IIPM Admission 2010

Monday, January 11, 2010

In the Pink of health

Economic development and health insurance go hand in hand; yet in the Indian context the correlation seems more skewed towards economic development. With enormous potential, glimmers of hope are emanating for the industry.

“Meant for the rich, educated or those in business… benefits hospitals more than holders” is the common (negative) perception about health insurance in India where the healthcare expense is a mere (3.6% of the GDP). What is startling is the fact that the health insurance market is still grossly under-penetrated with only 2% of the billion plus population possessing a health insurance cover. Juxtapose these with the fact that during 2008-09, the general insurance industry recorded total health insurance premium of Rs. 6,625 crore (a 30% improvement over the previous year).

Moreover, for the last six years health insurance industry has been growing at a CAGR of 35% to reach the current level. That clearly indicates the huge potential that the industry has in India. For private players in the domain, health insurance is emerging as an increasingly significant line of business. V. Vaidyanathan, MD & CEO ICICI Prudential Life Insurance Co Ltd, avers “health insurance contributes to 7% of the total premiums and we expect it to increase to 15%.”But then, as J. Hari Narayan, Chairman IRDA says, “the growth in numbers is also fraught with numerous challenges of ensuring accessibility, affordability and efficiency in the health insurance system, which requires sustained and focused efforts on the part of all stakeholders.”

But the question remains the same – why do people have a negative perception? It’s simply for the fact that approximately 70% of the health expenses are out of pocket. As a matter of fact out of the Rs.2 trillion health insurance spread, almost Rs.1.3 – 1.4 trillion are out-of pocket expenses. There is some inherent problems viz. definition of pre-existing disease/ critical illness, et al, which makes matter worse. 30% of health insurance claims are rejected and unbelievably 90% of these rejections are due to pre-existing diseases. If the industry has to grow, “the communication between sales force and policy holders must increase,” says Hari Narayan.

It is true that increasing awareness, rising healthcare costs, recent detariffing of the general insurance industry have been key drivers, but the real need is of products, which can capture other expenses. Standard definitions and list of critical illnesses and non-medical expenses will not only enhance customers understanding of these terms but will also help smoothen the interaction between the patients, hospitals, TPAs and insurers by minimising ambiguities.

Gyanendra Kumar Kashyap

For more articles, Click on IIPM Article.

Source : IIPM Editorial, 2010.

An Initiative of IIPM, Malay Chaudhuri and Arindam chaudhuri (Renowned Management Guru and Economist).

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