CaseStudyoftheInsuredPersons
SatisfactionwiththeAssistance
Centre
aleksanderjaneš
University ofPrimorska, Slovenia
aleksander.janes@fm-kp.si
martinafranˇ ceškin
Triglav,Zdravstvena zavarovalnica, Slovenia
martina.franceskin@triglavzdravje.si
Thepurposeof thepresented paper istodiscussonthefactors
thatinfluence thesatisfaction oftheinsuredpersonswith the
assistancecentre (ac)oftheinvestigated health insurancecom-
pany.Intheempirical part oftheresearch thefactors whichare
important forthesatisfaction oftheinsuredwith the acwere in-
vestigated with thequestionnaireforinsuredpersons.Thefactor
thatis themoststatistically positivelyrelated tousersatisfaction
is the‘understandingtheneeds andrequirements ofpolicyhold-
ers’. Basedon thefindings fromempirical research (question-
naire forinsuredpersons andinterview with ac’semployees), im-
provement proposals were defined whichshouldincrease thesat-
isfaction of policyholders with the ac’sservice. Recognized find-
ings andsuggestions shouldbe consideredandreasonably imple-
mented bytheinsurancepolicydesigners.
Key words: Health InsuranceCompany,insuredpersons,process
management, policyholders, satisfaction
https://doi.org/10.26493/1854-4231.15.121-136
Introduction
Health is the highest value in modern society, as it is the first con-
dition for increasing well-being. The company needs to take care
of the right environmental conditions as these are a prerequisite
for maintaining and promoting health (Svetovna zdravstvena orga-
nizacija 2014). Due to the current topic of population aging and the
consequentincreaseinthemorbidityandmortalityofpeopleandthe
nature of work, the investigation focused on the satisfaction of in-
sured persons with the assistance centre (ac) of the selected health
insurance company. It is a well-known fact that waiting times for
specialist examinations, diagnostics and public health interventions
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Aleksander JanešandMartinaFranˇ ceškin
in Slovenia are increasing and as a consequence, people’s dissatis-
faction is increasing (Nacionalni inštitut za javno zdravje 2019). As
a result of this, more and more people are opting to buy additional
healthinsurance,whichallowspolicyholderstohaveshorterwaiting
timesfor medicaltreatment.
The official records of the selected insurer show that the growth
of supplementary healthinsurance has increaseddramatically from
2013 to the present, with the increase in claims of insured persons
through the ac(Triglav zdravstvena zavarovalnica 2016). It was this
fact that prompted investigation of the insured persons satisfaction
with the acand which are the important factors to the satisfaction
of theinsuredpersonswiththe ac.
LiteratureReview
Call centres accept calls and forward them to the assistance cen-
tre based on insured’s requests for assistance. In assistive centres,
employeesarepromptedforappropriatetreatmentbasedonthena-
ture of the call. The AssistanceCentre is thus anindispensable part
of the insurance industry, whose core business is managing sudden
and unexpected events. Insurance companies provide assistance in
various areas such as: home assistance, car assistance, medical as-
sistance. Assistant centre employees offer a wide variety of invisi-
ble services to users. They can only provide information about the
desired assistance service or assistance as a service (Rolland et al.
2006).
ac’s employees are required to always have a friendly voice when
in contact with the insured. It is a well-known fact that working in
an acischaracterizedbyroutinetasksandahighlevelofstressand
a low level of control for employees in terms of work tasks and in-
teraction with clients. Ferreira et al. (2015) describe the purpose of
establishing assisted care centres designed for the insureds’ or pa-
tients’ needs and contributing to the overall satisfaction of citizens
withthe healthcaresystemandits effectiveness.
Mazzucato,Houyez,andFacchin(2014)andNayak,Bhattacharyya,
and Krishnamoorthy (2019) emphasize the need for telephone ser-
vices that are parallel to other information systems. Parallel to the
online providers of information on health advice or health services,
information services have been introduced, i.e. assistance centres,
based on telephone communication. Assistance centres have been
designedasanalternativeinformationaccesspointforpatientswith
rarediseases(Babacetal.2018).
The acof the selected Health insurance Company alias insurer
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started operating in 2013. It was also the first time that additional
healthinsurancewastakenout.Duetothesmallnumberofinsured
persons with supplementary health insurance, the need for assis-
tanceworkerswaslow.Onlyagraduatenurseandotheradministra-
tive employees were employed. With the surging growth in supple-
mentary health insurance policies, in 2016 the employees at the ac
increased to three employees with different health backgrounds. In
2019, there are six health professionals with different health back-
grounds in the ac. Zichello and Sheridan (2008) consider that most
frequently employed nursing assistantships in the European Union
(eu)areregisterednursinggraduateswhodirectpolicyholderstoap-
propriate medical treatment. If the patient’s condition does not re-
quire the judgment of a physician on call, the graduate nurse often
contacts the insured person only by telephone counselling. In Nor-
way, the system is organized in the municipal-owned primary care
sector. The system serves as the protector of the secondary health
servicesofstate-ownedhospitals.Medicalresponsibilityformedical
servicesislargelyassumedbygeneralpractitionerswhoalternatein
their area. Nursing assistance represents an important part of pri-
mary health care services. Medical assistance is an important and
extensive activity that educates and advises patients, healthcarers
andrelatives.Asaresult,theworkloadofclinicsisreduced(Midtbø,
Raknes,andHunskaar,2017).
The selected acof the insurer employs six people with a medical
degree,one graduatenurse,twograduatemedicaldoctors,onemas-
terofnursing,onemasterofeducationandhealthmanagementand
amedicaltechnician.Thework tasksofemployees arearrangedac-
cording to internal duties and assigned tasks in the ac.Oneofthe
key tasks of the help centres is to talk or counselling on health and
psychosocial issues. Research has shown that telephone lines are
needed for help or personal contact. Patients with chronic illnesses
orrelativeswanttelephonecounsellingledbymedicalprofessionals
with broad healthcare competencies. acsare created to assist pa-
tients and provide broad spectrum information on health and psy-
chosocial issues (Adam et al. 2012; Babac et al. 2018; Ekberg et al.
2014).Beesleyetal.(2010)describetheintroductionofan acthatof-
fers exclusive telephone counselling. Telephone counselling differs
fromassistancedependingonthetypeofinformationprovided,such
as references, counselling and or medical information. Zichello and
Sheridan (2008) stated that health education in eucountries plays
an important role in health insurance companies. They researched
that graduating a nurse by adapting an insurance plan would have
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an impact on managing claims and improving the safety of insured
persons.Ratanawongsaetal.(2012)describethatnursinggraduates
engage in supportive education for the insured persons to manage
andmanagechronicillnesses.WienerandGilliland(2011)foundthe
importance of properly documenting the insured person’s medical
treatment and care of the medical records. They found that nurs-
ing graduatescarewas inline with standards setby regulations and
professionalethicalexpectations (Cartwright-Vanzant2010).
Theworkprocessatthe ac isdefinedasasequenceofworkproce-
duresandactivities,whichisintegratedintothecomprehensivepro-
cess(Gošnik2019)oftheselectedinsurancecompany.Theactivities
of this process are directly related to the insurance or the enforce-
mentofthecontractuallyagreedliabilitiesoftheinsurancecompany
on the basis of covered risks insurance, which represents the ‘in-
surance case’ and the liability to the insured (Triglav zdravstvena
zavarovalnica2013).
Forinformationonregisteringaninsurancecase,theinsuredper-
son calls the call centre, which gives him instructions on register-
ing or announcing the insurance case. For more detailed explana-
tions of the medical personnel, the call centre connects the call of
the insured person to the acwhere they are employed with med-
ical knowledge. They provide policyholders with information, ad-
viceonhealthissues,insurance-relatedinformation,andhealthcare
providers. When exercising supplementary health insurance rights,
registrationorannouncementofthedesiredhealthservicetothe ac
isrequired.Insuredpersonshavetheoptionofannouncingorregis-
tration of the insurance case by e-mail, telephone call (Mevissen et
al. 2012) and in writing via regular paper mail. Upon arrival of the
announcementorregistrationoftheinsurancecase,thelatterisau-
tomatically transferred to the program where the documentation is
stored. The employee in charge of the program, where case is man-
aged and stored without paper documentation, assigns insurance
claims to employees atthe ac. Employees with health education are
involved in the treatment at the ac.Theacorganizes the terms of
medical treatment on the basis of the obtained medical documen-
tation and the wishes of the insured person, issues the consent on
the implementation of the provided health services, prepares reim-
bursementsofinsurancecasesandprovidesassistanceinexercising
rights.
The employees at the achave different health education and dif-
ferent job responsibilities and competences (Bach and Suliková
2019). When dealing with an insurance case, in addition to qual-
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ity nursing care, employees at the acmust also include insurance
skills in the process, as all insurances have different limitations on
the insurer’s obligations. ac’s employees must adapt to insurance
when dealing with an insurance case, since insurance is limited in
contentor coverage.
When dealing with an insurance case, the employees at the ac
must verify the formal, procedural and substantive relevance of the
insurancecase.Withthehelpofacomputerprogram(RathandPat-
tanayak2019),theemployeeverifiesalltherightsintheexistingin-
suranceandthenproceedswiththecase.Ifitfindsdeviationsinfor-
mal, procedural or substantive inadequacy, it calls the insured per-
sonanddismissesthecaseinthecomputerprogramandinformsthe
administrativeemployeestosendarejectionnotice.
When ordering the insured person for the intended health care
services, the employees of the acplay an important role, since they
provide the insured person with information about the order for in-
vestigationorspecialistexaminationsorinterventions.Whenorder-
ing an insured person for the planned health service, employees of
the actake into account the time and place restrictions of the in-
sured person. They provide the insured person with information on
possible preparationsfor investigationsandassistintheinterpreta-
tion and fulfilment of various investigations or interventions. They
are in close contact with healthcare providers, as they wish to pro-
videcomprehensiveassistancetopolicyholders atthe ac.
On the basis of mutual internal agreements between the employ-
ees of the acand prior communication with the insured person and
with health care providers, they advise the insured person about
possiblediagnosticsbeforespecialistexaminations.Withthehelpof
thelatter’sagreedmethodofworkandinternalarrangementsofem-
ployees and communication with health care providers, they speed
uphealthcareandshortentheinsured’s timetothefinaldiagnosis.
After completing the order for the planned examination or diag-
nostics or intervention, the employee in the acprepares the autho-
rization in the computer program for the intended health service of
the insured person. For the traceability of health treatments, the ac
hasacomputerprogram(RathandPattanayak2019)inwhichallin-
formation about the treatment of an insurance case is entered from
the date of announcement to the date of completion of the medical
treatment.
After expert processing of the insurance case and preparation of
authorization in the ac, the latter is handed over to the administra-
tive employees who arrange for the dispatch of the authorization.
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The administrative employees sendthe authorization tothe insured
person in electronic form or in physical form via regular mail, ac-
cording totheinsuredperson’s request.
Methodology
The purpose of the research was to gain in-depth insight into the
work process (Gošnik 2019) of the acof the selected health insur-
ance company case study (Gummesson 2000) and to research and
analyse the satisfaction of the insured persons with the acservices.
Forthatpurposethefollowingresearchquestions(rq)weredefined:
rq1 What importance do the insuredpersonsattribute to theassis-
tancecentre?
rq2 Whatfactorsareimportanttothesatisfactionofpolicyholders?
rq3 Howtoincreasethesatisfactionoftheinsuredpersonswiththe
helpcentre?
rq4 Howtoimprovetheworkprocessintheassistancecentre?
A survey of the acusers with a survey questionnaire was con-
ducted. The author’s original questionnaire was created using the
1ka (https://www.1ka.si) website. The online survey questionnaire
was active on med.over.net and mojforum.si forums and on social
networks from May 23, 2019 to August 22, 2019. The sample of
respondents was occasional, which is an unrepresentative sample.
During the three-month period, 117 people activated questionnaire
online; 74 questionnaires from acusers were submitted, of which
two were only partially completed. The completed questionnaires
about satisfactiondataof 72respondents wereusedinthe analysis.
The survey comprehended 52 women’s i.e. 72.22% of all respon-
dents,and20men’s i.e.27.78%of allrespondents.Mostrespondents
werebetween41and50yearsold.Thestructureoftherespondents’
education is usually higher education or university education, or as
muchas50%ofallparticipants.
Based on the obtained demographic data of the respondents, it
can be concluded that the majority of additional health insured is
from central Slovenia, that there are highly educated, married and
aged between 41 to 50 years. From this it can be concluded that
the insured are middle-aged, have a good economic standard and
want to create a secure future in the event of potential health prob-
lems. Purchasing additional health insurance allows them to have a
quick medicaltreatmentand,consequently,toobtainafinaldiagno-
sisquickly.
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Beside the questionnaire for acusers, the interview with the six
employeesfocus groupwasperformed(Adametal.2012).
EmpiricalFindingsandDiscussion
analysisoftheassistancecentreresponse
In the survey the responsiveness of the acin relation to the med-
ical records provided via e-mail, mobile application and telephone
call to the acwas analysed. The data, together with the frequency
ofcallsandcalltimes,servedasinformationaboutwhenthe acwas
the busiest and whether the work process was still optimal with re-
gardtothegrowthofinsuredpersons.
Most of the insured persons surveyed communicated with the ac
via telephone, i.e. 97.78% of all, and send the documentation via
email, i.e. 87.67%of all. The insured’s medical records were emailed
to 87.67%, followed by a call to the ac. Considering that 10.11% of
the insured persons did not send medical records via e-mail, but
only called the ac, it can be concluded that they wanted only gen-
eral information or information on exercising rights or some other
information relatedto assistance.Namely,claiming insurance rights
requirestheregistrationorannouncementofaninsurancecase,and
amedicalindicationisrequired,whichissentbyinsuredpersonsby
e-mailorregularmail.
Themostcommonanswergivenbytherespondentsregardingthe
accallbacktimewasupto1hour,whichwasansweredby29.23%of
allrespondents.This,indescendingorder,isfollowedbytheanswers
thattheyhadtowaitupto15minutes,26.15%,followedby15.38%of
the respondents who were waiting for the call until the next day.
12.31%oftherespondentswerecalledbackimmediatelyand10.77%
of respondents received a call back within two hours. The fewest
respondents claimed to have waited either 4 hours or 8 hours – two
participants ineachcase,whichis 3.08%ofallinboth cases.
Regarding the frequency of calls to the ac,themajorityofpar -
ticipants answered that they had called or sent medical records be-
tween10:01and14:00hours.Suchresponseswereashighas64.18%.
Thedescendingorderisfollowedbytheanswersregardinglastcalls
times: from 6:00 to 10:00 with 20.9% and in the penultimate place
from 14:01 to 18:00 with 11.94%. Last calls time was from 18:01 to
22:00withonly twoanswers,representing2.99%.
Throughinterviewwiththe acemployeefocusgroup,weobtained
information that they have the highest frequency of work between
10:00and14:00.Duringthistime,alunchbreakwithaslidingsched-
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uletakesplaceforemployees.Duetothisfact,employeesthinkthat,
as a result, it is very likely that the call back time will be extended.
Through the interview of the acemployee’s focus group, we found
thatallemployeeshaveaconsensusthattheworkprocessisnotop-
timal and that a work process audit is needed. They unanimously
believe thatthe rapidgrowth of policyholders hasledto anincrease
in the volume of work and consequently led to a sub-optimal work
process.
analysisofresearchquestionsanddiscussion
Regarding the research question rq1, ‘What importance do the in-
sured persons attribute to the assistance centre?’ two sets of ques-
tions wereused:
1.acServiceSatisfaction,and
2.Thecharacteristicsofthe employeesinthe ac.
The first set about the acservices included twelve questions,
which could had been answered by a choice on a six-point Likert
scale:Iwould not know, Verybad, Bad,Neithergood nor bad,Good,
Verygood(table1).
The most important assistance service according to policyholders
is receivingclearguidance on thehealthcareprovider (83.33%).An-
otherassistanceservicethatisveryimportanttopolicyholdersisthe
receiptofclearmedicaltreatmentinstructions (81.54%).
The surveyed policyholders expressed a poor opinion about the
telephoneconnection(63.64%)andtheexplanationoftheenvisaged
further treatment of the insured (64.18%). With these two services,
the insuredaretheleastsatisfied.
This can be related to the fact that the maximum frequency of
workinthe acisbetween10:00and14:00hoursandthatduringthis
timethemostinsuredpersonswaitedforthecalloftheassistantsfor
as much as 1 hour. This fact confirms that acis the busiest during
this time, and that work reorganization is needed to ensure policy-
holders satisfactionwith acresponsiveness.
The second set about the characteristics of the employees in the
ac included eleven questions, which could had been answered by a
choiceonasix-pointLikertscale:Iwouldnotknow,Itdoesn’tmatter
atall,Littleimportant,Important,Veryimportant,Especiallyimpor-
tant (table2).
Asseenfromtable2themostimportantattributeforthesurveyed,
is the employee’s communication skills (61.19%), and followed by
the knowledge regarding the exercise of rights from supplementary
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table1 FrequencyAnalysis of ac ServiceMetrics
Question (1) (2) (3) (4) (5) (6)
Doyouthink thattheemployeehas
deepenedenoughin yourproblem?
70.42 28.17 0.00 0.00 0.00 1.41
Theemployeewasconsiderate, respect-
fulandlistened toyou?
77.61 20.9 1.49 0.00 0.00 0.00
Wereyouexplainedthepurposeofthe
medicaltreatmentandanyfurtherproce-
dures,interventions?
64.18 28.36 1.49 1.49 0.00 4.48
Hastheorderedtreatmentbeen carried
outin accordancewith yourexpecta-
tions?
72.73 24.24 0.00 0.00 0.00 3.03
Were you involved in deciding about your
treatment?
75.38 21.54 0.00 0.00 0.00 3.08
Didyoueasily get a phoneconnection
withthe ac?
63.64 19.70 9.09 1.52 0.00 6.06
Didyouget the information youneeded? 74.24 24.24 0.00 0.00 0.00 1.52
Didyoureceiveclear instructionson the
selectedhealthcareprovider?
83.33 16.67 0.00 0.00 0.00 0.00
Didyoureceiveclear instructionsregard-
ingmedicaltreatment?
81.54 15.38 0.00 0.00 0.00 3.08
Doyouthink theemployeeexplainedthe
matter/treatment/informationthatyou
haveunderstood?
74.24 22.73 1.52 0.00 0.00 1.52
Doyouthinkthattheemployeestimu-
lated yourconfidence?
77.61 22.39 0.00 0.00 0.00 0.00
Doyouthink theemployeeis profession-
ally qualified for the job?
71.21 27.27 0.00 0.00 0.00 1.52
notes Columnheadingsareasfollows: (1)verygood,(2)good,(3)neithergoodnor
bad, (4)bad,(5)verybad,(6)iwouldnotknow.In percent.
health insurance (52.17%). In most cases, the gender (71.01%) and
age (56.52%) of the employee were chosen as an insignificant fea-
ture ofthe ac’s employees.
Proper handling of insurance casesrequires extensive healthcare
knowledge and work experience in various health fields. Insured
persons do not feel that the qualities of the employees at the acare
important.Themostimportantfeatureofassistingusersisthecom-
munication skill of the help desk employees. The first contact of the
insured person with the employee at the acis interpersonal contact
and communication. Insured persons are not aware of the impor-
tance of a broad knowledge of healthcare and work experience of
employees, as this enables them to properly refer the insured to the
intended medical treatment. At the same time, a great deal of work
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table2 ac Employee’sCharacteristics
Question (1) (2) (3) (4) (5) (6)
Occupationofan employee N 2 42 01 6425
% 33.8 28.17 22.54 5.63 2.82 7.04
Thegender oftheemployee N 22574 94
% 2.9 2.9 7.25 10.14 71.01 5.8
Employeeage N 431 253 96
% 5.8 4.35 17.39 7.25 56.52 8.7
Medicalknowledge N 2 41 71 7425
% 34.78 24.64 24.64 5.8 2.9 7.25
Employeeeducationlevel N 1 21 42 0977
% 17.39 20.29 28.99 13.04 10.14 10.14
At least 5 yearsofworkexperience
inhealthcare
N 16 15 15 11 6 6
% 23.19 21.74 21.74 15.94 8.7 8.7
Employeeknowledgeofhealth care
legislation
N 2 02 12 0403
% 29.41 30.88 29.41 5.88 0 4.41
Employeecreativity N 1 72 31 7504
% 25.76 34.85 25.76 7.58 0 6.06
itknowledge ofemployee N 1 12 52 4414
% 15.94 36.23 34.78 5.8 1.45 5.8
Knowledgeofexercisingsupplemen-
taryhealth insurancerights
N 3 62 37003
% 52.17 33.33 10.14 0 0 4.35
Communicationskills N 4 12 41001
% 61.19 35.82 1.49 0 0 1.49
notes Columnheadingsareasfollows:(1)especiallyimportant,(2)veryimportant,
(3)important,(4)little important,(5)itdoesn’tmatteratall, (6)Iwouldnotknow.
experienceinvariousfieldsofhealthcarehelpstointerpretcorrectly
the intendedhealthtreatmentof theinsuredperson.
Research questions rq2and rq3were examined using the factor
analysis.First,allthesetsofquestionsthatwererelatedtothesatis-
factionof theinsuredwiththe acwereidentified:
 estimatedtimeofinsurancecaseresolution (4sub-sets);
 evaluation ofthe acproperties(11sub-sets);
 evaluation ofsatisfactionwith acservices(7sub-sets);
 ac’s Quality Assessments(13sub-sets).
Respondentswereabletoanswereachofthesub-setsbyachoice
on a five-point Likert scale: Very unsatisfied, I’m not satisfied, Nei-
thersatisfiednor dissatisfied,Satisfied,Verysatisfied.
Beforeperformingthefactoranalysis,thedatawereanalysedwith
aPearsoncorrelationtest.Theresultsshowedthatsomevalueshave
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table3 SpearmanCorrelation Coefficient
Item rp
Accuracyinthemanagementofinsureddata 0.640 <0.001
Understandingtheneeds andrequirementsofpolicyholders 0.700 <0.001
Fulfilmentofpromises, agreements 0.436 0.006
Transparencyof authorization 0.682 <0.001
Transparencyof coverletters 0.684 <0.001
Accesstotheappropriatecontactperson 0.622 <0.001
Phoneresponsespeed 0.658 <0.001
Complaintshandling 0.282 0.112
Resolvingreclamation 0.233 0.192
Informingpolicyholders 0.502 0.001
notes Due to the space limitation of paper, only Spearman’s analysis is shown be-
causethetable ofFactors ofSatisfaction with the acis extensive.
a strong correlation (r > 0.8), which is present in questions of the
same set. Some measurements, however, either have no statistically
significantassociation(statisticalsignificancep>0.05)orhaveavery
weak correlation (r < 0.2), which is present for questions from dif-
ferentsets.
In order to get one measurement i.e. factor which represents sat-
isfaction of respondents with ac, exploratory factor analysis of all
sub-sets was performed. The recognized factor was called satisfac-
tion. The principal axis factoring method was used to find the satis-
factionfactor.InordertorotatethefactormodelestimationtheVari-
max method was used. When constructing the factors, the standard
limitof0.3forthefactorweightswasused,sothefollowingvariables
have fallen out: time to reject insurance, time to resolve complaints,
resolvecomplaints andresolvereclamation.
The result of Bartlett’s test of sphericity indicates that the vari-
ablesareinterrelatedandthe factorobtained isvalid(p<0.05).The
obtained factor explains as much as 40.2% of the variance of satis-
factionof allrespondents.
In reviewing the correlations of satisfaction with aca non-para-
metric test was used, i.e. Spearman Correlation Test, which results
arepresentedintable 3.
Based on the analysis, the response to rq2refers to variables
that are statistically significantly related to user satisfaction. The
strongestpositivecorrelationwithsatisfactionandunderstandingof
the needs and requirements of the insured persons is the strongest
(r = 0.7).This is followed by transparencyof cover letters (r = 0.684)
andauthorizationreview(r=0.682).Ofallthefactorsthatarestatis-
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ticallysignificantlyrelatedtoinsured’ssatisfaction,theweakestcor-
relationhasthefulfilment ofpromisesandagreements(r=0.436).
To find the answer to rq3’s research question on how to increase
acuser’s satisfaction, a factor analysis results were used to iden-
tifythesatisfactionfactor.Variableswiththehighestfactorsweights
value, which also have the greatest impact on acuser satisfaction,
are:
 explaining the purpose of the treatment and possible follow-up
procedures,interventions (0.942);
 orderedtreatmentwasperformedasexpected(0.859);
 understanding the needs and requirements of policyholders
(0.829).
With increased attention to these aspects, insureds’ satisfaction
with acwould alsoincreasethe most. Therefore,when dealing with
an acinsurance case, it is very important to focus on an in-depth
explanation to policyholders of what the purpose or the intended
treatmentis(0.942).Itshouldbeemphasizetheimportanceofmany
years of work experience of health care professionals in ac and the
importance of knowledge of different fields of work, since the latter
contributes tothe proper healthtreatmentof the insured.
The satisfaction of the insured with the acis also greatly influ-
enced by the expectation of ordered medicaltreatment(0.859). This
variableisalsoconfirmedbythefactthatitisveryimportantforthe
insuredpersontoexplainthecourseofthemedicaltreatmentbefore
thehearing,sothatheorshecancreatearealisticexpectationofthe
intended healthservice.
The third most important variable, for the satisfaction of policy-
holders with ac, is in understanding the needs and requirements of
policyholders(0.829).Thisvariableisstronglyrelatedtothecommu-
nication skills of ac employees, since only good communication be-
tweenthe insured personandthe acemployee canensure aproper
understandingoftheinsured’sneedsanddesiresand,consequently,
leadtoasatisfiedinsuredperson.
Regarding the rq4research question, ‘How to improve the work
process in the assistance centre?’ focus group interview was per-
formed. In order to obtain an answer to the rq4,theinternaldocu-
mentsoftheselectedinsurancecompanyontheworkprocessofthe
ac(Triglav zdravstvena zavarovalnica 2013)was reviewed. With the
help of interview with the ac’s employees, the opinions of about the
work process in the acfrom another perspective were gained and
improvementproposals weredefinedasfollows:
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 Continuouseducationofemployeesinthe ac oncommunication
skills;
 Focus on the needs/wishes/requirements of policyholders re-
gardinghealthcareproviders;
 Orientation towards the needs/wishes/requirements regarding
theinterpretationofthe envisagedhealthservices;
 Updatingthecomputerprogramtospeedupthehandling ofin-
surancecases;
 Updating of a computer program for automated verification of
theformal,substantive,proceduresuitabilityofinsurancecases;
 For faster response of the acto move lunch time for employees
withanon-slip schedule;
 To include additional employees in the acduring the maximum
frequencyofcalls,whowouldreceivecallsand,basedoncallers
needsaddresstheneedsofpolicyholdersasamatterofpriority;
 Additional training of call centre employees would also con-
tribute to a faster response of the ac, as certain information
would be processed at the level of the call centre. As a result,
therewould befewercallstothe acduring thebusiest hours;
 Toemployadditionalmedicalstaffinthe ac(themostexpensive
proposal).
Findings and improvement proposals can be tied to several re-
searches about; training and education of employees (Cartwright-
Vanzant2010;Mevissenetal.2012;ZichelloandSheridan2008),fo-
cusontheneeds/wishes/requirementsofpolicyholders(Adametal.
2012;Ferreiraetal.2015),computerprograms(RathandPattanayak
2019), and additional employees (Ekberg et al. 2014 by Babac et al.
2019).
Conclusion
The case study focused on the satisfaction of the insured with ac
of the selected insurance company. Through the method of survey-
ing the insured persons, in-depth insight into the satisfaction of ac
users was gained. Through a focus group interview of acemploy-
ees, an employee opinion on the impact of the work process on the
satisfaction of the insured persons was obtained (Adam et al. 2012).
ThestudyconfirmedtheopinionoftheZichelloandSheridan(2008)
that health-educated personnel play a very important role in health
insurancecompaniesindealingwithinsurancecases.UsedTriangu-
lation (interview, questionnaire for insured persons and documents
number2·2020
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Aleksander JanešandMartinaFranˇ ceškin
analysis)inthesurveyallowedtoobtainopinionsfromdifferentper-
spectives on the important attributes of employees with health edu-
cationatthe assistingcentre,astheseinfluence thereflectionof the
satisfactionof the insuredpersons.
Interviewwithemployeesofthe acrevealedthattheworkprocess
was not optimal due to the rapid increase of the insurance cases.
They believe thatchanges in the work process and upgrading of the
informationsystemareneededtofacilitateandfasterhandlingofin-
surance cases.Based on the answeredquestionnaires of acusers,it
wasfoundthattheinsuredpersonsdidnotfeelthelackofefficiency
oftheworkingprocess(NovakandJaneš2019)inthe acwhendeal-
ing withinsurancecases.
Investigationsupportedfindingsonanswerstoresearchquestions
(rq):Answer to rq1led to the realizationthat it is important for the
insured persons to receive clear instructions on the desired service
orhealthcareprovider.Regardingtheanswerto rq2:Thefactorthat
is the most statistically positively related to user satisfaction is the
‘understanding the needs and requirements of policyholders’. An-
swertothird rq3wasachievedwithfindingsonthemostinfluential
factorsregardingthesatisfactionoftheinsured(explainingthepur-
pose of the treatment and possible follow-up procedures, interven-
tions (0.942); ordered treatment was performed as expected (0.859);
understanding theneedsandrequirementsofpolicyholders (0.829);
table 3). Answer to researchquestion rq4,was found through focus
groupinterviewwith acemployeesandreviewoftheinternaldocu-
mentationoftheinsurancecompany(Triglavzdravstvenazavaroval-
nica2013).Basedontheobtainedanswerstotheresearchquestions
suggestionsfor improvementsweremadeout.
Thehighlevelofsatisfactionoftheinsuredwiththe ac willproba-
blyalsomeantheexpansionofnewinsuredpersonswithadditional
healthinsurance.Asaresult,itwillaffectfasterspecialisttreatment
and faster diagnosis for policyholders. However, directly raising the
insured persons of the selected insurance company will contribute
to lower mortality of the population, as they will be faster to get di-
agnosesortreatment(Mold2017).
Presented research has also some limitations: Firstly the survey
period was limited by time and relatively small sample of respon-
dents; and secondly investigation considers only one health insur-
ance Company. Research on the factors that influence the satisfac-
tionoftheinsuredpersonswiththe acsshouldbeextendedtoother
health insurance companies on Slovenian and eumarkets in order
toacquirenew insightsandfindings.
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Case Studyof the InsuredPersons Satisfaction
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