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HEALTH INSURANCE

--INDIAN EXPERIENCE

INTRODUCTION
PROVIDING QUALITY HEALTHCARE
A CONCERN
GOVERNMENT ROLE IN HEALTH
CARE
HEALTH CARE FINANCING
INSURANCE AS AN OPTION

HEALTH INSURANCE MARKET


PRIOR TO LIBERALISATION
PRE-NATIONALISATION :
Hospitalisation and Sickness Insurance
POST NATIONALISATION:
Prior to 1986
1986: Introduction of Mediclaim

HEALTH INSURANCE IN THE


LIBERALISED MARKET
Growth in Health Insurance premium
Product Development
Customer Service
Market share

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

HEALTH INSURANCE:
ISSUES AND CONCERNS
ADVERSE SELECTION
HIGH PAY OUTS
PROVIDER MALPRACTICES
ISSUES RELATING TO THIRD PARTY
ADMINISTRATORS
LACK OF INTEREST BY INSURERS

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

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.

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

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

RECOMMENDATIONS OF SUBCOMMITTEES
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)
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
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

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

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

THANK YOU

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