Cost management strategies in health insurance: a scoping review

Insurance plays a significant role in health systems financing. The existence of multiple risks has led to an increase in the costs of insurance organizations.

The study aimed to identify cost management strategies in health insurance.

A scoping review was conducted by focusing on published studies in Farsi and English languages in the field of health insurance through the world by the end of June 2020. Search was performed using valid keywords in PubMed, Scopus, Web of Science, SID, Magiran, Google and Google scholar search engines. A list of credible sources and journals were assessed, too. Finally, 51 articles fulfilled the inclusion criteria, were reviewed and analyzed using MAXQDA software.

In total, 97 cost management strategies were identified which were classified into 3 groups: providers, insured people and insurance organizations. Modification of payment methods to providers and monitoring of services provided and medications prescribed in the field of providers, cost sharing, deductible, consumption management and culture building in using services in the field of insured people, strategic purchasing, coverage constraints, internal controls, using risk management and employing specialized personnel were among the most important cost management strategies in the field of insurance internal processes. Other institutions that make policy and oversee the insurance industry will also play a significant role in reducing the costs.

Understanding the solutions to cost control in health insurance helps policymakers and managers to plan and apply corrective interventions and appropriate changes that lead to reduce the costs of insurance companies.