Topic

Family Decision Making Pattern and Framework for Health Insurance

Authors Mr. Sujit Kumar Patra Asst. Professor Institute of management & Information Science (IMIS) Email Id- sujitp@imis.ac.in Spatra_pkace@rediffmail.com Mobile No. 9583312434 Mailing Address- Swagat Vihar Bankuala Bhubaneswar-751002 Ms. Chunku Pani Asst. Professor Institute of management & Information Science (IMIS) Email Id- chunku@imis.ac.in chunkupani@gmail.com Mobile No.- 9937022278 Mailing Address- Swagat Vihar Bankuala Bhubaneswar-751002

Family Decision Making Pattern and Framework for Health Insurance Sujit Kumar Patra1 Chunku Pani2

Abstract Families constitute an important economic and social unit that affects consumption decisions of individual family members. Of all the reference groups, family has one of the strongest, immediate, and most pervasive effects on consumer's psyche. The familys decision-making process has been studied by researchers for years. Although the knowledge has increased substantially on this topic, research has generally focused on goods. Since services continue to dominate Indian GDP and Insurance plays a very dominant role in increasing the GDP, understanding the behavior of the family while buying health insurance becomes critical. Family decision-making research has frequently examined role relationship between husband and wife across stages and sub-decisions. In this study it is being tried to find out, the role played by parents and children other than husband and wife in family decision-making process and how does a family decide on a financial product such as a Health Insurance Product.

Keywords: Family decision making, Health Insurance, Family Role, Decision making, Consumer Behavior

Introduction The family has been identified as the most essential decision making and consumption unit (Assael, 1998). Therefore the realm has attracted the interest of marketers and marketing academicians over the years (e.g., Kim and Lee, 1997; Moore et al., 2002; Shoham & Dalakas, 2005). For many consumer purchase decisions, it is the family rather than the individual that is the critical decision making and consumption unit. This idea has been recognized by researchers for some time: joint decision-making has been reported in the areas of home purchasing (Cunningham and Green 1974; Davis and Rigaux 1974; Munsinger, Weber, and Hasen 1975), automobile purchasing, and home furnishings (Davis 1970;Green and Cunningham 1975). Decision-making describes the process by which families make choices, judgments, and ultimately come to conclusions that guide behaviors. Family decision-making entails that more than one members input and accord is involved (Scanzoni & Polonko 1980). The decision-making process is centered on core communication processes involved in creating shared meaning. In the decision-making process, families can accept the differences among members and confer their needs for imminence and independence (Baxter & Montgomery 1996). Davis has identified various stages in the decision-making process and the relative amount of influence each of the family members has in these stages (Davis 1970, 1971; Davis and Rigaux 1974). Others have also considered the differences in perceived influence of the husband and wife (Ferber and Lee 1974; Filatrault and Ritchie 1980). Haley, Overholser, and Associates (1975) measured both the direct and indirect (taking the husbands wifes preference into consideration) influence of the husband and wife in the purchase of 87 packaged products. Other studies have begun to consider the determinants of role structure, such as empathy and involvement (Burns 1977; Bums and Granbois 1977). According to Shets (1974), joint decision making is more likely in the following situations: 1) when the level of perceived risk in buying is high, 2) when the purchasing decision is more important to the family, 3) when there are few time pressures, and 4) for certain demographic 3

groups (e.g. upper and lower socio economic groups, younger families, those with no children, and those with only one of the parents working). Decisions within families can be classified into types such as: instrumental, affective, Socioeconomic, and technical. Instrumental decisions are those that focus on issues of money, health, shelter, and food for the family members (Epstein et al. 1982). Family members play a variety of roles in decision-making. There are five roles that could be played by the members of the family. In any given situation, the same member may take on several or even all five roles (Assael 1992): The information gatherer (gatekeeper), the influencer, the decision maker, the purchasing agent, and the end consumer. These studies have been very important in developing a basic understanding of family buying patterns. However, as suggested by Davis (1976), most past studies have focused only on the outcomes of the decision-making process, rather than on the process itself. The result is that very little is known about how families reach decisions. Influence of children Research on family decision making has been largely confined to spouses, who have been considered as the relevant decision making unit in a family. However, the role of third party influences, such as children, on decision making strategies and negotiations is essential to taking a broader view of the relevant unit of analysis. Conventionally, women were seen to be the purchasing agents for the family. Nevertheless, increasing participation of women in the workforce has prompted a shift in this role as children are increasingly the buyers for the entire family. Even in families where women do not work, children are observed to share this role with their mothers. Children enjoy greater prudence not only in making everyday consumption decisions for the family but also in influencing their parents to buy other products desired by them. The temperament and disposition of each child can greatly vary within the same family. Foxman et al. (1989) concluded that children tend to have more say in the purchase of products that are less expensive and for their own use. Contemporary researchers express that children constitute a major consumer market, with direct purchasing power for snacks and sweets, and indirect purchase influence while shopping for big-ticket items (Halan, 2002; Singh, 1998). Consequently, the relationship between parents and different siblings is dynamic and unique, with each individual responding to and modifying the behavior of the other (e.g., Pecchioni et al. 2005). Geuens et al. (2002) observed that the relative influence of children varies by the extent to which the parents are busy. 4

Indian children have recently attracted substantial attention from marketers because the market for childrens products offers fabulous potential (pegged at Rs. 5000 crore/$1110mn) and is rapidly growing. According to available industry data, 54% of India is estimated to be under the age of 25 (Bansal, 2004). Family Decision Making in India According to Webster (2000), India is an interesting culture in which to explore the antecedents of marital power because its social and intellectual grains operate in ways vastly different from those the West takes for granted. For instance, unlike western culture, where the nuclear and neo local families are both the ideological and factual norm, the joint family has been and continues to be an important element of Indian culture. Family Decision Stages Just as there are different purchase roles, there are also a number of different steps in the decision to buy a product or service. And the amount of influence exerted by the husband, wife and children will vary, depending on the stage of the decision process. Following is the five-stage decision-making model which includes: 1. Problem recognition 2. Search for information 3. Evaluation of alternatives 4. Final decision 5. Purchase The role of husband, wife and children will differ across the stages. There can thus be shifts in the husband-wife decision-making from stage one of problem recognition, to stage two of search for information and finally, to the decision. Marketers should therefore examine husband-wife decision-making in terms of specific purchase factors. Health Insurance Family Decision Making Jennifer Schultz, Roger Feldman & Jon Christianson et al. (2002) has evaluated the health insurance choices of families enrolled in a direct contracting model developed by an employer purchasing alliance.

Families are often uniquely qualified in terms of understanding patient attitudes and decision making strategies and can therefore assist as an important resource in helping the patient to make better decisions about their care (Blustein 1998). Families make decisions about health issues using information from a variety of sources, including insurance provider lists, internet research, recommendations from primary care physicians and specialists, interpersonal communication with friends and family members, and mediated messages (see Pecchioni & Sparks 2007). The decisions made by families involve large amounts of money and, it is necessary to understand as much as possible about this consumption unit. In this section we will examine how families make their purchase decision. How many members are involved in each decision? How are they involved? How does this influence work on the outcome? What is the best way to reach them? As in other small groups, there is a well defined role structure in families as well, as you would find if you apply this concept to your own family. Thus, there is the Instrumental role, usually taken by the head of the family for the achievement of specific goals. In addition, there is the expressive role undertaken by the wife and other family members to provide emotional support to the functioning of the family group. In addition to this goal-oriented behavior there is also a set of purchase roles undertaken by family members. Emerging health insurance market Health insurance in a narrow sense would be an individual or group purchasing health care coverage in advance by paying a fee called premium. In its broader sense, it would be any arrangement that helps to defer, delay, reduce or altogether avoid payment for health care incurred by individuals and households. Given the appropriateness of this definition in the Indian context, this is the definition, we would adopt. The health insurance market in India is very limited covering about 10% of the total population. The existing schemes can be categorized as: (1) Voluntary health insurance schemes or private-for-profit schemes; (2) Employer-based schemes; (3) Insurance offered by NGOs / community based health insurance, and (4) Mandatory health insurance schemes or government run schemes (namely ESIS, CGHS).

In recent years, there has been a liberalization of the Indian healthcare sector to allow for a much-needed private insurance market to emerge. Due to liberalization and a growing middle class with increased spending power, there has been an increase in the number of insurance policies issued in the country. In 2001-02, 7.5 million policies were sold. By 2003-04, the number of policies issued had increased by 37%, to 10.3 million. Still, it is quite disheartening to find that Insurance is limited to only a small proportion of people in the organized sector covering less than 10% of the total population. Currently, there is no mechanism or infrastructure for collecting mandatory premium among the large informal sector. Even in terms of the existing schemes, there is insufficient and inadequate information about the various schemes. Data gaps also prevail. Much of the focus of the existing schemes is on hospital expenses. There continues to be lack of awareness among people about health insurance. Hence, this study was made to find out how a family as a buying unit behaves while purchasing a Health Insurance product. Importance of the study: Families are more complex to understand as compared to individual consumers for specific roles played by family members undergo dynamic and continuous changes because of psychographic and attitudinal metamorphosis. Some families remain essentially traditional in their life styles following the traditional role patterns and relationships, while others adopt more materialistic orientations; wherein the individual family member becomes of prime importance because of his individuality. In such families, the choice of each individual needs to be considered independently and every individual priority owes due consideration before the final decision outcome. Still, some other families are left in between-trying to adopt the modern life style and at the same time confining to the traditional norms and values. The roles and relationships in such families follow an entirely different pattern. These shifts are also being increasingly caused by participation of women in the labor force. The dual-career families, within a social stratum, have relatively greater discretionary income to buy products that are otherwise sometimes out of reach, for single-earner families. Not only are the buying structures different, but also the persons involved in the purchase and use of these products differ due to various factors playing in the family, one of which is the time pressure experienced by women in such families.

Such a study is important for the marketers, as in the current business scenario, the choice of which health insurance to purchase has become crucial in the Indian economy, especially since today it is a service driven one.

Objectives of the study: The authors had the following objectives for this study: To understand the familys decision making process. To identify the factors those contribute to the familys decision making To attempt to provide a framework of buying behavior among Indian families

process while buying health insurance. while purchasing health insurance. In order to fulfill their first objectives, the authors have framed 3 Hypothesis for their study. Hypothesis H01: There is an association between family and health Insurance purchase Initiation H11: There is no association between family and health Insurance purchase Initiation H02: Family has a role in evaluation of alternatives H12: Family does not have a role in evaluation of alternatives H03: An association exists between HI purchase and the final decision made by the Family H13: An association exists between HI purchase and the final decision made by the Family Methodologies: The following methodologies were adopted for this study: Type and Design of the Study: This study is exploratory in nature and attempt was taken to explore the roles adopted by various members of the family. Sample Criteria: The scope of this research encompassed the familys decision-making process while buying health insurance in India. The sampling technique used was convenient sampling. Due to scarcity of resources equal representation in each 8

of the resources category could not be reached. A total of 80 samples were collected for this study. Sample Selection: The sample is restricted to Indian families residing in metros and Tier-II cities. Data Collection: Data were collected from both primary and secondary sources. The secondary source includes internet, brochures, pamphlets, published and unpublished reports etc, where as the primary sources include, interactions, structured and unstructured interviews, administration of questionnaire, directive brain storming etc. Analysis: The data analysis has been done using frequency and Chi square tests to find out the implications as set in the objectives. Questionnaire description The interviewees to whom the questionnaire was administered were assured of anonymity. The survey was conducted online with the help of googledocs. The questionnaire was mostly of close ended type except for one question which required short open ended answers. The questionnaire for this study is shown in Annexure 1.

Result Analysis and Discussion The Authors consolidated the information received through both primary and secondary research material and the following analysis was done. The demographic analysis showed that out of the 80 respondents, 18 belonged to the age group of 26-30 and 15 belonged to the age group of 31-35. This constituted 42% of the respondents. The age group 26-30 and 31-35 seems to be more sensitive towards purchasing Health Insurance. If we go by theory, the first stage is primarily the bachelor and new married stage without children. Out of the 18 respondents belonging to the age group of 26-30, 9 are single and 9 are married with no children. It is interesting to note that all the people belonging to these two groups already have a Health Insurance, barring 9. The gender distribution is as follows. 13 of the respondents are women and 67 are men. Out of the 3 female respondents, 4 are single (either divorced /widow or spinster).
Age Frequency Valid 18-25 26-30 31-35 36-40 41-50 51-60 >60 Total 9 18 15 12 12 8 6 80 Percent 11.2 22.5 18.8 15.0 15.0 10.0 7.5 100.0 Gender Frequency Valid male 2 Total 67 13 80 Percent 83.8 16.2 100.0 Marital Status Frequency Valid married 51 Percent 63.8 Valid Percent 63.8 Cumulative Percent 63.8 Valid Percent 83.8 16.2 100.0 Cumulative Percent 83.8 100.0 Valid Percent 11.2 22.5 18.8 15.0 15.0 10.0 7.5 100.0 Cumulative Percent 11.2 33.8 52.5 67.5 82.5 92.5 100.0

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Age Frequency Valid 18-25 26-30 31-35 36-40 41-50 51-60 >60 Total 9 18 15 12 12 8 6 80 Percent 11.2 22.5 18.8 15.0 15.0 10.0 7.5 100.0 Gender Frequency Valid male 2 Total 67 13 80 Percent 83.8 16.2 100.0 Marital Status Frequency single Total Table 1-Demography 29 80 Percent 36.2 100.0 Valid Percent 36.2 100.0 Cumulative Percent 100.0 Valid Percent 83.8 16.2 100.0 Cumulative Percent 83.8 100.0 Valid Percent 11.2 22.5 18.8 15.0 15.0 10.0 7.5 100.0 Cumulative Percent 11.2 33.8 52.5 67.5 82.5 92.5 100.0

72% of the respondents said they have Health Insurance.

HaveHI Cumulative Frequency Valid yes no Total 58 22 80 Percent 72.5 27.5 100.0 Valid Percent 72.5 27.5 100.0 Percent 72.5 100.0

Table 2- Percentage of respondents having Health Insurance

Stages of HI Decision making The following set of analysis took care of the first objective ie to understand the familys decision making process. As per the literature on Consumer Behavior and Decision making, it is seen that decision making has 5 stages-initiations being the first stage. The following frequency analysis table gives a snapshot of the initiative stage of decision making. 11

Initiative Frequency Valid you spouse Parents Children Total Missing Total Table 3- Initiative for HI purchase System 55 7 7 9 78 2 80 Percent 68.8 8.8 8.8 11.2 97.5 2.5 100.0 Valid Percent 70.5 9.0 9.0 11.5 100.0 Cumulative Percent 70.5 79.5 88.5 100.0

In 69% of the cases, the respondent himself took the initiative to purchase HI. Spouse influence was only 9%. Out of these 55 respondents who are the initiators themselves, 8 are female. Out of the 47 male respondents who themselves took the initiative to buy HI, 32 were married. And even after that the spouse initiative is on a lower side. Out of these 32 married respondents, 11 of the respondents wives are working ladies. If we go buy the recent research on spouse influence, it can be said that working wives influence in initializing a buying decision is reducing. In all the 7 cases, where the Parents played the initiators role, the respondent is single barring one. So, it can be said that a small percentage of single bachelors are still not the initiators as far as buying HI is concerned. 9 respondents said that their children took the initiative. When we look at the demography of these 9 respondents, we find that all are in between 50-60 barring 2. Hence, it is evident that people beyond 50 and dependant on their children are not the initiators. Information search
InfoSearch Frequency Valid You Spouse Parents Children Total Missing Total System 55 7 6 8 76 4 80 Percent 68.8 8.8 7.5 10.0 95.0 5.0 100.0 Valid Percent 72.4 9.2 7.9 10.5 100.0 Cumulative Percent 72.4 81.6 89.5 100.0

Table 4- Information search for HI purchase

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Information sourcing, an important stage in buying process, too shows a similar kind of nature. Spouse influence is same as compared to Initiation. Evaluation of alternatives
AlternativeEval Frequency Valid Single Joint Total 45 35 80 Percent 56.2 43.8 100.0 Valid Percent 56.2 43.8 100.0 Cumulative Percent 56.2 100.0

Table 5- Evaluation of Alternatives for HI purchase

It is interesting to note that evaluation of alternatives is a joint effort in the family. This shows that Indian families together evaluate the alternatives available to them as far as HI family decision making process is concerned. Since HI is a financial product, the entire familys role becomes prominant. Final decision
Finaldecesion Frequency Valid You Spouse Parents Children Total 47 16 7 10 80 Percent 58.8 20.0 8.8 12.4 100 Valid Percent 58.8 20.0 8.8 12.4 100 Cumulative Percent 62.7 78.8 87.6 100.00

Table 6- Final Decisionmaker on HI purchase in the family

Here comes an interesting point to note. The married respondents depend on their spouses to make the final decision. Final buyer
Buyer Frequency Valid You Spouse Parents Children Total Missing Total Table 7- Final HI buyer in the family System 55 7 6 8 76 4 80 Percent 68.8 8.8 7.5 10.0 95.0 5.0 100.0 Valid Percent 72.4 9.2 7.9 10.5 100.0 Cumulative Percent 72.4 81.6 89.5 100.0

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The final purchaser in 69% of the cases is the respondent himself. Source of Information
Friends and Peers Internet Company Website Company Representative Social Networking Websites Newspaper Business/News Channel review Other Table 8- Source of Information 43 40 34 36 7 4 6 0 57% 53% 45% 47% 9% 5% 8% 0%

Friends and peers seem to be the best source of information. It shows that Indian customers still rely on traditional means of information seeking. However, Internet scores and company representatives are the second options. The second objective that the authors had in their mind was to find out the factors affecting Health Insurance purchase decision
Premium Product Features Company Brand and Image Service Network Hospitals OPD benefits Tax benefits Capping & Loading Portability benefits Table 8: factors affecting Health Insurance purchase decision 51 69 38 66 33 16 9 1 2 67% 91% 50% 87% 43% 21% 12% 1% 3%

If we look at the factors which are important for a customer before deciding on a HI purchase, Product features are the most important factor, followed by service. The authors would take up further research using Factor analysis to find out the most important factor having the highest loading. Factor influence behind Health Insurance purchase
A touching Advertisement A family member's death/disability/health problem A friend's or peer's death/disability/health problem Doctor's Recommendation 1 1% 25 31% 13 16% 8 10%

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Forceful selling by Sales person Friends'/Peers/Relatives Recommendation Other Table 9: Factor influence behind Health Insurance purchase

1%

13 16% 19 24%

It is interesting to note that the factor that influenced them to buy a Health Insurance product is some mishap in their family. It could be death, disability or health problem. Another factor is mishap in their friends or peers family. Thus it is evident that HI is felt to be important only after there is some sort of mishappenings faced or seen by the respondents. It shows that people are still reactive and not proactive as far as buying HI is concerned. However, further research can help us to conclude which factor has the highest loading in terms of affecting the purchase initiation. Hypothesis Testing The authors have come up with three hypotheses, the first one being H01: There is an association between family and health Insurance purchase Initiation The alternative Hypothesis is: H11: There is no association between family and health Insurance purchase Initiation The null Hypothesis was tested using Chi Square with 95% confidence level and the result showed that the significance was 0.022 (P<0.05), thus rejecting null hypothesis. Hence we can accept the alternate hypothesis and say that there is no significant association between HI purchase and the initiation by the family.
Case Processing Summary Valid N Initiative * HaveHI 78 Percent 97.5% N 2 Cases Missing Percent 2.5% N 80 Total Percent 100.0%

15

Chi-Square Tests Asymp. Sig. (2Value Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases 9.659 13.915 8.864 78
a

df 3 3 1

sided) .022 .003 .003

a. 3 cells (37.5%) have expected count less than 5. The minimum expected count is 1.97.

Initiative * HaveHI Crosstabulation HaveHI yes Initiative you spouse Parents Children Total Count Expected Count Count Expected Count Count Expected Count Count Expected Count Count 34 39.5 6 5.0 7 5.0 9 6.5 56 no 21 15.5 1 2.0 0 2.0 0 2.5 22 Total 55 55.0 7 7.0 7 7.0 9 9.0 78

Expected Count 56.0 22.0 78.0 Table 10: Chi Square Test Summary for Association between Initiation and HI Purchase

The second Hypothesis was H02: Family has a role in evaluation of alternatives The Alternative Hypothesis was H12: Family does not have a role in evaluation of alternatives Through this hypothesis the authors wanted to test whether Evaluation of alternatives is a joint decision or not. The resultant Chi Square summary shows that there is high significant association between alternative evaluation and HI purchase. P value = 0.231(P>0.05). Hence Null Hypothesis accepted.

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Case Processing Summary Valid N AlternativeEval * HaveHI 80 Percent 100.0% N 0 Cases Missing Percent .0% N 80 Total Percent 100.0%

AlternativeEval * HaveHI Crosstabulation HaveHI yes AlternativeEval Single Joint Total Count Expected Count Count Expected Count Count Expected Count 35 32.6 23 25.4 58 58.0 no 10 12.4 12 9.6 22 22.0 Total 45 45.0 35 35.0 80 80.0

Chi-Square Tests Asymp. Sig. (2Value Pearson Chi-Square Continuity Correctionb Likelihood Ratio Fisher's Exact Test Linear-by-Linear Association N of Valid Cases
b

Exact Sig. (2sided)

Exact Sig. (1sided)

df
a

sided) 1 1 1 .231 .344 .232

1.437

.896 1.430

.313 1.419 80 1 .234

.172

a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 9.63. b. Computed only for a 2x2 table Table 11: Chi Square Test Summary for Association between family role and evaluation of alternatives

The third Hypothesis that was tested was H03: An association exists between HI purchase and the final decision made by the Family H13: An association exists between HI purchase and the final decision made by the Family The authors used Chi Square test to find the association. The result showed a significant association between Final decision and HI purchase. P value = 0.251(P>0.05), thus accepting the Null Hypothesis.
Case Processing Summary Valid N Finaldecesion * HaveHI 75 Percent 93.8% N 5 Cases Missing Percent 6.2% N 80 Total Percent 100.0%

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Finaldecesion * HaveHI Crosstabulation HaveHI yes Finaldecesion You Spouse Parents Children Total Count Expected Count Count Expected Count Count Expected Count Count Expected Count Count Expected Count 32 33.2 6 7.8 6 4.9 9 7.1 53 53.0 no 15 13.8 5 3.2 1 2.1 1 2.9 22 22.0 Total 47 47.0 11 11.0 7 7.0 10 10.0 75 75.0

Chi-Square Tests Asymp. Sig. (2Value Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases 4.098a 4.500 2.019 75 df 3 3 1 sided) .251 .212 .155

a. 4 cells (50.0%) have expected count less than 5. The minimum expected count is 2.05. Table 12: Chi Square Test Summary for Association between Final decision and HI Purchase

One of the important objectives that the authors had in this paper was to come up with a framework for purchasing Health Insurance. Following Figure shows the Framework for Health Insurance Buying pattern.

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Figure 1. Framework on Health Insurance Buying Pattern

Need to purchase Health Insurance Premium Cashless Facilities Critical Illness Benefit Accidental Protection No Claim Bonus Pre-existing Disease Waiting Period Clause No of diseases covered Portability Rising Medical Expenses Change in Lifestyle Low healthcare expenses (Public/Private)

Information Search Primary SourcesRelatives, Friends, Peers Secondary SourcesInternet, Company Website, IRDA, Insurance comparison portal

Product Influence

External Influence Negative word of mouth by friends/peers and relatives Attractive offer by the competitor

Purchase Decision

Purchase

Post purchase Evaluation After Claim

Identification/Evaluation of Alternatives

Premium, features, services

Service Influence Network Hospitals Hassle-free Claim Assistance by TPA Proactiveness of TPA/Co./Hospital

ncom e I

Fina ncial Influ ence

Conclusion This research was based on the widely accepted premise that it is the couple rather than the individual that is the critical decision-making unit for many consumer purchase decisions. The authors in this research tried to find out the decision making process of a family while purchasing a financial product like Health Insurance. It is concluded from the research that the need for purchasing HI came only after the family faced some unforeseen events related to rising medical expenses which lead to economic and emotional imbalance of the family. However, the need is further strengthened by initiation of friends/peers and relatives and substantiated by websites and other secondary sources. Health Insurance is the prerogative of the male earning member of the family. However, wifes role cannot be ignored as she contributes more during the evaluation of alternatives. Even though Health Insurance buying initiation, information search and final decision is a single activity, evaluation of alternatives is a joint activity wherein even the children and elderly parents play some roles. Actual evaluation is done by the male earning member of the family based on numerous criteria like premium, product feature and service. Ultimately, a choice set is created which is again affected by situational factors like financial influence (Family Income) and service influence (Network Hospitals, assistance by Third Party Administrator, hassle-free claim, proactiveness of co, TPA, Hospitals). Post purchase feedback of customers depends upon the services rendered by the HI Company, TPA and the network hospital. Services include hassle-free claim settlement, quality of treatment, individual attention given to the customer etc. This feedback is very important from the perspective of the company because it would generate more referrals, positive word of mouth and ultimately more business.

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