8.26 (an improvement of 0.41), while self-evaluated condition-specific self-management capability changed from 7.25 to 8.06 (0.81 improvement). Conclusions In conclusion, the proposed Community Health Experience Model is a novel and promising approach to designing the structure of more effective and efficient health services and collaborative networks. Electronic supplementary material The online version of this article (10.1186/s40985-018-0105-8) contains supplementary material, which is available to authorized users.
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India in a state of epidemiological health transition i.e shifting from communicable to non-communicable diseases. The annually 3.2% Indians falling below the poverty line and three forth Indians spending their entire income on health care and purchasing drugs. The government of India announced a Ayushman Bharat Yojana- National Health Protection Scheme (AB-NHPM) in the year 2018. The aim of this programme is to providing a service to create a healthy, capable and content new India and two goals are to creating a network of health and wellness infrastructure across the nation to deliver comprehensive primary healthcare services and to provide health insurance cover to at least 40% of India's population which is deprived of secondary and tertiary care services. This Yojana will be implemented through Health and Wellness Centres that are to be developed in the primary health centre or sub-centre in the village and that will provide preventive, promotive, and curative care for non-communicable diseases, dental, mental, geriatric care, palliative care, etc. These centres would be equipped with basic medical tests for hypertension, diabetic and cancer and they are connected to the district hospital for advanced tele-medical consultations. The government has aims to set up 1,50,000 health and wellness centres across the country by the year 2022.
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Background: Severe underutilization of healthcare facilities and lack of timely, affordable and effective access to healthcare services in resource-constrained, bottom of pyramid (BoP) settings are well-known issues, which foster a negative cycle of poor health outcomes, catastrophic health expenditures and poverty. Understanding BoP patients' healthcare choices is vital to inform policymakers' effective resource allocation and improve population health and livelihood in these areas. This paper examines the factors affecting the choice of health care provider in low-income settings, specifically the urban slums in India. Method: A discrete choice experiment was carried out to elicit stated preferences of BoP populations. A total of 100 respondents were sampled using a multi-stage systemic random sampling of urban slums. Attributes were selected based on previous studies in developing countries, findings of a previous exploratory study in the study setting and qualitative interviews. Provider type and cost, distance to the facility, attitude of doctor and staff, appropriateness of care and familiarity with doctor were the attributes included in the study. A random effects logit regression was used to perform the analysis. Interaction effects were included to control for individual characteristics. Results: The relatively most valued attribute is appropriateness of care (β=3.4213, p = 0.00), followed by familiarity with the doctor (β=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (β=1.8132, p = 0.00). As expected, respondents prefer shorter distance (β= - 0.0722, p = 0.00) but the relatively low importance of the attribute distance to the facility indicate that respondents are willing to travel longer if any of the other statistically significant attributes are present. Also, significant socioeconomic differences in preferences were observed, especially with regard to the type of provider. Conclusion: The analyses did not reveal universal preferences for a provider type, but overall the traditional provider type is not well accepted. It also became evident that respondents valued appropriateness of care above other attributes. Despite the study limitations, the results have broader policy implications in the context of Indian government's attempts to reduce high healthcare out-of-pocket expenditures and provide universal health coverage for its population. The government's attempt to emphasize the focus on traditional providers should be carefully reconsidered.
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Introduction: According to the World Health Organization (WHO), over 130 million people are in constant need of humanitarian assistance due to natural disasters, disease outbreaks, and conflicts, among other factors. These health crises can compromise the resilience of healthcare systems, which are essential for achieving the health objectives of the sustainable development goals (SDGs) of the United Nations (UN). During a humanitarian health crisis, rapid and informed decision making is required. This is often challenging due to information scarcity, limited resources, and strict time constraints. Moreover, the traditional approach to digital health development, which involves a substantial requirement analysis, a feasibility study, and deployment of technology, is ill-suited for many crisis contexts. The emergence of Web 2.0 technologies and social media platforms in the past decade, such as Twitter, has created a new paradigm of massive information and misinformation, in which new technologies need to be developed to aid rapid decision making during humanitarian health crises. Objective: Humanitarian health crises increasingly require the analysis of massive amounts of information produced by different sources, such as social media content, and, hence, they are a prime case for the use of artificial intelligence (AI) techniques to help identify relevant information and make it actionable. To identify challenges and opportunities for using AI in humanitarian health crises, we reviewed the literature on the use of AI techniques to process social media. Methodology: We performed a narrative literature review aimed at identifying examples of the use of AI in humanitarian health crises. Our search strategy was designed to get a broad overview of the different applications of AI in a humanitarian health crisis and their challenges. A total of 1459 articles were screened, and 24 articles were included in the final analysis. Results: Successful case studies of AI applications in a humanitarian health crisis have been reported, such as for outbreak detection. A commonly shared concern in the reviewed literature is the technical challenge of analyzing large amounts of data in real time. Data interoperability, which is essential to data sharing, is also a barrier with regard to the integration of online and traditional data sources. Human and organizational aspects that might be key factors for the adoption of AI and social media remain understudied. There is also a publication bias toward high-income countries, as we identified few examples in low-income countries. Further, we did not identify any examples of certain types of major crisis, such armed conflicts, in which misinformation might be more common. Conclusions: The feasibility of using AI to extract valuable information during a humanitarian health crisis is proven in many cases. There is a lack of research on how to integrate the use of AI into the work-flow and large-scale deployments of humanitarian aid during a health crisis.
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This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that—even with respect to their ‘autonomy enhancing’ potential—these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy (which refers to processes of psychological deliberation) and substantive-relational autonomy (which refers to the opportunities people have for exercising potential actions). While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation.
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The booming increase of the senior population has become a social phenomenon and a challenge to our societies, and technological advances have undoubtedly contributed to improve the lives of elderly citizens in numerous aspects. In current debates on technology, however, the »human factor« is often largely ignored. The ageing individual is rather seen as a malfunctioning machine whose deficiencies must be diagnosed or as a set of limitations to be overcome by means of technological devices. This volume aims at focusing on the perspective of human beings deriving from the development and use of technology: this change of perspective - taking the human being and not technology first - may help us to become more sensitive to the ambivalences involved in the interaction between humans and technology, as well as to adapt technologies to the people that created the need for its existence, thus contributing to improve the quality of life of senior citizens.
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India launched the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) health insurance scheme for the poor in 2008. Utilising 3 waves (1999-2000, 2004-05 and 2011-12) of household level data from nationally representative surveys of the National Sample Survey Organisation (NSSO) (N=346,615) and district level RSBY administrative data on enrolment, we estimated causal effects of RSBY on out-of-pocket expenditure. Using ‘difference-in-differences’ methods on households in matched districts we find that RSBY did not affect the likelihood of inpatient out-of-pocket spending, the level of inpatient out of pocket spending or catastrophic inpatient spending. We also do not find any statistically significant effect of RSBY on the level of outpatient out-of-pocket expenditure and the probability of incurring outpatient expenditure. In contrast, the likelihood of incurring any out of pocket spending (inpatient and outpatient) rose by 30% due to RSBY and was statistically significant. Although out of pocket spending levels did not change, RSBY raised household non-medical spending by 5%. Overall, the results suggest that RSBY has been ineffective in reducing the burden of out-of-pocket spending on poor households.
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Background & objectives: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar s0 tates of India on insured households′ self-medication and financial position. Methods: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was "staggered implementation" cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results. Results: Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH′s location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations. Interpretation & conclusions: The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.
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Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs. We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review. Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment. In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers' access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.
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Co-creation of value has emerged as the most recent and dynamic phenomenon in management literature. Resource integrators as actors (customers, suppliers, intermediaries) are at the helm of every value co-creation process, nesting it in the social context. Thus, the value emerging from co-creation is social in nature. The purpose of our study is to define how stakeholders are creating social value in co-creation for themselves and other customers. Considering the case study of Rastriya Swasthya Bima Yojna (RSBY), we would be discussing how the engagement of various stakeholders led to the evolution of social value for all the stakeholders involved in value co-creation. The study primarily focuses on social value through co-creation. Thus, other outcomes have been purposely left out which is a major limitation of this study.
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It is usually a significantly complex decision to buy private health insurance. There are multiple factors which influence a buyer’s decision before s/he decides to buy a health insurance policy. In an Indian context it becomes even more imperative to know the exact influencing factors which can lead towards a purchase of private health insurance especially by consumers from low earning groups. This paper presents an identification of factors which influence the decision of buying health insurance product by specific consumer groups namely Auto Rickshaw Drivers, Cab Drivers, Panwalla, Women home maids in an Indian perspective as seen by expert sales professionals who have sold specific products to these consumer groups. Ten expert sales professionals were presented with a collection of nine important factors which influence buying of private health insurance and through Analytic Hierarchy Process were requested to identify and rank the factors which they considered most influential from the point of view of specific consumer groups. The Analytic Hierarchy Process approach identifies and ranks Premium, Customer Service and Claims settlement history as the top three criterions in private health insurance buying. This analysis offers insights into the expectations of specific consumer groups from private health insurance providers.
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Purpose This study aims to explore the impact of the adoption of wearable technology products for Indian health insurance firms. It identifies the key dynamic capabilities that health insurance firms should build to manage big data generated by wearable technology so as to attain a competitive advantage. Design/methodology/approach A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance experts was conducted with a semi-structured questionnaire. The data were coded using holistic and pattern codes and then analyzed using the content analysis technique. The findings were based on the thematic and relational intensity analysis of the codes. Findings An empirical model was established where all the propositions were strongly established except for the moderate relationship between wearable technology adoption and product innovation. The study established the nature of the interaction of variables on technology policy, organizational culture, strategic philosophy, product innovation, knowledge management and customer service quality with wearable technology adoption and also ascertained its influence on firm performance and competitive advantage. Research limitations/implications From a dynamic capabilities perspective, this study deliberates on wearable technology adoption in the health insurance context. It also explicates the relationship between the variables on technology policy, organizational culture, strategic philosophy, product innovation, knowledge management and customer service quality with wearable technology adoption on firm performance. Originality/value This study is one of the first studies to add the context of wearable technology and health insurance to the existing body of knowledge on dynamic capabilities and sustainable competitive advantage for the service sector. It would help existing and prospective players in adopting or setting up appropriate business models.
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How much are low-income individuals willing to pay for health insurance, and what are the implications for insurance markets? Using administrative data from Massachusetts' subsidized insurance exchange, we exploit discontinuities in the subsidy schedule to estimate willingness to pay and costs of insurance among low-income adults. As subsidies decline, insurance take-up falls rapidly, dropping about 25 percent for each $40 increase in monthly enrollee premiums. Marginal enrollees tend to be lower-cost, indicating adverse selection into insurance. But across the entire distribution we can observe (approximately the bottom 70 percent of the willingness to pay distribution) enrollees' willingness to pay is always less than half of their own expected costs that they impose on the insurer. As a result, we estimate that take- up will be highly incomplete even with generous subsidies. If enrollee premiums were 25 percent of insurers' average costs, at most half of potential enrollees would buy insurance; even premiums subsidized to 10 percent of average costs would still leave at least 20 percent uninsured. We briefly consider potential explanations for these findings and their normative implications.
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Technology plays an important role in reducing inequalities in health care delivery and enhancing quality of life. Health insurance firms require a potent technology policy to understand social determinants of health insurance that can lead to more innovative approaches to social inclusivity initiatives. This paper explicates critical factors of technology policy of health insurance firms that can contribute to better social inclusion and move towards universal health care. Through structured survey questionnaire, data were collected from 125 senior health insurance executives from India for identifying factors important for technology policy. A technology policy scale comprising six distinct factors is developed for health insurance firms using exploratory factor analysis. The factors are “organizational technology strategy,” “technology value drivers,” “technology utilization,” “firm agility in technology,” “firm technology capabilities,” and “customer focus through technology.” The factors identified in this study can be utilized and integrated with enabling technologies such as machine learning, internet of things, big data analytics, and digital phenotyping for creation of electronic health records that are critical for risk management of health insurance firms. This would help to promote healthy lifestyles and disease prevention strategies to strengthen universal health care for society. This paper looks at the factors that are essential in framing a technology policy for the health insurance sector. It provides reasons on how the factors contribute in the evolving health insurance field and can increase the rate of social inclusion for health care. And, finally, it helps in distinguishing how technology requirements and utilization in health insurance is different from other businesses.
Article
Since the mid-2000s, government initiatives in India have been gripped by the idea that biometric identification is more efficient than any form of paper-based documentation. In this article, I explore how new health care schemes in India have adopted this technocratic promise. On the basis of ethnographic research in Karnataka, I describe how enrolments for biometric smartcards for RSBY insurance proceeds. These enrolments are meant to turn the rural poor into consumer citizens, yet the RSBY cards elicit unexpected responses from the beneficiaries. Instead of reproducing state authority, the new ID cards become a fulcrum for questioning the stability of government.
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Purpose The purpose of this paper is to examine m-payment adoption for the bottom of pyramid (BoP) segment in a developing country context. Design/methodology/approach A questionnaire was distributed to 247 BoP customers in Bangladesh. Data were analysed by employing confirmatory factor analysis and Structural Equations Modelling. Findings The results show that performance expectancy (PE), effort expectancy (EE), facilitating conditions (FC), habit and social influence (SI) significantly influence the BoP segment’s behavioural intention (BI). It is revealed that PE, lifestyle compatibility (LC), SI and habit have relatively stronger effects being higher predictor of intentions. Again EE and FC have relatively lower effects on m-payment BI. On the other hand, hedonic motivation (HM) and price value (PV) are two non-significant predictors of m-payment adoption. Practical implications The study recommends that financial institutions, such as banks and other non-banking service firms, need to know the antecedents affecting BI suggested by the unified theory of acceptance and use of technology (UTAUT2) theory along with “LC”. This will increase m-payment adoption for the BoP segment in developing countries. Originality/value To the extent of researcher’s knowledge, none of the previous studies using the UTAUT2 theory to examine m-payment adoption for BoP segment. This study contributes empirical data to the predominantly theoretical literature by offering a deeper understanding of the inclusion of LC, which is one of the significant antecedents in explaining BoP segment’s m-payment adoption.
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Objectives There are growing concerns that social isolation presents risks to older people's health and well‐being. Thus, the objective of the review was to explore how technology is currently being utilised to combat social isolation and increase social participation, hence improving social outcomes for older people. Methods A systematic review of the literature was conducted across the social science and human‐computer interaction databases. Results A total of 36 papers met the inclusion criteria and were analysed using a four‐step process. Findings were threefold, suggesting that: (i) technologies principally utilised social network services and touch‐screen technologies; (ii) social outcomes are often ill‐defined or not defined at all; and (iii) methodologies used to evaluate interventions were often limited and small‐scale. Conclusion Results suggest a need for studies that examine new and innovative forms of technology, evaluated with rigorous methodologies, and drawing on clear definitions about how these technologies address social isolation/participation.
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The growing trend of using information technology (IT) in the present era has been associated with generating a huge amount of data. Throughout the history, the healthcare industry has generated a large amount of data on patient care. The current trend of is in the direction towards digitalization of these large amounts of data. Digital data and information in healthcare organizations are growing extensively. These data are gathered from a variety of sources and create new challenges, which lead to a lot of changes in health sciences. In the near future, the high availability of digital data makes it difficult to handle them, and big data will overcome the traditional scales and dimensions. Today, improving the performance of the healthcare industry depends on having more information and more organized knowledge. Big data allow us to do a lot of works that could not have been done in the past. The progress of IT and solutions for management of big data can lead to more effective outcomes in healthcare. This article begins by presenting the current and future statue of big data in healthcare and then explains the features of big data in the area of health as well as the potential benefits of studying big data. Finally, it identifies and ranks the challenges of using big data by the use of a multi-criteria decision-making technique. The aim of this study is to identify the most important challenges for the adoption of big data solutions for healthcare organizations.
Article
The term “big data” has gotten increasing popular attention, and there is growing focus on how such data can be used to measure and improve health and healthcare. Analytic techniques for extracting information from these data have grown vastly more powerful, and they are now broadly available. But for these approaches to be most useful, large amounts of data must be available, and barriers to use should be low. We discuss how “smart cities” are beginning to invest in this area to improve the health of their populations; provide examples around model approaches for making large quantities of data available to researchers and clinicians among other stakeholders; discuss the current state of big data approaches to improve clinical care including specific examples, and then discuss some of the policy issues around and examples of successful regulatory approaches, including deidentification and privacy protection.
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One particular trend observed in healthcare is the progressive shift of data and services to the cloud, partly due to convenience (e.g. availability of complete patient medical history in real-time) and savings (e.g. economics of healthcare data management). There are, however, limitations to using conventional cryptographic primitives and access control models to address security and privacy concerns in an increasingly cloud-based environment. In this paper, we study the potential to use the Blockchain technology to protect healthcare data hosted within the cloud. We also describe the practical challenges of such a proposition and further research that is required.
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We need to consider the ethical challenges inherent in implementing machine learning in health care if its benefits are to be realized. Some of these challenges are straightforward, whereas others have less obvious risks but raise broader ethical concerns.
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THE CAPITALIST SYSTEM is under siege. In recent years business increasingly has been viewed as a major cause of social, environmental, and economic problems. Companies are widely perceived to be prospering at the expense of the broader community.
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The chapter aims to analyse a sample of insurance services distribution websites located in Europe and USA. The description and the analysis of the models have been carried out from a potential customer’s perspective, who visits the operators’ websites in order to know the various insurance alternatives by surfing the internet; in this way, he is confident in the sole information available on the website he visited, as the relationship with the insurance company originates and develops exclusively or mainly through the web. The chapter ends with an analysis model which, still from a potential customer’s perspective, permits the detection of the automated distribution distinctive traits, that is, accessibility, transparency, and quality of the offer, by basing the judgement on the objective elements the customer can gather through the digital channel.
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Indian government launched the Rashtriya Swasthya Bima Yojana (RSBY), a national health insurance scheme, in 2008 that provides cashless health services to poor households in India. We evaluate the impact of RSBY on RSBY beneficiary households’ (average treatment impact on treated, ATT) utilization of health services, per capita out-of-pocket (OOP) expenditure, and per patient OOP expenditure on major morbidities. To address the issue of non-randomness in enrollment into the scheme, we exploit the longitudinal aspect of a large nationally representative household survey data to implement difference-in-differences with matching. We find that RSBY beneficiary households are more likely to report and receive treatment for long-term morbidity in rural areas; however, the differences in reporting and treatment of long-term morbidity is not statistically significant in urban areas. We do not find strong evidence that the RSBY reduced per person OOP expenditure for RSBY beneficiary households in both rural and urban areas. Conditional on having received medical treatment, we find that RSBY beneficiary patient spend less on medicine in rural areas but no statistically significant impact in urban areas. We also conduct a placebo experiment to support the parallel trend assumption of DID.
Article
Mobile health (m‐health) technologies offer many benefits to individuals, organizations, and health professionals alike. Indeed, the utilization of m‐health by older adults can foster the development of proactive patients, while also reducing financial burden and resource pressures on health systems. However, the potentially transformative influence of m‐health is limited, as many older adults resist adoption leading to the emergence of an age‐based digital divide. This study leverages protection motivation theory and social cognitive theory to explore the factors driving resistance among older adults. This mixed methods study integrates survey findings with insights from qualitative interviews to highlight that the m‐health digital divide is deepening due to older adults' perceived inability to adopt and their unwillingness to adopt stemming from mistrust, high risk perceptions, and strong desire for privacy. The paper contributes to the privacy and social inclusion literature by demonstrating that while many older adults have access to m‐health, they are currently excluded and require careful consideration by technology organizations and researchers. The study provides recommendations for narrowing the m‐health digital divide through inclusive design and educational efforts to improve self‐efficacy, develop privacy literacy, and build trust, thereby ensuring that older citizens are both capable and willing to adopt.
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The new president and Congress will face the question of how to deal with the Affordable Care Act. Repealing and replacing it will not be simple. Politicians also will have to focus on the rising public and private costs of health care, driven by an aging population and the advent of new drugs and treatments, and will need to make decisions about how to preserve the highly popular Medicare program, whose current funding is unsustainable. This chapter explores the available options and some of the realities that constrain action.
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The nationwide implementation of electronic medical records (EMRs) resulted in many unanticipated consequences, even as these systems enabled most of a patient’s data to be gathered in one place and made those data readily accessible to clinicians caring for that patient. The redundancy of the notes, the burden of alerts, and the overflowing inbox has led to the “4000 keystroke a day” problem¹ and has contributed to, and perhaps even accelerated, physician reports of symptoms of burnout. Even though the EMR may serve as an efficient administrative business and billing tool, and even as a powerful research warehouse for clinical data, most EMRs serve their front-line users quite poorly. The unanticipated consequences include the loss of important social rituals (between physicians and between physicians and nurses and other health care workers) around the chart rack and in the radiology suite, where all specialties converged to discuss patients.
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Objective: To propose nonparametric ensemble machine learning for mental health and substance use disorders (MHSUD) spending risk adjustment formulas, including considering Clinical Classification Software (CCS) categories as diagnostic covariates over the commonly used Hierarchical Condition Category (HCC) system. Data sources: 2012-2013 Truven MarketScan database. Study design: We implement 21 algorithms to predict MHSUD spending, as well as a weighted combination of these algorithms called super learning. The algorithm collection included seven unique algorithms that were supplied with three differing sets of MHSUD-related predictors alongside demographic covariates: HCC, CCS, and HCC + CCS diagnostic variables. Performance was evaluated based on cross-validated R2 and predictive ratios. Principal findings: Results show that super learning had the best performance based on both metrics. The top single algorithm was random forests, which improved on ordinary least squares regression by 10 percent with respect to relative efficiency. CCS categories-based formulas were generally more predictive of MHSUD spending compared to HCC-based formulas. Conclusions: Literature supports the potential benefit of implementing a separate MHSUD spending risk adjustment formula. Our results suggest there is an incentive to explore machine learning for MHSUD-specific risk adjustment, as well as considering CCS categories over HCCs.
Article
Vicarious embarrassment is a negative emotion, which is experienced by an individual when others misbehave. People can feel vicariously embarrassed when observing other people's pratfalls or awkward appearance. For instance, vicarious embarrassment is elicited when watching reality TV or in service encounters where many other customers are present. However, the relevance of vicarious embarrassment in physical service environments has not yet been thoroughly analyzed in the context of service encounters. The objective of the present study is to close this research gap and to introduce the phenomenon of vicarious embarrassment to service research. The findings of 25 in-depth interviews indicate that vicariously embarrassing incidents mostly occur in service encounters and that these incidents are triggered by the violation of social norms in both customer-to-customer and customer-to-employee interactions. The authors of the present paper identified closeness of relationship, the service context, and parties involved as important situational variables influencing vicarious embarrassment and further emotional, cognitive, and behavioral consequences for the observing person. From a managerial point of view, the relevance of vicarious embarrassment in physical service environments is caused by negative spillover effects of the service experience, which lead to decreasing customer satisfaction, negative word-of-mouth and purchase intentions, and a negative impact on the overall image of the service provider.
Article
What is the role of spatial peers in diffusion of information about health care? We use the implementation of a health insurance program in Karnataka, India that provided free tertiary care to poor households to explore this issue. We use administrative data on location of patient, condition for which the patient was hospitalized and date of hospitalization (10,507 observations) from this program starting November 2009 to June 2011 for 19 months to analyze spatial and temporal clustering of tertiary care. We find that the use of healthcare today is associated with an increase in healthcare use in the same local area (group of villages) in future time periods and this association persists even after we control for (1) local area fixed effects to account for time invariant factors related to disease prevalence and (2) local area specific time fixed effects to control for differential trends in health and insurance related outreach activities. In particular, we find that 1 new hospitalization today results in 0.35 additional future hospitalizations for the same condition in the same local area. We also document that these effects are stronger in densely populated areas and become pronounced as the insurance program becomes more mature suggesting that word of mouth diffusion of information might be an explanation for our findings. We conclude by discussing implications of our results for healthcare policy in developing economies.
Article
Computer science advances and ultra-fast computing speeds find artificial intelligence (AI) broadly benefitting modern society - forecasting weather, recognizing faces, detecting fraud, and deciphering genomics. AI's future role in medical practice remains an unanswered question. Machines (computers) learn to detect patterns not decipherable using biostatistics by processing massive datasets (big data) through layered mathematical models (algorithms). Correcting algorithm mistakes (training) adds to AI predictive model confidence. AI is being successfully applied for image analysis in radiology, pathology, and dermatology, with diagnostic speed exceeding and accuracy paralleling medical experts. While diagnostic confidence never reaches 100%, combining machines plus physicians reliably enhances system performance. Cognitive programs are impacting medical practice by applying natural language processing to read the rapidly expanding scientific literature and collate years of diverse electronic medical records. In this and other ways, AI may optimize the care trajectory of chronic disease patients, suggest precision therapies for complex illnesses, reduce medical errors, and improve subject enrollment into clinical trials.
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The preceding papers in this Series have outlined how underuse and overuse of health-care services occur within a complex system of health-care production, with a multiplicity of causes. Because poor care is ubiquitous and has considerable consequences for the health and wellbeing of billions of people around the world, remedying this problem is a morally and politically urgent task. Universal health coverage is a key step towards achieving the right care. Therefore, full consideration of potential levers of change must include an upstream perspective-ie, an understanding of the system-level factors that drive overuse and underuse, as well as the various incentives at work during a clinical encounter. One example of a system-level factor is the allocation of resources (eg, hospital beds and clinicians) to meet the needs of a local population to minimise underuse or overuse. Another example is priority setting using tools such as health technology assessment to guide the optimum diffusion of safe, effective, and cost-effective health-care services. In this Series paper we investigate a range of levers for eliminating medical underuse and overuse. Some levers could operate effectively (and be politically viable) across many different health and political systems (eg, increase patient activation with decision support) whereas other levers must be tailored to local contexts (eg, basing coverage decisions on a particular cost-effectiveness ratio). Ideally, policies must move beyond the purely incremental; that is, policies that merely tinker at the policy edges after underuse or overuse arises. In this regard, efforts to increase public awareness, mobilisation, and empowerment hold promise as universal methods to reset all other contexts and thereby enhance all other efforts to promote the right care.
Article
Along with the digital revolution, information and communication technology applications are currently transforming the delivery of health and social care services. This paper investigates prevailing opinions toward future technology-based healthcare solutions among Austrian healthcare professionals. During a biphasic online Delphi survey, panelists rated expected outcomes of two future scenarios describing pervasive health monitoring applications. Experts perceived that the scenarios were highly innovative, but only moderately desirable, and that their implementation could especially improve patients’ knowledge, quality of healthcare, and living standard. Contrarily, monetary aspects, technical prerequisites, and data security were identified as key obstacles. We further compared the impact of professional affiliation. Clearly, opinions toward pervasive healthcare differed between the interest groups, medical professionals, patient advocates, and administrative personnel. These data suggest closer collaborations between stakeholder groups to harmonize differences in expectations regarding pervasive health monitoring.
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The Internet of Things (IoT) is a physical device along with other items network that embedded with software, electronics, network connectivity, and sensors to collect objects in order to exchange data. The IoT impact in healthcare is still in its initial development phases. The IoT system has several layers that lead to implementation challenges where many engaged devices have sensors to collect data. Each has its manufacturer own exclusive protocols. These protocols using software environment associated with privacy and security raise new challenges in the IoT technology. This current chapter attempts to understand and review the IoT concept and healthcare applications to realize superior healthcare with affordable costs. The chapter included in brief the IoT functionality and its association with the sensing and wireless techniques to implement the required healthcare applications.
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Health economic studies provide information to decision makers for efficient use of available resources for maximizing health benefits. Economic evaluation is one part of health economics, and it is a tool for comparing costs and consequences of different interventions. Health technology assessment is a technique for economic evaluation that is well adapted by developed countries. The traditional classification of economic evaluation includes cost-minimization, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. There has been uncertainty in the conduct of such economic evaluations in India, due to some hesitancy with respect to the adoption of their guidelines. The biggest challenge in this evolutionary method is lack of understanding of methods in current use by all those involved in the provision and purchasing of health care. In some countries, different methods of economic evaluation have been adopted for decision making, most commonly to address the question of public subsidies for the purchase of medicines. There is limited evidence on the impact of health insurance on the health and economic well-being of beneficiaries in developing countries. India is currently pursuing several strategies to improve health services for its population, including investing in government-provided services as well as purchasing services from public and private providers through various schemes. Prospects for future growth and development in this field are required in India because rapid health care inflation, increasing rates of chronic conditions, aging population, and increasing technology diffusion will require greater economic efficiency into health care systems.
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The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.
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High private healthcare spending as well as high out of pocket spending in India are placing a considerable financial burden on households. The 60th national morbidity and healthcare survey of the National Sample Survey Organisation provides an opportunity to examine the impoverishing effect of healthcare spending in India. This paper presents an analysis of the nsso survey data with some new approaches to correcting some of the biases in previous assessments of the "impoverishing" effect of health spending. Despite these corrections, the results suggest that the extent of impoverishment due to healthcare payments is higher than previously reported. Furthermore, outpatient care is more impoverishing than inpatient care in urban and rural areas alike. The analysis of the extent of impoverishment across states, regions (urban and rural areas), income quintile groups, and between outpatient care and inpatient care yields some interesting results.