ECONOMICS OF PRIVATE MEDICAL INSURANCE AMONG MEDICAL LABORATORIES IN JORDAN: A CROSS-SECTIONAL STUDY

Abstract

This study aimed to evaluate the economic and operational impact of private medical insurance on medical laboratories in Jordan by examining the relationship between insurance providers and laboratories and its influence on service efficiency and financial sustainability. A descriptive cross-sectional study was conducted using a structured questionnaire distributed to 264 medical laboratory specialists across different regions of Jordan. The collected data were analyzed using SPSS statistical software.

The findings revealed that medical laboratories demonstrate a moderate dependence on private medical insurance, with 43.9% of respondents reporting that approximately half of their patients use private insurance for laboratory services. Nearly half of the laboratories submitted monthly insurance claims ranging between 1,000 and 3,000 Jordanian Dinars (JOD). However, a considerable proportion experienced reimbursement delays of 45–70 days, in addition to unpaid and rejected claims. The most common reasons for claim rejection were expired claim forms and incomplete or missing medical diagnoses. Furthermore, the majority of laboratories indicated that insurance companies impose financial approval thresholds before authorizing specific laboratory tests.

The study concludes that the current relationship between private insurance companies and medical laboratories is hindered by financial and administrative challenges, including delayed reimbursements, inconsistent claim approvals, and the absence of standardized reimbursement procedures. These issues negatively affect laboratory performance, service quality, and the sustainability of diagnostic healthcare services. The study recommends implementing integrated electronic claim management systems, establishing national reimbursement and pricing standards, and strengthening collaboration among regulatory authorities, insurance companies, and medical laboratories to improve healthcare financing efficiency and ensure the long-term sustainability of diagnostic services in