Managing reimbursement of complementary health insurances in Chile: barriers and needs faced by health professionals and patients
Abstract
Introduction: Complementary health insurance pays for expenses not covered by public or private insurance. The collective insurance market is growing in Chile. However, little evidence exists on how reimbursement management is perceived by users. This study aims to charac¬terize the management of reimbursement of complementary health insurance from the pers¬pective of patients, physicians, and dentists, and to provide recommendations for innovation. Materials and methods: Mixed design based on a cross-sectional quantitative study (412 participants) and an exploratory qualitative study (20 participants), conducted in 2022. The study used a self-administered questionnaire for quantitative analysis, whi¬le semi-structured interviews and content analysis were used for qualitative analysis. Results: The reimbursement forms can be obtained at health facilities or are printed and carried by the patient. Patients perceive the form-filling process as complex due to a lack of information, inadequate insurance support, and websites that are difficult to navigate. Healthcare profes¬sionals point to the loss of healthcare time due to filling out the forms (especially dentists), the additional steps involved, and the complex and non-standardized forms. The need for an inte¬grated and user-friendly digital system that facilitates reimbursement management is recognized.
Discussion: The healthcare industry needs to develop integrated reimbursement systems with innovative solutions that prioritize the user experience and leverage new technologies to improve outcomes and enhance care quality.
