Optimization of Quality Management in Health Insurance for Sustainable Cost Reduction

Daniela Grotewold-Sosa (), Janio Jadán-Guerrero (), Luis Pusey-Alvarado () and Nelson Díaz-Alvarez ()
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Daniela Grotewold-Sosa: Universidad Galileo
Janio Jadán-Guerrero: Universidad Tecnológica Indoamérica
Luis Pusey-Alvarado: Universidad Galileo
Nelson Díaz-Alvarez: Universidad Galileo

A chapter in Demographic Transitions, Health, and Well-Being, 2025, pp 477-484 from Springer

Abstract: Abstract This study addresses the optimization of quality management in health insurance to achieve sustainable cost reduction while maintaining service standards. Utilizing a mixed-methods approach, the research combines literature review and survey data to analyze user perceptions of service quality and the role of digital technologies. The survey included a diverse sample of health insurance users, capturing insights on satisfaction, technological tools, and quality management processes. Key findings reveal that user satisfaction is significantly influenced by transparency, accessibility, and the integration of digital tools such as mobile apps, web portals, CRM systems, and telemedicine. Correlation analyses showed a moderate positive relationship between the frequency of technology usage and perceived effectiveness, satisfaction, and future impact expectations. Despite moderate satisfaction levels with current technologies, participants emphasized the need for advanced tools to enhance efficiency and user experience. Demographic analysis indicated that educational level positively correlated with satisfaction, highlighting the importance of user training for technology adoption. Additionally, older users reported lower satisfaction, signaling the need for more inclusive and user-friendly systems. Gender differences in satisfaction and the positive association between customer loyalty and perceived service quality further underscore the importance of personalized strategies. The study concludes that digital transformation in health insurance can sustainably reduce costs while meeting user expectations. Key recommendations include increasing user education, investing in advanced technologies, and tailoring solutions to diverse demographic needs. These findings provide actionable insights for insurance companies aiming to improve operational efficiency and enhance service quality sustainably.

Keywords: Optimization; Quality; Medical insurance; Costs; Ensure healthy lives; SDG 3 (search for similar items in EconPapers)
Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:spr:prbchp:978-3-031-94487-1_42

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DOI: 10.1007/978-3-031-94487-1_42

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