Satisfaction Level of Health Insured and Financial Profitability of Health Insurance Companies from Health Insurance Product

The research is focused on finding whether the insurance companies are providing health insurance to their clients are enough to meet their expectations or the employees are bound to pay the premium for availing the employer-based health insurance. Another part of the study is focused on finding the financial profitability of health insurance companies particularly, from the health insurance product they are offering to their clients. The premium these companies charging are enough to generate the profitability of health insurance companies or there is not any significant impact on their profitability from this product. It is obvious that a sick employee would be less interested in his or her work and the ratio of absenteeism will increase. The main purpose is to evaluate if providing health insurance is a profitable activity for both sides. This research was conducted through primary data; the data has been collected with the help of adopted questionnaire and a sample size is of 70 respondents. It is found from the research that employees are moderately satisfied with employer-based insurance facility and there is not any significant difference between premium paid and utilized. So, insurance companies are earning less from health insurance product. ARTICLE INFORMATION


INTRODUCTION
This study has been divided into two parts; the first part focuses to find out the satisfaction level of health insured customers of Health Insurance Companies in Pakistan. It is generally thought that after having a health insurance all your health related expenses will be borne by Health Insurance Companies. That gives an assumption that people who have insured their health with the insurance companies must be very satisfied as they have a relief that they will not have to pay for their medical treatments. The second part of this study focuses to find out the profitability of the Health Insurance Companies of Pakistan. Since we have a concept that Health Insurance Companies spent most of their premium on the health expenses of their customers therefore this study intends to find out whether the health insurance companies are earning profits or they are not earning enough profit from health insurance product they are offering. In such a dynamic environment, every organization needs healthy workforce just to remain competitive, productive and profitable. A sick workforce will reduce the consistency of performance and this will reduce the overall profitability of organization too. This is the only answer to the question why employer based health insurance came into existence (Aamir & Qureshi, 2012). Workers are more reluctant to give the jobs in America that provide health insurance. Not being able to find another job that provides health insurance or to afford insurance in the individual market may lead workers to stay at a job even when it is a poor fit (Baker, 2015).

Research Questions
Are health insured customers satisfied with their health insurance companies? Are health insurance companies earning profit from health insurance product?
Hypotheses H 01 : Health insured customers are not satisfied with the health insurance companies. H a1 : Health insured customers are satisfied with the health insurance companies. H 02 : Health insurance companies are earning profit from health insurance product. H a2 : Health insurance companies are not earning profit from health insurance product.

Research Limitations
Following are two research limitations of this study:  Companies were not willing to disclose their profitability and other related information. The annual reports of the insurance companies show profitability of all the products offered by insurance companies, but this study was focused to find profitability of health insurance products only. So, there were no separate profits of health insurance mentioned in the annual reports of insurance companies.

Literature Review
Satisfaction level of health insured Satisfaction level of employees working in private sector with the employer based health-insurance provided to them in Pakistan was observed. The extracted results from the survey conducted from different private sector showed that employee's satisfaction level is high with the health insurance policy provided by respective employer (Aamir & Qureshi, 2012). M.Sabbir, Osman, Fadi, Abdel, & Nusrtae (2014) conducted a research on repurchase intentions for health insurance, which reflects the satisfaction level of policy consumers in Malaysia. An exploratory data analysis was used for this purpose, results of which showed a positive relationship between these two factors. Abd & Izham (2016) analyse the satisfaction level of employees and also to analyse the trend of increasing spending on health care expenditure among employees, few characteristics were measured that could contribute to it. For this purpose research demographics were tested (age, gender, education level, ethnicity) on satisfaction level. Exploratory interviews were conducted with administrators from both insurance company and client. T-test and One-way ANOVA showed no significant attribution to satisfaction. A comparative study between private and public sector was conducted to examine the satisfaction level of health insurance policy holders in India. The study is focused on understanding the level of commitment of respondents towards particular sector and certain factors were kept in view. Like premium rates, renewal pattern, pre-existing disease coverage, link with hospitals and claim settlement pattern are compared. Primary and secondary data both were collected through questionnaires and secondary from books and journals. Through this collected data the results were extracted that showed the satisfaction level of public and private policy holders are more or less equal, but on comparison the private insurers holds an upper hand (Varier, 2016).

Profitability of insurance companies
Premium charges are another important factor people mostly consider it a health care cost which they have to pay after each interval even if they are not utilizing it most of the time. To investigate, the willingness of people to purchase the policy and their connection with health cost and health status, a research was conducted keeping these factors into consideration (Ajmal & Haq, 2015). The research conducted by (Perminus & Wilson, 2017) for finding the root cause of profitability of insurance firms in Kenya. The primary data was obtained by questionnaires. The descriptive statistics results indicated that majority of respondents agreed their firm positively influenced consumer's perception through fair pricing in setting premium prices. Reduction in operation costs were kept in consideration. Effective premium pricing-strategy had led to more sales of their insurance products. Results of regression and correlation analysis showed a positive relationship between the premium prices the firms are charging with its financial profitability.

Research Approach
Mixed approach is used for the purpose of this research in which quantitative and qualitative approaches both are used. The research aims to explore the profitability of insurance companies. For this purpose, the study adopts a 'Mixed research approach' to examine how much insurance companies are earning from the Health insurance product particularly and also to find the satisfaction level of employees from employer based health insurance policy provided to them.

Research Design
The descriptive research design is in the form of a questionnaire survey for the data collection process. The questionnaire is adopted from Kaiser family foundation with few changes in it.

Data Source
The data source of the study is 'Primary', which involves collection of research data directly from the respondents. In other words, primary source is the direct data source related to the subject or problem. Here, data will be collected directly from the participants using a structured adopted questionnaire after making few changes in it based on satisfaction level of employees availing the policy and health insurance companies' profitability from particularly this product they are offering to their clients.

Sampling Strategy
In a primary research, sampling is an important component, which determines the number of respondents participating in the research study. Due to several constraints, including time, geographic and finance, it is important for a study to select a subset for the population. The sampling process can be either probability or nonprobability. In this case, 'random sampling technique is used, which is a form of non-probability sampling, and considers accessibility and proximity of the respondents (Weiss, 2012). The research study selects a sample size, as it is practically not possible to explore the entire research population, due to many limitations. In this study, to ensure an adequate sample, data was collected from 70 respondents Table 1.

Research Instrument
The data source of the study is primary, and therefore data is collected directly from the research participants with the help of 5-point Likert scale Questionnaire. Likert scale is measured as follows particularly for finding the satisfaction level of health insured. 1-Very slightly or not at all 2-A little 3-Moderately 4-Quite a bit 5-Extremely Research instrument of the study is adopted from single source, the questionnaire is measuring the difference between the premium paid and utilized by the clients of insurance companies.

ONE SAMPLE T-TEST
The test is used to check whether a population mean is different or not from some hypothesized value. Satisfaction level of health insured is tested using one sample t-test. To check the significant difference and satisfaction level one sample t test is used in this study.

PAIRED SAMPLE T-TEST
Financial profitability of insurance companies is extracted by using paired sample t test method. This test is used to compare two samples (two different conditions results on one group). Similarly, for the purpose of this study to uproot the outcome of findings of premium paid by health insured and utilization of premium is checked.

RELIABILITY ANALYSIS
Reliability is the fundamental element in the evaluation of a measurement instrument. It should be noted that the reliability of an instrument is closely associated with its validity. An instrument Cannot be valid unless it is reliable. So, for this purpose most widely used tool is Cronbach's Alpha measure for reliability (Tavakol, 2011)

Results from one sample t test
Satisfaction level of health insured The tested scores at the value of 35 showed that employees are moderately satisfied. Test value of 35 shows the Sig. (2-tailed) is .335; Therefore, Null hypothesis is accepted. Test value of 30 shows the Sig. (2-tailed) is .000, Null hypothesis is rejected.  To test the significant difference in means of premium paid and premium utilized paired sample t test was conducted. The Table 6 shows the significance (2-tailed) result which is showing no significant difference between premium paid and premium utilized. Therefore, the conclusion can be drawn from the result mentioned above is insurance companies are not generating much of the profit from health insurance product they are offering. Hence the null hypothesis is accepted. The difference between the two means is because of sampling.

RELIABILITY ANALYSIS
In order to find the reliability and internal consistency of scale reliability analysis is conducted for the purpose of this research. The Table 7 shows the value of cronbach's alpha 0.647. In response to the question of satisfaction of health insured employees. Graphical results showed that employees are moderately satisfied with employer based insurance policy provided to them Figure 1.

Conclusion
It can be concluded from the results of this particular study that employees are moderately satisfied with the employer-based health insurance facility they get these days from the organizations they are working in. It is putting a very good impression of a particular organization, those who are providing health insurance and showing that they are concerned about the well-being of their employees but what employees are considering it this is more important to know first.
The second part of this study is mainly concerned about finding the profitability from health insurance product the insurance companies are providing through the premium charges they are charging to their clients. Results of this also showed that they are not generating enough out of this particular product.

Future recommendations
• The Annual reports are showing the financial results of insurance companies as whole and not the sector/product wise which makes it difficult for researchers to extract out the financial profitability of a particular sector and also how much it is contributing or not contributing in to the financial profitability of company. So, the annual reports should be constructed in such way that the sector wise profitability could be checked conveniently. • This study recommends the insurance companies to spread more awareness among people about the benefits of being health insured. • This study also recommends the insurance companies to take steps towards reducing product cost and to increase the profitability of the company through health insurance product which is found to be less profitable through this research work