The key message at the 8th Asia Conference on Healthcare and Health Insurance centered on the sustainability of the health insurance industry in India. This article in Asia Insurance Review (subscription required) cites Alam Singh, who said the industry needs to, “Collaborate, as it is everyone’s problem!”
It is crucial for insurers to create an internal culture of information sharing so processes and guidelines evolve quickly. Insurers also need to provide regular training to sales, underwriting and claims employees and invest in data analysis and also offer rewards to whistleblowers,” he added. The industry as a whole should have a mechanism to share case studies, tools and training and should also create data standards that facilitate analytics, which is the unique provider code.
…The industry [needs] to collaborate in data analysis and to collectively engage with policy makers and consumer bodies. The industry also needs to collaborate with media to increase public awareness that fraud will not be tolerated and finally demand tougher laws and facilitate prosecution.
The Indian healthcare system is at a familiar juncture. eHealth picks up on the story:
The size of the Indian medical technology industry may touch US$ 14 billion by 2020 from US$ 2.7 billion in 2008 on account of strong economic growth, higher public spending and private investments in healthcare, increased penetration of health insurance and emergence of new models of healthcare delivery.
Says Alam Singh, Assistant MD, Milliman India, “As the healthcare industry matures in terms of infrastructure and innovative technologies, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks. Evidence based medicine is already being promoted globally and has been proved to be beneficial for all the stakeholders- clinical teams, hospital management as well as the patients. Evidence based medicine tools like clinical protocols and clinical pathways provide explicit and well defined standards of care for the clinical teams and support multi-disciplinary care planning.”
He further says, “From a management perspective these tools reduce healthcare costs, reduce patient documentation, optimise management of resources and help continuous clinical audit. They improve clinical care by delivering superior outcomes, improved clinical effectiveness and patient satisfaction.”
The Asia Insurance Review considers some of the challenges facing the Indian insurance market. Here is an excerpt:
The entry of TPAs [third-party administrators] a decade ago changed the face of the health insurance industry and accelerated growth as customers felt that their claims would be genuinely addressed. The added benefit of cashless services through the network of TPAs was well used by the masses till things began to go wrong in the implementation of the rules laid down by insurers.
Insurers started distrusting hospitals, who they say inflate bills and charge insured patients more than the uninsured ones. Hospitals complain that insurance companies and TPAs are not correct in their assessment of illness and its treatment.
This has not only affected the industry’s credibility but, indeed, threatened its very viability. “Health insurance has a significant image problem,” says Mr Alam Singh, Managing Director, Milliman India, on some of the challenges facing the Indian health insurance sector. This industry has been a favourite target of the print media with at least two negative newspaper articles each month against some insurer or another, he says. He feels that with such bad publicity, a lot of consumers must doubt if their claim will be paid and it undermines the core premise of insurance.
To counter this image, he is of the opinion that the industry needs to highlight the millions of families they help every year. There is no collaborative or sustained effort by the industry to create a positive image, he says. Reforms needed In the past, property, motor and engineering insurance were tariffed, making them the preferred choice for the general insurance sector as health insurance was non-tariffed.