This document provides an overview of health insurance, including definitions of key terms, models of health expenditure, and examples of health insurance systems in different countries. It discusses the history of health insurance beginning in Germany in 1883 and adoption in other countries. It also outlines the traditional model of health insurance focusing on insurers/employers and proposes a more flexible model to serve different populations. Private health insurance is described as having an important role to play in overall healthcare systems by enhancing access and increasing service capacity.
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
Insuring yourself against the risk of incurring medical expenses is important. However, before choosing the health insurance policy, it is important to know more about the different health insurance plans. This SlideShare provides more information about medical insurance and its benefits. http://bit.ly/1pHFP90
Overview of Community Based Health Insurance LessonsHFG Project
Presentation during the Institutionalizing Community Health Conference in Johannesburg, South Africa, on March 28th, 2017. This presentation gives an overview of Community-based Health Insurance (CBHI), and explores country experiences and lessons with CBHI in Rwanda, Ghana, and Senegal.
Importance of Health Insurance: Incase you get sick or need any kind of medical attention. Can you afford to pay for a doctor’s visit without insurance? Depending on the type of doctor and practice it can cost from www.lifethenfinance.com 2 $95–$265 per visit. Insurance co-pays: $5–$50 per visit. Are you certain you won’t hurt yourself or catch some type of cold? Do you have allergies, wear contacts or need any other type of regular prescriptions? Can you afford those medications without insurance? On average prescription generic medications start around $50. Insurance co pays usually around $5–$20.
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
Insuring yourself against the risk of incurring medical expenses is important. However, before choosing the health insurance policy, it is important to know more about the different health insurance plans. This SlideShare provides more information about medical insurance and its benefits. http://bit.ly/1pHFP90
Overview of Community Based Health Insurance LessonsHFG Project
Presentation during the Institutionalizing Community Health Conference in Johannesburg, South Africa, on March 28th, 2017. This presentation gives an overview of Community-based Health Insurance (CBHI), and explores country experiences and lessons with CBHI in Rwanda, Ghana, and Senegal.
Importance of Health Insurance: Incase you get sick or need any kind of medical attention. Can you afford to pay for a doctor’s visit without insurance? Depending on the type of doctor and practice it can cost from www.lifethenfinance.com 2 $95–$265 per visit. Insurance co-pays: $5–$50 per visit. Are you certain you won’t hurt yourself or catch some type of cold? Do you have allergies, wear contacts or need any other type of regular prescriptions? Can you afford those medications without insurance? On average prescription generic medications start around $50. Insurance co pays usually around $5–$20.
There are three types of health insurance cover available in the market today. These are:
Mediclaim:
These policies cover you for hospitalization expenses. Actual hospitalization expenses are paid subject to a maximum limit of the sum assured opted for. All insurers offer policyholders cashless treatment in their network of hospitals. Policyholders can also pay upfront and then claim reimbursement from the insurer.
We recommend Mediclaim as a basic “must have” health insurance to our customers. Mediclaim can be individual or a family floater. In individual every person has his or her own individual policy. In a family floater the members of a family pay a single premium and have one insurance policy that covers the family. Sometimes parents and in-laws can also be included in the family cover. A floater cover provides a lot of flexibility for the family and normally works out more economical.
Fixed Benefit Cover
These is a new class of insurance products in the Indian market. These plans pay a pre-determined sum of money depending upon the number of days a person is in hospital and the type of surgery done. This amount may be more or less than the actual expenses you incur. We recommend this as an additional insurance to purchase after you have the basic mediclaim policy. Similar to the indemnity cover, fixed benefit cover has individual and family floater options. Fixed benefit policies will pay you the benefit even if the actual costs are reimbursed by a mediclaim policy.
Critical Illness plans
In these plans a fixed sum of money is paid if the person gets certain pre-specified diseases. Plans can cover anywhere from 9 to 35 diseases. In our view these plans are best bought after one has the basic medicliam and fixed benefit plans. They are ideal for diseases that are debilitating but may not require constant hospitalization - for example cancer or renal failure.
Each of the insurance plans described here can be taken for a single Individual or may include dependents such as the spouse, minor children, parents, parents-in-law, grandparents and grandchildren.
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*Health Insurance in India and Genesis of the Ayushman Bharat PMJAY Pradhan Mantri Jan Arogya Yojana
*Critical review of the health insurance schemes
*SWOCh analysis of Ayushman Bharat PMJAY
Created - July 2019
Author- Dr. Madhushree Acharya, Academic Junior Resident, Community & Family Medicine, AIIMS Bhubaneswar
The materials were collected and compiled into the presentation as a study project for Public Speaking class (COMM 110) in Cañada College in Redwood City, CA. Made by students of Spring 2012 - Jenna Baleix, Inge Verschueren, Julia Meinhold, Lissette Saravia, Ja Juarez, Mikhail Maryakhin.
Cholera is a social disease which is generally result of depreciation of environmental conditions as well as the poor economical status of people or community.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. RajbirKaur,MPH,PU
Contents:
• Meaning of health insurance.
• Some of the key terms used.
• History of health insurance.
• Model of total health expenditure.
• Table of different countries for health
expenditure and private health insurance.
• Health insurance in different countries.
3. RajbirKaur,MPH,PU
• Health insurance in India.
• Statistics
• Table of health care financing
• Typical model of health insurance.
• Proposed model of health insurance.
• Role of private health insurance
• Laws and authorities
• List of Public Sector Banks.
• List of Private banks.
• Coverage of health insurance
• Benefits of health insurance.
• Drawbacks of health insurance.
• How to go for insurance.
4. RajbirKaur,MPH,PU
Health Insurance: Meaning
• prepayment plan providing services or
cash indemnities for medical care
needed in times of illness or disability.
• all about protection- against an illness.
5. RajbirKaur,MPH,PU
Terms
• Policy – the legal document issued by
the insurance company that outlines the
terms and conditions of the insurance.
• Policyholder – the person who buys
the insurance; also called the "insured."
• Premium – the payment required to
keep your insurance policy in force
6. RajbirKaur,MPH,PU
• Claim –. a person's request for
payment by an insurer of a loss covered
by a policy
first-party claims- claims to your
own insurance company
third-party claims- claims made by
one person against another person's
company
• Exclusion – specific conditions or
circumstances listed in the policy that
are not covered by the policy.
7. RajbirKaur,MPH,PU
• Occurrence – an accident that results
in bodily injury during the period of an
insurance policy.
• Peril – the cause of loss or damage.
• Risk – the chance of a loss.
• Underwriting – the process of
selecting risks for insurance, and
determining how much to charge to
insure these risks and which coverage
to provide.
8. RajbirKaur,MPH,PU
Health insurance history
• (1883–84) in Germany Compulsory
accident and sickness insurance was
initiated by Otto von Bismarck
• adopted by Great Britain, France,
Chile, the Soviet Union, and other
nations after World War I.
• Act of 1946, In Britain the National
Health Insurance which went into effect
in 1948, provided the most
comprehensive compulsory medical care
plan.
9. RajbirKaur,MPH,PU
individual obtained free medical
attention (participating doctor national
health service)
cost was met by the national
government and local taxation
nominal charges for some services
were levied since then
• 1958 the Canadian Hospital and Diagnoses
Act provided full hospital services almost
free of charge in public wards
10. RajbirKaur,MPH,PU
• more comprehensive coverage added
in 1967( financed by the federal
government ; administered by the
provinces)
• National health insurance- widely
adopted in Europe and parts of Asia.
• United States –the only Western
industrial nation without
comprehensive national health
insurance
11. RajbirKaur,MPH,PU
Health expenditure
Tax-based and
out-of-pocket
expenses are
direct expense
related outlays
Health
insurance
involves a fund
pool for future
health care
External fund
sources rely on
donations,
grants
Total healthTotal health
expenditureexpenditure
PublicPublic
PrivatePrivate
SocialSocial
securitysecurity
ExternallyExternally
fundedfunded
Tax-fundedTax-funded
PrivatePrivate
health ins.health ins.
ExternallyExternally
sourcedsourced
Out-of-Out-of-
pocketpocket
Using central / stateUsing central / state
revenues for healthrevenues for health
Compulsory premiumCompulsory premium
contributions tocontributions to
healthhealth
Channeling loans,Channeling loans,
grants etc. togrants etc. to
healthcarehealthcare
Payments to healthPayments to health
care providers forcare providers for
servicesservices
PremiumPremium
contributions towardscontributions towards
health supporthealth support
Channeling donationsChanneling donations
etc. to healthcareetc. to healthcare
13. RajbirKaur,MPH,PU
PHE*
(% of total)
PHE* cover
(%)
Nature of PHE* cover PHI**
(% of total)
PHI** cover
(%)
Australia 68.9 100 • All permanent residents as
enrolled under MediCare (tax-
financed)
7.3 44.9
France 75.8 99.9 • Social security systems
covering all residents
12.7 86.0
Greece 56.1 100 • All population (financed through
tax and health insurance
contributions)
N.A. 10.0
Mexico 47.9 50 • Formal worker section and
government employees
• Voluntary system for others
2.5 2.8
Portugal 68.5 100 • All permanent residents as
enrolled under NHS (tax-
financed)
1.5 14.8
UK 80.9 100 • All permanent residents as
enrolled under NHS (tax-
financed)
3.3 10.0
US 44.2 24.7 • Above 65 or disabled
(MediCare), poor (Medicaid) and
poor children (SCHIP)
35.1 71.9
* PHE: Public health expenditure
** PHI: Private health insurance
14. RajbirKaur,MPH,PU
UK
The National Health Service (NHS)
• Founded over 50 years ago.
• defining element - principle of equal
treatment
• equal access to all necessary medical
services –regardless of their financial
status
• basic medical services are guaranteed
to all residents of the UK.
• Medical treatment is free.
17. RajbirKaur,MPH,PU
France
Régime général d`assurance
maladie
• Everyone (a domicile of France)
receives protection through insurance
• Principle of solidarity
• covers financial risks caused by illness,
maternity, disability and death
• offers financial protection in case of
industrial accidents and occupational
diseases
18. RajbirKaur,MPH,PU
• also special health insurances apart
from the general health insurance, for
· self-employed persons, artists and
traders (3.1%)
· farmers (4.2%)
· some occupational groups like sailors,
miners or railway men
19. RajbirKaur,MPH,PU
Couverture maladie
universelle
• students and persons, who do not belong
to the area of responsibility of a
professional insurance system
• The CMU came into force on January 1,
2000 in order to introduce compulsory
health insurance not connected with any
occupation.
20. RajbirKaur,MPH,PU
Australia
Lifetime Health Cover
• Lifetime Health Cover is a Government
initiative
• health funds charged differently
premiums based on age of member
• recognizes the length of time of private
health insurance -rewards by offering
lower premiums.
• People taking hospital cover early in life
charged lower premiums throughout
their life
21. RajbirKaur,MPH,PU
India
• No universal health insurance in India
• Limited to industrial workers and their
families
• Central Govt. Health Scheme(1954)
• Employees state Insurance
scheme(1948)
22. RajbirKaur,MPH,PU
Statistics
• Yet, 80 per cent of Indian
population is without life insurance
cover
• this part of the population subject
to weak social security and
pension systems with hardly any
old age income security.
23. RajbirKaur,MPH,PU
The proportion of insurance in health care
financing in India is extremely low . . .
Public spending in
health care is
very low at 17%
and the National
Health Policy has
recognized this
More than 86% of
healthcare
financing is
through
unplanned or,
non-contributory
spending
0%
100%
Source of finance Means of finance
86% from
out-of-
pocket
expenses
83% from
private
sector
spending
Health care financing in India
2002, %
Source: WHO. CII-McKinsey. 2003.
25. RajbirKaur,MPH,PU
The traditional
model has
focused on
insurers or
intermediaries
working with
the employed
segment only
as the front-
end
IndividualIndividual
InsurerInsurer
ProviderProvider
GovernmentGovernment
/ Employer/ Employer
Fixed feesFixed fees
ServiceService
chargescharges
VoluntaryVoluntary
premiumspremiums
MandatoryMandatory
premiumpremium
MandatoryMandatory
premiumpremium
Could be allied toCould be allied to
insurer or be ainsurer or be a
governmentgovernment
approvedapproved
providerprovider
IntermediariesIntermediaries
Financial flows
Service flows
26. RajbirKaur,MPH,PU
to one that allows the flexibility
to serve different segments of
the population, in an efficient
manner . . .
27. RajbirKaur,MPH,PU
. . .
Health insurance
providers may need
to align themselves
to overall health
care including
financing,
preventive health
care and health
outreach in order
to grow coverage
Regulations and
policy must be
designed to
encourage this
Self-employedSelf-employed
populationpopulation
SalariedSalaried
populationpopulation
Unemployed /Unemployed /
PoorPoor
Government /Government /
EmployersEmployers
GovernmentGovernment
PrivatePrivate
hospitalshospitals
PublicPublic
hospitalshospitals
ClinicsClinics ChemistsChemists
Insurers / NGOsInsurers / NGOs::
Processing activities and claims settlementProcessing activities and claims settlement
Insurers / NGOsInsurers / NGOs::
Enrolments and actuarial assessmentEnrolments and actuarial assessment
Health
care
Health
insurance
Insurers / NGOs:Insurers / NGOs:
Community health facilities / health educationCommunity health facilities / health education
EmployerEmployer
supportedsupported
healthhealth
insuranceinsurance
GovernmentGovernment
sponsoredsponsored
healthhealth
insuranceinsurance
VoluntarilyVoluntarily
funded healthfunded health
insuranceinsurance
CommunityCommunity
healthhealth
schemesschemes
28. RajbirKaur,MPH,PU
The experience of different
countries suggests that private
insurance has an important
role to play in overall health
care . . .
29. RajbirKaur,MPH,PU
• Private health insurance has enhanced access to
timely hospital care
e.g. In UK, waiting time reduction and private
health insurance coverage have led to a
virtuous cycle
• Private health insurance has increased service
capacity and supply by injecting financial
resources up front
e.g. In the US, private health insurance has
financed hospitals in terms of doctors and
facilities
• Private health insurance increases choice
(provider, benefits, cost-sharing) for the individual
e.g. In Australia, private health insurance offer
the option of access to spare capacity and
elective care in non-public institutions
Private health
insurance has led
to expansion of
health coverage
and expenditure
in other countries
However,
regulation as well
as the role of
public health
expenditure
cannot be
ignored
30. RajbirKaur,MPH,PU
laws
• Insurance regulation formally began in
India with the passing of the Life
Insurance Companies Act of 1912 and
the provident fund Act of 1912
• Insurance is a federal subject in India.
There are two legislations that govern
the sector- The Insurance Act- 1938
and the IRDA Act- 1999.
31. RajbirKaur,MPH,PU
Authority-IRDA
• The General Insurance Corporation has
regulated some of the main health
policies that are offered by the Indian
Insurance Companies.
• United India Insurance Co Ltd.,
• New India Assurance Co Ltd.,
• Oriental Insurance Co Ltd. and
• National Insurance Co Ltd.
32. RajbirKaur,MPH,PU
Oriental Insurance Corporation, National
India Assurance Corporation, National
Insurance Corporation,
United India Insurance Corporation.
• Overseas Mediclaim Insurance
(Employment & Study)
(Corporate Frequent Traveller)
(Business & Holiday)
• Personal Accident Insurance
• Group Personal Accident Insurance
• Jan Arogya Bima Policy
• Medi Claim Policy
33. RajbirKaur,MPH,PU
Central Govt. Health Scheme
• Provides comprehensive medical care to
central govt. employees
• Mutual advantage to both employee and
employer
• Started in 1954 with 16 allopathic
dispensaries covering 2.3 lac
beneficiaries
• Now 320 dispensaries/hospitals in
various systems of medicines covering
42.76 lac beneficiaries
35. RajbirKaur,MPH,PU
List of private banks
• Bajaj Alliaz
• Cholamandalam
• ICICI Lombard
• Iffco-Tokio
• National Insurance
• New India
• Oriental Insurance
• Reliance
• Royal Sundaram
• Star Health
36. RajbirKaur,MPH,PU
insurance cover applies to
various costs
1. care through general practitioner
2. care services
3. artificial limbs
4. pharmaceutical products
5. medical aid
6. analysis and laboratory examination
stay and treatment in care facilities
7. rehabilitation clinics and surgical
stations
part of the transportation costs
37. RajbirKaur,MPH,PU
9. care in case of maternity; also aid care
and hospital stay
10.medical observation of newly born
children
11.Care services, which are required due
to the state of health, will be covered
for people in need of care.
38. RajbirKaur,MPH,PU
Benefits of insurance
• timely coverage for regular or at least
with annual health check ups.
• ability to afford for the medical
expenses.
• Uninsured Pregnant women use lesser
services
• get screening or preventive services.
40. RajbirKaur,MPH,PU
. .• Limited coverage
– Only around 10% of the population is covered
– Geographic spread in terms of health care
facilities and financing awareness is limited
– Selection criteria by suppliers often restricts
the poor (and more likely to be ill) from
affordable pre-payment schemes
• System leakages
– Provider malpractices leading to over-
charging or pre-selection / selective
recommendation
• Lack of universal schemes
– Limitations in terms of coverage of illnesses
as well as treatment options
– Alternative therapies often not considered /
included under insurance
The extent of
coverage as well
as the type of
coverage are the
key issues related
to insurance
penetration
Some companies
have put-off plans
for India due to
potential leakages
in the system
41. RajbirKaur,MPH,PU
Criticism of insurance companies
• modern insurance companies –
indulging in money-making businesses
with little interest in insurance.
• the purpose of insurance is to spread
risk so the reluctance of insurance
companies to take on high-risk cases to
run counter to the principle of
insurance.
42. RajbirKaur,MPH,PU
Other criticisms include:
• Insurance policies contain too many
exclusion clauses.
• Most insurance companies now use call
centres and staff attempt to answer
questions by reading from a script. It is
difficult to speak to anybody with expert
knowledge.
43. RajbirKaur,MPH,PU
How to go for insurance- basic
knowledge
• If you are healthy- Basic Health Insurance
Plan
• If at hereditary risk/poor health-Critical
Illness Policy
-plays lump sum when holder is
diagnosed with one of specified critical
illness.( cancer, CAD, Heart attack, major
organ transplant, paralysis, stroke)
-after lump sum is paid policy
terminates
-these policies are far cheaper than
basic health policies, so can’t depend
alone on these.
44. RajbirKaur,MPH,PU
Bajaj Allianz general
insurance
Silver Health
National Insurance Varishtha Mediclaim
New India Assurance Sr. Citizen Mediclaim
Oriental Insurance Health of Privileged Elder
Star Health Allied Sr. Citizen Red Carpet
United India
Insurance
Sr. Citizen Mediclaim
• Critical Plans-3 types-Rider, Term &
Regular
• Senior citizens specific covers
45. RajbirKaur,MPH,PU
• Family Health Cover- Floater Plans
covers each member separately
gives higher coverage at lower cost
per person
• Disease Specific Plans- covers specific
diseases including pre-existing ones
good as regular checkups are done
regular screening & early detection
ICICI Prulife Cancer, Diabetes
Star Health Diabetes
46. RajbirKaur,MPH,PU
Below Poverty Line
• Union Budget- 15% hike on Health
• Punjab & Haryana (April 1,2008)
• Arogaya Kosh Yojana under NHIS-2cr
for free diagnostic tests
• Heart ailments, blood diseases, cancer,
ENT, Coronary bypass surgery covered.
• Vikalp Yojana- public-private
partnership, free consultancy and
medicines for registered BPL families in
private hospitals & clinics.
47. RajbirKaur,MPH,PU
Conclusion
• Growth potential for the insurance
sector is immense.
• Consideration required to poor and
unemployed.
• Private health insurance has positive
role to play.
• Insurance sector needs to widen its
scope from only providing treatment
facilities to promotive and preventive
health care
48. RajbirKaur,MPH,PU
References
• rparera@kpmg.comrparera@kpmg.com
• www.in.kpmg.comwww.in.kpmg.com
• World Health OrganizationWorld Health Organization
• Park K.(!8th Edition):Park K.(!8th Edition): Preventive and SocialPreventive and Social
MedicineMedicine
• Rowitz Louis:Rowitz Louis: Public Health for the 21stPublic Health for the 21st
CenturyCentury
• Merson Micheal H.:International PublicMerson Micheal H.:International Public
HealthHealth
• www.google.comwww.google.com
49. RajbirKaur,MPH,PU
• The Tribune
• The Indian Express-Money Express
Special Thanks to Mr.Gurpreet Singh
Senior Relationship Manager
ICICI direct