Today India is experiencing the beginning of a socio-economic shift in many ways, demonetization being one of them. It is apparent that a healthy population is essential for rapid advancements to take place. Sustainable and viable”Health Insurance Schemes For all” to ensure sufficient healthcare financing, a strong healthcare infrastructure, a population gaining more awareness about the changing dynamics of our lifestyles are the key components that will keep a nation healthy.
Unfortunately, there exists a double whammy when it comes to health of the nation currently. On the one hand healthcare providers now have cutting edge technology and processes to provide the best medical care to our people, but on the other hand this care will also cost money!
With regards to healthcare financing, almost 80% of the people pay for healthcare services from their own pockets, pushing some people below the poverty line each year. Expenses on healthcare by the year 2020 are expected to rise to a staggering USD 230 billion. The question we should ask ourselves is who is responsible for attaining and maintaining a healthy population and how can this be achieved. How can we develop a sustainable model that caters to the healthcare needs of 1.2 billion Indian citizens and is viable for all stakeholders – healthcare providers, insurers, TPAs and customers?
In order to have a healthy population, I believe a strong public-private partnership (PPP) is essential, where both work positively towards creating a better healthcare infrastructure and financing options for all. But before doing so, we must all understand and acknowledge that our massive Indian population cannot be put into one bucket. Population is most often grouped under two divisions–People below the poverty line and above the poverty line.
To provide financial protection to the mass population, including those below the poverty line, the government has implemented several schemes like the Rashtriya Swasthya Bima Yojana (RSBY) that covers the cost of secondary-level hospitalisation. This is indeed a good, well designed paperless health insurance scheme for the poor. However this program did face various challenges primarily due to poor pricing by the insurance industry leading to lower than expected enrolment rates and high operational costs. To eliminate such challenges, it must be ensured that the pricing should be such that all stakeholders win- Government, Providers, Health Insurance Companies, Third Party Administrators (TPAs) and the Customer – It is very much possible!. Scheduled Banks, Post Offices, Schools and Colleges etc. across the specified geographies can be used as enrolment centers and all data and processes could be linked to the Aadhar Cards to curb impersonation. In addition, enrolments for government sponsored health insurance schemes can also be tagged along with birth or marriage certificates to ensure health insurance for all, with better monitoring and management systems in place.
In urban India and also in other growing geographies, people above the poverty line require efficient healthcare delivery and financing models to hedge against the rising incidence of ailments and the increasing burden on personal finances. The solution lies in a healthcare access model where public and private enterprises work towards creating healthcare delivery models and health insurance plans for all regions, at affordable rates. The creation of an insurance pool (more house hold savings moving into health insurance products) for healthcare and critical illnesses can allow for an efficient private-public partnership, built on trust and transparency. This would not only enable universal access, but also enhance our readiness to address the growing gap of healthcare demand and supply.
For a vast and populous country such as India, where private insurance penetration is as low as 5%, providing affordable and quality healthcare remains a challenge even today. One of the main reasons for low penetration is the limited reach of the existing distribution channels; other causes include complex, traditional buying processes and inconsistent after sales services. To combat this situation, the health insurance industry has started moving towards unique, disruptive and technology-driven distribution models to reach wide and deep into Tier 2, 3, 4 and beyond, while eliminating the need to have physical offices in cities and towns. With the help of technology, it is a win-win situation for both agents and customers as it makes the buying process simple and quick.
Technology can be used to simplify the complex data and through analysis of this data, meaningful solutions can be created. Medical data, tech data, consumer trends etc. can help showcase trends in healthcare and what people prefer. Players in the healthcare and health insurance segments are taking best advantage of such information and building their laurels on fulfilling the consumer needs that emerge from it. The industry is working towards creating data analysis techniques to develop strong, innovative insurance covers that could help people mitigate every possible healthcare expense incurred during their lifetime.
Through cohesive efforts by the government, the regulatory body and the industry, I am personally optimistic and enthusiastic to see ‘Health Insurance For All’ turn in to reality in the next 5 years.