HEALTH INSURANCE

1
HEALTH INSURANCE

• --INDIAN EXPERIENCE

2
PRESENTATION PLAN

• INTRODUCTION
• HEALTH INSURANCE MARKET PRIOR TO LIBERALISATION
• HEALTH INSURANCE MARKET IN THE LIBERALISED MARKET
• LAW AND REGULATIONS
• ISSUES AND CONCERNS
• INITITATIVES OF FEW STAKEHOLDERS
• WAY FORWARD

3
INTRODUCTION

• PROVIDING QUALITY HEALTHCAREA CONCERN
• GOVERNMENT ROLE IN HEALTH CARE
• HEALTH CARE FINANCING INSURANCE AS AN OPTION

4
HEALTH INSURANCE MARKET PRIOR TO LIBERALISATION

• PRE-NATIONALISATION Hospitalisation and
  Sickness Insurance
• POST NATIONALISATION
• Prior to 1986
• 1986 Introduction of Mediclaim

5
HEALTH INSURANCE IN THE LIBERALISED MARKET

• Growth in Health Insurance premium
• Product Development
• Customer Service
• Market share

6
LAW AND REGULATIONS

• Health Insurance defined
• Priority in licensing
• Other relevant regulations
• IRDA Protection of policyholders interests,
  2002
• IRDA Advertisements and Disclosures
  Regulations, 2002
• IRDA Third Party Administrators- Health
  Services Regulations, 2001
• File Use procedure

7
HEALTH INSURANCE ISSUES AND CONCERNS

• ADVERSE SELECTION
• HIGH PAY OUTS
• PROVIDER MALPRACTICES
• ISSUES RELATING TO THIRD PARTY ADMINISTRATORS
• LACK OF INTEREST BY INSURERS

8
INITIATIVES

• PRIVATE INSURERS KEEN TO DEVELOP HEALTH INCE
  PORTFOLIO
• DEVELOPED NEW PRODUCTS
• INCREASED THEIR MARKET SHARE
• LIFE INSURERS HAVE SHOWN INCREASED INTEREST

9
INITIATIVES contd

• INTRODUCTION OF GOVT. FUNDED HEALTH INSURANCE FOR
  POOR
• STATE GOVTS. INTRODUCING SCHEMES FOR POOR IN
  PANCHAYAT ANDVILLAGE LEVELS
• INCREASED GOVT. SPENDING TO STRENGTHEN PRIMARY
  HEALTHCARE FACILITY IN SELECTED STATES.
• PRELIMINARY STUDY BEING HELD FOR EVOLVING HEATH
  INSURANCE SCHEME FOR URBAN AND RURAL POOR.

10
INITIATIVES contd

• MORE TPAs LICENSED AND EXISTING TPAs STRENGTHENED
  THEIR OPERATIONS
• EMERGENCE OF COMMUNITY AND GROUP INSURANCE
• INVOLVEMENT OF NGOs AND MICRO FINANCE
  INSTITUTIONS

11
INITIATIVEScontd,

• CONSTITUTION OF WORKING GROUP ON HEALTH INSURANCE
  BY IRDA
• DATA SUB GROUP
• SUB-COMMITTEES
• 1) Sub-group for Health Insurance data
• 2) Sub-group on Product Innovations
• in Health Insurance ( including arriving at a
  common acceptable definition of Pre-existing
  diseases)
• 3) Registration of Stand-Alone Health Insurers

12
RECOMMENDATIONS OF SUB-COMMITTEES

• Sub-group on Health Insurance Data
• 1)Collection of existing data
• 2)Collection of future data in standardized
  formats
• 3)Training of personnel in ICD 10 coding
• Sub-group on Product Innovation ( definition of
  pre-existing disease)
• Distinction made between pre-existing disease
  and condition and common definitions recommended
• Medical Savings Accounts recommended
• Creation of a pool for covering senior
  citizens
• Committee to study insurance cover for common
  man in rural area

13
RECOMMENDATIONS OF SUB-COMMITTEEScontd,

• Sub-group on registration of stand-alone Health
  Insurers
• 1) Minimum Required Capital of Rs.50 Crores
  recommended
• 2) Foreign Direct Investment of 51 suggested
• 3) Adoption of Risk Based Capital proposed
• 4) Besides health, it was recommended that
  companies be allowed to write Personal Accident
  and Travel Insurance

14
WAY FORWARD

• Insurers to collect correct data,develop new
  products price properly, improve u/w and claims
  management
• Explore possibilities of setting up pure health
  insurance company with JV partners
• Insurers TPAs Data Warehouse to have common IT
  framework to facilitate easy data transfer
• Govt. to evolve National health scheme for common
  man in urban and rural area and Sr.citizen and
  terminally ill

15
WAY FORWARD.contd,

• Support health Insurance scheme for population
  below poverty line.
• Foster Public private partnership
• Providers to to be more disciplined, bring
  standardization, accreditation etc
• Govt. to regulate the healthcare providers
• IRDA to set up data warehouse
• Implement other recommendations of the sub -
  group including

16
THANK YOU