Designing a Supplemental Health Insurance Plan and Analyzing the Related Risk Factors Faced by Insurance Companies

One of the most important pillars for improving health care services is supplemental health insurance, which increases people's access to health care. Supplemental health insurance plans, which cover health expenses above basic medical coverage, with nearly 18% of the Iranian insurance industry portfolio, plays an important role in the Iranian health system. It is worth mentioning that in addition to profitability for insurance companies, supplemental health insurance must be customer-driven. This requires more attention and exploration in the two categories of customer demand assessment and the insurance company’s limitations to meet customer’s expectations and needs. In this research, by analyzing customer’s expectations and needs using the fuzzy QFD and FMEA hybrid method, a model for designing of supplemental health insurance for treatment has been presented and risk factors faced by insurance companies have been identified and rated.