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…
Sobre la simulación
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.
Para quién es
Una simulación de nivel intermedio para participantes que ya conocen los conceptos básicos de la materia, pensada para programas de máster y MBA.
Cómo funciona una sesión
- El docente crea una sesión desde el panel de Eureka e invita a los participantes.
- Los participantes juegan 4 rondas. En cada una envían sus decisiones y la simulación calcula los resultados.
- La simulación se puede jugar en: English, Español.
- El docente sigue el progreso y los resultados de cada participante desde el panel, y usa los resultados de la clase para el debriefing.