HEALTH INSURANCEHEALTH INSURANCE

--INDIAN EXPERIENCE

PRESENTATION PLANPRESENTATION PLANINTRODUCTIONHEALTH INSURANCE MARKET PRIOR TO LIBERALISATIONHEALTH INSURANCE MARKET IN THE LIBERALISED MARKETLAW AND REGULATIONSISSUES AND CONCERNSINITITATIVES OF FEW STAKEHOLDERSWAY FORWARD

INTRODUCTIONINTRODUCTION

PROVIDING QUALITY HEALTHCARE—A CONCERN

GOVERNMENT ROLE IN HEALTH CARE

HEALTH CARE FINANCING – INSURANCE AS AN OPTION

HEALTH INSURANCE MARKET HEALTH INSURANCE MARKET PRIOR TO LIBERALISATIONPRIOR TO LIBERALISATION

PRE-NATIONALISATION : Hospitalisation and Sickness Insurance

POST NATIONALISATION:

Prior to 1986

1986: Introduction of Mediclaim

HEALTH INSURANCE IN THE HEALTH INSURANCE IN THE LIBERALISED MARKETLIBERALISED MARKET

Growth in Health Insurance premium

Product Development

Customer Service

Market share

LAW AND REGULATIONSLAW AND REGULATIONS‘Health Insurance’ definedPriority in licensingOther relevant regulations:

IRDA Protection of policyholders interests, 2002 IRDA Advertisements and Disclosures

Regulations, 2002 IRDA Third Party Administrators- Health Services

Regulations, 2001File & Use procedure

HEALTH INSURANCE: HEALTH INSURANCE: ISSUES AND CONCERNSISSUES AND CONCERNS

ADVERSE SELECTION

HIGH PAY OUTS

PROVIDER MALPRACTICES

ISSUES RELATING TO THIRD PARTY ADMINISTRATORS

LACK OF INTEREST –BY INSURERS

INITIATIVESINITIATIVES

PRIVATE INSURERS KEEN TO DEVELOP HEALTH INCE: PORTFOLIO

DEVELOPED NEW PRODUCTS

INCREASED THEIR MARKET SHARE

LIFE INSURERS HAVE SHOWN INCREASED INTEREST

INITIATIVES …contdINITIATIVES …contdINTRODUCTION 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.

INITIATIVES …contdINITIATIVES …contdMORE TPAs LICENSED AND EXISTING TPAs STRENGTHENED THEIR OPERATIONS

EMERGENCE OF COMMUNITY AND GROUP INSURANCE

INVOLVEMENT OF NGOs AND MICRO FINANCE INSTITUTIONS

INITIATIVES…contd,INITIATIVES…contd,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

RECOMMENDATIONS OF SUB-COMMITTEES

Sub-group on Health Insurance DataSub-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-Sub-group on Product Innovation ( & definition of pre-existing diseaseexisting 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

RECOMMENDATIONS OF RECOMMENDATIONS OF SUB-COMMITTEES…contd,SUB-COMMITTEES…contd,

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

WAY FORWARDWAY FORWARDInsurers to – collect correct data,develop new products price properly, improve u/w and claims managementExplore possibilities of setting up pure health insurance company with JV partnersInsurers TPAs Data Warehouse to have common IT framework to facilitate easy data transferGovt. to evolve National health scheme for common man in urban and rural area and Sr.citizen and terminally ill

WAY FORWARD….contd,WAY FORWARD….contd,Support health Insurance scheme for population below poverty line.Foster Public – private partnershipProviders to to be more disciplined, bring standardization, accreditation etcGovt. to regulate the healthcare providersIRDA to set up data warehouseImplement other recommendations of the sub - group including

THANK YOUTHANK YOU