El Ramo que Sangra
The new technical director of the home insurance line of a regional Spanish insurer in Zaragoza, with 300,000 policies and about 80 million euros of…
About this simulation
The new director of benefits and network of a Spanish private health insurer with 240,000 members faces a hospital group that takes 60 percent of hospital spending and asks for 9 percent more, while utilisation of visits, tests and admissions keeps climbing.
Over four quarters of 2027 the participant answers the hospital group, prepares an alternative and trades terms besides price; decides how tests are authorised, whether a co-payment applies and what is done for high-risk chronic members; sets the renewal premium, bids for a 14,000-member group policy and chooses a preferred network; and finally chooses the hospital contract model, the medical director bonus and the last investment.
The model is deterministic: medical cost is price times utilisation, members lapse with price, network disruption and denials, the healthy leave first when the premium rises, and every patient whose necessary care is denied or delayed has a cost. The score combines the quality of each decision with the quarter underwriting result, and is capped when necessary care is denied by rule rather than on clinical criteria.
Spanish (primary, peninsular) and English.
Who it is for
An intermediate simulation for participants who already know the core concepts of the subject, designed for master's and MBA programmes.
How a session runs
- The instructor creates a session from the Eureka dashboard and invites the participants.
- Participants play 4 rounds. In each one they submit their decisions and the simulation calculates the results.
- The simulation can be run in English, Español.
- The instructor follows each participant's progress and results from the dashboard, and uses the class results for the debrief.