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At
IIRM Hyderabad
On
PREVAILING HEALTH INSURANCE
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Indian Scenario
National Rural Health Mission(2005-2012) document of the Indian Federal Government describes the Public Health as under: Public Health expenditure in India has declined from 1.3% of GDp in 1990 to 0.9% of GDP in 1999. The union Budgetary allocation for health is 1.3% while the States Budgetary allocation is 5.5% Union Government contribution to pubic health expenditure is 15% while states contribution about 85%
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Indian Scenario
Vertical Health and Family Welfare programme have limited synergisation at operational levels. Lack of community ownership of public health programmed impacts levels of efficiency,accountability and effectives. Lack of integration of sanitation,hygiene,nutrition and drinking water issues. There are striking inequalities. Only 10% Indians have some form of health insurance, mostly inadequate.
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Indian Scenario
Hospitalised Indians spend on an average 58% of their total annual expenditure. Over 40% of hospitalised Indians borrow heavily or sell assets to cover expenses. Over 25% of hospitalized Indians fall below poverty line because of hospital expenses. In the recent past lots of research and study were carried out on the state of Indian Health and Indian Health Insurance. Several Insurance Journals including IRDA Journals, Insurance Post, Insurance Chronicle etc have brought out well researched articles on the subject.
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Indian Scenario
These articles and Government of Indias document on the subject reveals starling facts about the state public health and the health insurance scenario in India. Some of them are: 71% of all deaths are due to Cancer,Health attack, Stroke and renal failure. About 7o million people in India suffer from one form or other heart ailment. Out of this 10% need bypass surgery. Treatment for all these ailments costs between Rs. 3 Lakhs and Rs.5 Lakhs, which is beyond the reach of middle class population.
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Indian Scenario
Span of life increasing. More serious diseases occur during old age I.e between 60 & 80years This age group is without any Insurance cover back up. No social Security scheme of Government for providing healthcare treatment. Tremendous escalation in the Cost of treatment People needs to make provision to manage the economies of scale needed to manage the health of the entire family. Hence the need for health insurance arises.
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Indian Scenario
India spends about 6.5% to 7% of GDP on Health care. Out of this 1.5% is in the Govt. Sector and 4.7% in private sector. Provision of Health care in the Country is the shared responsibility of the Centre, State and Local Governments. Includes beneficiaries covered under ESIS,CGHS,Army, Railways,self funded,PSUs and Insurance products. Most of the health care providers in the country are in private sector and are on fee for service basis.
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Indian Scenario
More concentration of medical facilities in urban areas than rural areas. ESIS and CGHS, a form of Insurance cover are not governed by Regulatory norms. Health Service provision by Railways and Army are not governed by Ministry of Health. The middleclass population of India is estimated to be around 350 millions. Out of this about 30 million people employed in Central and State Govt, PSUs are enjoying the facility of healthcare whilst in service.
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Indian Scenario
Problem area is after retirement. Some charitable trusts or individuals try to contribute in the delivery of Health care to the needy people. Traditionally, Indians have been a close knit society. In cases of illness the earlier joint family system, tendered to give best of the comforts to the sick persons cost of giving such care was not an issue. With the change in times all that have changed. Expensive hospital,expensive treatments and medicines have come to stay.
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Indian Scenario
It puts tremendous stress on family savings or sometimes wipe it out. But still only less than 1% of the teaming population of India is covered by some form of Insurance protection. The four Nationalised general insurance Companies introduced Mediclaim product in 1986. Underwent various changes sine then. Basically an indemnity based product for the reimbursement of eligible expenses under the terms and conditions of Coverage.
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Indian Scenario
TPA- a recent development. Some of the private players are also into medical covers. Various plans under different ministries. Working employees get provider facility if the ailment is of primary or secondary care level. Tertiary care is a problem area. Retired personnel face worst situation. They no longer may be residing near own facility. Procedure delays in authorisation Tertiary care which is required at a higher level as the person gets older makes it more difficult.
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Indian Scenario
Defense Ministry sought help from the General Insurance Industry for retired army personnel and their families. Some state government shave approached Insurers for administration of Health Schemes for their employees. According to one study, the NGO sector might be covering more than 5% of the population. Some of the important NGOs health care services are: Child in Need Institute SEWA Street nit karni Parivar Seva snatha etc
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Indian Scenario
Some concerns,issues and challenges: Low level of awareness. Pre existing conditions and other exclusions. Up front payment to hospitals Reimbursement policies TPA recent development. Claims procedure Service standards. High Claims ratios Over utilisation of services.
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Indian Scenario
Mostly Group /Corporate orientated. Inadequate information regarding health,ailments, procedures, treatment costs. Low level of medical penetration the population to bed ratio in India is 1 bed Per 1000 as against the WHO norm of 1 bed Per 300
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