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HEALTH INSURANCE

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Title: 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
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