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Insurance, Pharma and Health Care Industry need to work together in health insurance sector

Article147.png”” alt=””Article147.png”” />The Indian Health Insurance sector focused mainly on traditional in–patient indemnity cover, is now increasingly realizing the need to innovate and introduce products to cater to the needs of the consumers. A report by FICCI says that three factors have increased the industry’s appetite for experimental and product innovation — While the industry has grown at a CAGR of ~20% since 2001, health insurance is less than 10% of total healthcare spend, change in pattern of healthcare spend – from infectious and contagious diseases to chronic disease with a consequent need for outpatient insurance and recognition of the need for pilot and innovative products in the work done by the expert committee on reviewing the health insurance regulations, in April 2015, and proposing of a regulatory framework.

There are 2.6 cr disabled in India, as per the census of 2011 – approximately 2.3% of the population. Of this, the main categories of disability are “in movement” (20%), “in hearing” (19%) and “in seeing” (19%). Together these constitute more than 50% of the disabled population. Similarly, India has the third largest HIV positive population in the world. Global prevalence is estimated at 32 million and India has 2.1 million HIV positive. India faces a rising burden of infertility – an estimated 27 million couples are infertile.

In the past, there have been limited health insurance covers available for conditions such as HIV, Infertility and Persons with Disabilities. While the health insurance industry has not shied away from these segments, product innovation has been limited. Traditionally, these conditions have been either excluded or have been underwritten on a case-to-case basis. FICCI Health Insurance Committee, created a Task Force to study and analyze the current landscape and situation of insurance products availability for persons with disability, HIV positive and infertility, and come out with its recommendations to find solutions for the insurability of these conditions.

The FICCI report examines the insurability of these three segments – People with Disabilities (PwD’s), HIV positive and infertility. It analyzes the demand side, current insurance industry underwriting practices, and existing product coverages. It recommends product structures suing a range of possible options – including public-private partnership, discounted access structures, and peak risk covers. It advocates a sustainable model, where the insurance industry, pharmaceutical companies as well as health care industry should work together on a break-even model to get the right combination of insurance and health care to PwDs.

The report also suggests creation of an industry level not for profit scheme, partly funded by the Central Government which would run for first two years on Government funding, this period is long enough to collect statistics for pricing the scheme. For the initial period, scheme design and pricing would be modelled similar to one of the existing schemes (Niramaya or Swavlamban).

Alternately, existing models such as Swavlamban should be broad-based and scaled up, for which a mass awareness campaign should be run, which will create the demand pull in order for PwD’s come forward to enroll, a bit like aadhar campaigns.”

By TIS Staffer
the authorBy TIS Staffer

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