1) The document discusses improving the cashless health insurance system in India by learning from processes in Western markets.
2) It identifies key issues like high claim ratios, lack of standardization, and limited consumer awareness in the Indian system.
3) Recommendations include grading hospitals and insurance products, establishing standard operating procedures, conducting surprise audits, and improving distribution channels. The goal is to enhance quality, coverage, and cost-efficiency of health insurance in India.
An analysis of the Indian Cashless Health Insurance Industry identifying the key structural deficiencies leading to a situation of distrust between parties involved. The study as a part of IIM, Indore’s Consulting competition, Chanakya, organized in association with Cognizant also proposes solutions for resolving the present imbroglio between the service providers and insurance companies.
This document provides an overview of health insurance in India, including what it is, its importance, and common products. It discusses how health insurance works by pooling risks collectively. It outlines the rising costs of healthcare as a driver for health insurance penetration. Common plan types include individual, family floater, senior citizens, critical illness, daily hospital cash, and unit-linked plans. It also discusses government schemes like ESIS and CGHS, as well as community-based and employer-provided insurance options. Impediments to the industry like lack of data, pricing challenges, and government provision of care are also covered.
Legislative Update Patient Protections And Affordable Care Act Timeline 4 1...ForestFinancialGroup
Forest Financial Group provides a legislative update on the timeline for implementation of the Patient Protection and Affordable Care Act. Key provisions beginning in 2010 include a temporary reinsurance program for early retirees, establishing high-risk pools, and requiring dependent coverage until age 26. Starting in 2014, major reforms take effect such as prohibiting pre-existing condition exclusions, establishing health insurance exchanges, and expanding Medicaid eligibility. An excise tax on high-cost health plans begins in 2018.
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
The document summarizes an upcoming FICCI Health Insurance Conference to take place on July 19, 2011 at Hotel "The Lalit" in New Delhi. The conference will focus on improving efficiency in health insurance delivery to benefit all stakeholders. It will feature sessions on standardization initiatives, promoting healthcare quality through insurance, government-sponsored health schemes, and partnerships between insurers and providers. The goal is to address challenges and facilitate greater health insurance penetration in India. A variety of industry representatives, experts, policymakers and international speakers will participate in the conference.
The document discusses the service sector in India. Some key points:
1) The service sector now accounts for over half (51.16%) of India's GDP, growing from agriculture and industry. This marks a shift to a more developed economy model.
2) Within services, trade and transportation have seen increasing shares of GDP while construction has remained steady.
3) Some economists caution that unchecked service sector growth without corresponding industrial growth could distort the economy.
4) Strong customer satisfaction is vital in the service industry where intangibles are sold. Insurance companies must focus on both sales and customer service.
The Patient Protection and Affordable Care Act (PPACA) timeline outlines key provisions and their implementation dates between 2010-2018. Major provisions include prohibiting pre-existing condition exclusions (2010), expanding dependent coverage to age 26 (2010), establishing state-based health insurance exchanges (2014), an individual mandate to purchase insurance (2014), an employer mandate for firms with 50+ employees (2015), and a tax on high-cost "Cadillac" plans (2018). The timeline provides an overview of how PPACA rolls out major health insurance reforms over an 8 year period.
An analysis of the Indian Cashless Health Insurance Industry identifying the key structural deficiencies leading to a situation of distrust between parties involved. The study as a part of IIM, Indore’s Consulting competition, Chanakya, organized in association with Cognizant also proposes solutions for resolving the present imbroglio between the service providers and insurance companies.
This document provides an overview of health insurance in India, including what it is, its importance, and common products. It discusses how health insurance works by pooling risks collectively. It outlines the rising costs of healthcare as a driver for health insurance penetration. Common plan types include individual, family floater, senior citizens, critical illness, daily hospital cash, and unit-linked plans. It also discusses government schemes like ESIS and CGHS, as well as community-based and employer-provided insurance options. Impediments to the industry like lack of data, pricing challenges, and government provision of care are also covered.
Legislative Update Patient Protections And Affordable Care Act Timeline 4 1...ForestFinancialGroup
Forest Financial Group provides a legislative update on the timeline for implementation of the Patient Protection and Affordable Care Act. Key provisions beginning in 2010 include a temporary reinsurance program for early retirees, establishing high-risk pools, and requiring dependent coverage until age 26. Starting in 2014, major reforms take effect such as prohibiting pre-existing condition exclusions, establishing health insurance exchanges, and expanding Medicaid eligibility. An excise tax on high-cost health plans begins in 2018.
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
The document summarizes an upcoming FICCI Health Insurance Conference to take place on July 19, 2011 at Hotel "The Lalit" in New Delhi. The conference will focus on improving efficiency in health insurance delivery to benefit all stakeholders. It will feature sessions on standardization initiatives, promoting healthcare quality through insurance, government-sponsored health schemes, and partnerships between insurers and providers. The goal is to address challenges and facilitate greater health insurance penetration in India. A variety of industry representatives, experts, policymakers and international speakers will participate in the conference.
The document discusses the service sector in India. Some key points:
1) The service sector now accounts for over half (51.16%) of India's GDP, growing from agriculture and industry. This marks a shift to a more developed economy model.
2) Within services, trade and transportation have seen increasing shares of GDP while construction has remained steady.
3) Some economists caution that unchecked service sector growth without corresponding industrial growth could distort the economy.
4) Strong customer satisfaction is vital in the service industry where intangibles are sold. Insurance companies must focus on both sales and customer service.
The Patient Protection and Affordable Care Act (PPACA) timeline outlines key provisions and their implementation dates between 2010-2018. Major provisions include prohibiting pre-existing condition exclusions (2010), expanding dependent coverage to age 26 (2010), establishing state-based health insurance exchanges (2014), an individual mandate to purchase insurance (2014), an employer mandate for firms with 50+ employees (2015), and a tax on high-cost "Cadillac" plans (2018). The timeline provides an overview of how PPACA rolls out major health insurance reforms over an 8 year period.
Health insurance and Labor Market in Bangladesh (Animated)Fahmida Ankhi
The document discusses the relationship between health insurance and the labor market. It begins with background on labor markets and health insurance. It then discusses how health is a form of human capital and that poor health can lead to lower wages and productivity. Health insurance may increase labor force participation by reducing healthcare costs and uncertainty. The document also provides an overview of health insurance in Bangladesh, noting low coverage rates but growing demand. It concludes by discussing how employer-provided health insurance can incentivize firms to employ more productive workers and substitute hours for additional workers.
HEALTH INSURANCE PROVIDED BY GOVERNMENT VS PRIVATE SECTOR IN INDIAVedica Sethi
Healthcare is significant for each individual on the planet, on account of this each nation should focus on wellbeing, because of increment pace of sickness and ailments.
In India medical coverage part is an undiscovered market, still it has crying needs. There is colossal potential for this part. The medical coverage suppliers are not satisfying this interest. After 1999 the privatization of protection area, the protection segment has developed in past decade. By and by there are 25 medical coverage suppliers, in that four are with open area and twenty one private medical coverage suppliers. The piece of the overall industry of open segment is 60 rates while the rest with other private players.
This paper inspects the present status of medical coverage in India, advancement in health care coverage area and difficulties looked by it. It additionally investigates the job of both open and private medical coverage players to arrive at most extreme inclusion in health care coverage.
PPP in Healthcare- An Indian Perspective, World Bank MOOC, By Saurav Kumar Dassauravkumar das
Having undertaken this course in the “Policy and Practice Track” I intend the presentation to be of value to policy makers and ground level stakeholders in the healthcare sector. The main purpose of the presentation was to provide the major challenges and opportunities for Healthcare PPPs in the Indian context. I envisage it to be of help for government agencies as well as private healthcare players. It would also be helpful to researchers and NGOs who are working in the healthcare sector. The presentation dives deep into the different PPP models and highlights some of the success stories under each model. It also touches upon certain key risks and drivers of success under challenging circumstances.
This policy paper discusses the emerging role of public-private partnerships (PPPs) in the Indian healthcare sector. It identifies five major thrust areas where PPPs could help address challenges in the sector by combining social objectives of universal access with business objectives of operating profitable facilities. These areas are infrastructure development, management and operations, capacity building and training, financing mechanisms, and IT infrastructure. The paper provides an overview of the Indian healthcare system, stakeholders in PPPs, models for PPPs, and an evaluation framework to assess PPP models. It recommends the government play a facilitator role by supporting private sector service delivery and quality of care.
Indian Insurance Industry - Key Issues and Challenges - Part - 2Resurgent India
While a range of economic and financial reforms have helped the insurance sector grow, there remains a host of challenges which need to be addressed for harnessing the full potential of the sector:
Death Claim Under Micro Insurance PortfolioRaja Ram
This document discusses death claims under micro insurance policies in India. It provides data on death claim amounts and numbers of policies from 2010-2011 for individual and group categories under private insurers and LIC. For individual policies, most claims were booked, paid and pending with LIC. For group policies, most claims amounts and numbers were with LIC. It also examines the duration of settlement, with most claims under both individual and group categories settled within 1 month by LIC according to regulations. Micro insurance aims to provide social security to low income populations in India.
The document discusses the emerging trend of health insurance in India. It summarizes that the Indian health insurance market grew at a CAGR of 37% between 2002-2008 and is expected to grow at a CAGR of 42.3% between 2008-2015. The main drivers of growth are increasing awareness, rising healthcare costs, and supportive demographic trends of a prospering middle class. However, the market also faces restraints like inadequate healthcare infrastructure and lack of standardization.
This document provides a timeline and overview of key provisions in the Patient Protection and Affordable Care Act (ACA). It outlines the legislative timeline from when the House and Senate passed versions of health care reform in 2009-2010 to when President Obama signed the bill into law. It then summarizes major ACA provisions being implemented from 2010 through 2018 and beyond, including requirements for insurance plans, the establishment of health insurance exchanges, Medicaid expansion, and individual/employer mandates. The document concludes by discussing how the ACA is paid for through various new taxes and fees and its projected impact on the private health insurance marketplace.
The current book provides and analyse the existing insurance market in India. It is a throughout study of Indian insurance with exact data archived from IRDA and Trustworthy Financial institute of India.
This book Provides the complete specification and integration required to reach the vision 2025 in prudent understanding.
This document provides an overview of public-private partnership (PPP) models for social healthcare insurance in India. It discusses the challenges of healthcare accessibility and affordability for low-income citizens. It reviews the Yeshaswini health insurance scheme in Karnataka as a successful PPP model and notes other states are implementing similar schemes. The document aims to compare different social health insurance models and identify a best-fit model for India.
The Problems Being Faced By Insurance Agency OwnersCogneesol
Insurance business owners face a number of challenges which hit their business performance. Check out this Cogneesol presentation that describes the major issues faced by insurance agency owners and the recommendations to avoid these issues.
The document discusses three provisions of the Affordable Care Act (ACA) that address market failures in the health insurance market:
1) Health insurance exchanges allow the uninsured to purchase qualified coverage, addressing missing markets. This increases insurance uptake and lowers overall healthcare expenditures.
2) Guaranteed issue prohibits denying coverage or charging more based on health status, addressing adverse selection. Risk adjustment offsets this by transferring payments between insurers.
3) Consumer protections like online tools provide information to allow informed plan choices, addressing high search costs in a complex market with little transparency.
The present book is a great step in forward direction of Indian Insurance sector ; and I have no doubt that after studying this book in detail and getting through the examination successfully, the insurance agent will gain substantially in accomplishing the tasks that are assigned to him or her. I would keenly look forward to its huge success in the Indian insurance domain in the days to come.
Australia vs India: Health care insuranceVedica Sethi
Health care insurance: A Comparative overview.
The retrospective review focuses on the timeline of Healthcare systems and development of Healthcare Insurance policies of India and Australia. The review also includes
the consensus and impact of Healthcare legislature in India and Australia and offers a
comparison to the development in the BRICS countries.
1) Microinsurance in India has grown rapidly in recent years but over 90% of the population remains uninsured. Key developments include the 2005 microinsurance regulation by IRDA and growth of government schemes like RSBY.
2) Life insurance, especially credit-life, dominates the microinsurance sector in India. New products like Max Vijay are emerging but savings-linked microinsurance remains underdeveloped. Health and crop insurance have also grown but face challenges around implementation and basis risk.
3) Innovations include index-based crop insurance partnerships and programs to expand micro-pensions to informal sectors. However, most microinsurance remains supply-driven and seeks subsidies over designing sustainable customer-centric products. Strategic perspectives and
Landscape Review of Prepaid Health Schemes in BangladeshHFG Project
The document summarizes prepaid health schemes in Bangladesh, including their challenges. It describes several types of schemes: provider-driven schemes run by healthcare organizations, MFI-driven schemes run through microfinance institutions, and innovative pilot programs. Provider-driven schemes like Gonoshasthaya Kendra's social class-based insurance and Dhaka Community Hospital's garment worker program provide primary care but have low enrollment rates and limited geographic reach. MFI schemes initiated by organizations like Grameen Kalyan and SAJIDA aim to protect borrowers but struggle with low renewal rates and a lack of continuum of care beyond primary services. Pilot programs have generally failed to achieve financial sustainability due to low enrollment. Overall, prep
This document describes a proposed microinsurance medical product for Jubilee Insurance Company of Kenya. It provides specifications for the product, including an inpatient cover for families with a general limit of 200,000 KES. Premiums would be 1,800 KES per member annually. The target market is low income Kenyans with credit facilities. Actuarial pricing techniques are used to estimate premiums, drawing on available data sources and adjusting assumptions to reflect the community characteristics. The premiums estimated using standard techniques are intended to be comparable to practical rates.
The Indian healthcare market has grown significantly but insurance penetration remains low, covering less than 20% of the population. While annual healthcare spending is over $60 billion, out-of-pocket expenses account for 70% of costs. Third party administrators (TPAs) play a key role in the insurance industry by processing claims, maintaining provider networks, and facilitating cashless access to healthcare. However, issues remain like a lack of standardized treatment costs and morbidity data as well as over-utilization of services. In order to address these challenges and increase insurance coverage, industry experts recommend strategies like regulated health markets, self-funded corporate plans, and consumer-driven healthcare products.
Health insurance provides coverage for medical expenses and loss of earnings due to illness or injury. It depends on the conditions, benefits, and treatment options covered by the policy. Premiums are paid in advance for future health coverage. There are different types of health insurance plans such as group, individual, and family floater plans. While perceptions of health insurance in India are mixed, it has become necessary due to rising medical costs, the need to share health risks, and securing one's family's health. Government initiatives aim to increase health insurance penetration and affordability, but challenges remain around healthcare delivery and costs, consumer awareness, and claim ratios.
Epgp09 10 - term v - prm - group ii - pricing in-insurance_industry - project...Rajendra Inani
The document discusses pricing strategies in the Indian insurance industry. It first provides background on the current scenario of insurance pricing and perceptions about health insurance in India. It then discusses key principles in determining pricing, including risks considered and the product development process. The main pricing models used in the industry are described as claim propensity models, market situation models, and customer behavior models. Recommendations are made to improve pricing innovation and better meet customer needs through ease of claims, expanded hospital networks, and product innovations.
Health insurance and Labor Market in Bangladesh (Animated)Fahmida Ankhi
The document discusses the relationship between health insurance and the labor market. It begins with background on labor markets and health insurance. It then discusses how health is a form of human capital and that poor health can lead to lower wages and productivity. Health insurance may increase labor force participation by reducing healthcare costs and uncertainty. The document also provides an overview of health insurance in Bangladesh, noting low coverage rates but growing demand. It concludes by discussing how employer-provided health insurance can incentivize firms to employ more productive workers and substitute hours for additional workers.
HEALTH INSURANCE PROVIDED BY GOVERNMENT VS PRIVATE SECTOR IN INDIAVedica Sethi
Healthcare is significant for each individual on the planet, on account of this each nation should focus on wellbeing, because of increment pace of sickness and ailments.
In India medical coverage part is an undiscovered market, still it has crying needs. There is colossal potential for this part. The medical coverage suppliers are not satisfying this interest. After 1999 the privatization of protection area, the protection segment has developed in past decade. By and by there are 25 medical coverage suppliers, in that four are with open area and twenty one private medical coverage suppliers. The piece of the overall industry of open segment is 60 rates while the rest with other private players.
This paper inspects the present status of medical coverage in India, advancement in health care coverage area and difficulties looked by it. It additionally investigates the job of both open and private medical coverage players to arrive at most extreme inclusion in health care coverage.
PPP in Healthcare- An Indian Perspective, World Bank MOOC, By Saurav Kumar Dassauravkumar das
Having undertaken this course in the “Policy and Practice Track” I intend the presentation to be of value to policy makers and ground level stakeholders in the healthcare sector. The main purpose of the presentation was to provide the major challenges and opportunities for Healthcare PPPs in the Indian context. I envisage it to be of help for government agencies as well as private healthcare players. It would also be helpful to researchers and NGOs who are working in the healthcare sector. The presentation dives deep into the different PPP models and highlights some of the success stories under each model. It also touches upon certain key risks and drivers of success under challenging circumstances.
This policy paper discusses the emerging role of public-private partnerships (PPPs) in the Indian healthcare sector. It identifies five major thrust areas where PPPs could help address challenges in the sector by combining social objectives of universal access with business objectives of operating profitable facilities. These areas are infrastructure development, management and operations, capacity building and training, financing mechanisms, and IT infrastructure. The paper provides an overview of the Indian healthcare system, stakeholders in PPPs, models for PPPs, and an evaluation framework to assess PPP models. It recommends the government play a facilitator role by supporting private sector service delivery and quality of care.
Indian Insurance Industry - Key Issues and Challenges - Part - 2Resurgent India
While a range of economic and financial reforms have helped the insurance sector grow, there remains a host of challenges which need to be addressed for harnessing the full potential of the sector:
Death Claim Under Micro Insurance PortfolioRaja Ram
This document discusses death claims under micro insurance policies in India. It provides data on death claim amounts and numbers of policies from 2010-2011 for individual and group categories under private insurers and LIC. For individual policies, most claims were booked, paid and pending with LIC. For group policies, most claims amounts and numbers were with LIC. It also examines the duration of settlement, with most claims under both individual and group categories settled within 1 month by LIC according to regulations. Micro insurance aims to provide social security to low income populations in India.
The document discusses the emerging trend of health insurance in India. It summarizes that the Indian health insurance market grew at a CAGR of 37% between 2002-2008 and is expected to grow at a CAGR of 42.3% between 2008-2015. The main drivers of growth are increasing awareness, rising healthcare costs, and supportive demographic trends of a prospering middle class. However, the market also faces restraints like inadequate healthcare infrastructure and lack of standardization.
This document provides a timeline and overview of key provisions in the Patient Protection and Affordable Care Act (ACA). It outlines the legislative timeline from when the House and Senate passed versions of health care reform in 2009-2010 to when President Obama signed the bill into law. It then summarizes major ACA provisions being implemented from 2010 through 2018 and beyond, including requirements for insurance plans, the establishment of health insurance exchanges, Medicaid expansion, and individual/employer mandates. The document concludes by discussing how the ACA is paid for through various new taxes and fees and its projected impact on the private health insurance marketplace.
The current book provides and analyse the existing insurance market in India. It is a throughout study of Indian insurance with exact data archived from IRDA and Trustworthy Financial institute of India.
This book Provides the complete specification and integration required to reach the vision 2025 in prudent understanding.
This document provides an overview of public-private partnership (PPP) models for social healthcare insurance in India. It discusses the challenges of healthcare accessibility and affordability for low-income citizens. It reviews the Yeshaswini health insurance scheme in Karnataka as a successful PPP model and notes other states are implementing similar schemes. The document aims to compare different social health insurance models and identify a best-fit model for India.
The Problems Being Faced By Insurance Agency OwnersCogneesol
Insurance business owners face a number of challenges which hit their business performance. Check out this Cogneesol presentation that describes the major issues faced by insurance agency owners and the recommendations to avoid these issues.
The document discusses three provisions of the Affordable Care Act (ACA) that address market failures in the health insurance market:
1) Health insurance exchanges allow the uninsured to purchase qualified coverage, addressing missing markets. This increases insurance uptake and lowers overall healthcare expenditures.
2) Guaranteed issue prohibits denying coverage or charging more based on health status, addressing adverse selection. Risk adjustment offsets this by transferring payments between insurers.
3) Consumer protections like online tools provide information to allow informed plan choices, addressing high search costs in a complex market with little transparency.
The present book is a great step in forward direction of Indian Insurance sector ; and I have no doubt that after studying this book in detail and getting through the examination successfully, the insurance agent will gain substantially in accomplishing the tasks that are assigned to him or her. I would keenly look forward to its huge success in the Indian insurance domain in the days to come.
Australia vs India: Health care insuranceVedica Sethi
Health care insurance: A Comparative overview.
The retrospective review focuses on the timeline of Healthcare systems and development of Healthcare Insurance policies of India and Australia. The review also includes
the consensus and impact of Healthcare legislature in India and Australia and offers a
comparison to the development in the BRICS countries.
1) Microinsurance in India has grown rapidly in recent years but over 90% of the population remains uninsured. Key developments include the 2005 microinsurance regulation by IRDA and growth of government schemes like RSBY.
2) Life insurance, especially credit-life, dominates the microinsurance sector in India. New products like Max Vijay are emerging but savings-linked microinsurance remains underdeveloped. Health and crop insurance have also grown but face challenges around implementation and basis risk.
3) Innovations include index-based crop insurance partnerships and programs to expand micro-pensions to informal sectors. However, most microinsurance remains supply-driven and seeks subsidies over designing sustainable customer-centric products. Strategic perspectives and
Landscape Review of Prepaid Health Schemes in BangladeshHFG Project
The document summarizes prepaid health schemes in Bangladesh, including their challenges. It describes several types of schemes: provider-driven schemes run by healthcare organizations, MFI-driven schemes run through microfinance institutions, and innovative pilot programs. Provider-driven schemes like Gonoshasthaya Kendra's social class-based insurance and Dhaka Community Hospital's garment worker program provide primary care but have low enrollment rates and limited geographic reach. MFI schemes initiated by organizations like Grameen Kalyan and SAJIDA aim to protect borrowers but struggle with low renewal rates and a lack of continuum of care beyond primary services. Pilot programs have generally failed to achieve financial sustainability due to low enrollment. Overall, prep
This document describes a proposed microinsurance medical product for Jubilee Insurance Company of Kenya. It provides specifications for the product, including an inpatient cover for families with a general limit of 200,000 KES. Premiums would be 1,800 KES per member annually. The target market is low income Kenyans with credit facilities. Actuarial pricing techniques are used to estimate premiums, drawing on available data sources and adjusting assumptions to reflect the community characteristics. The premiums estimated using standard techniques are intended to be comparable to practical rates.
The Indian healthcare market has grown significantly but insurance penetration remains low, covering less than 20% of the population. While annual healthcare spending is over $60 billion, out-of-pocket expenses account for 70% of costs. Third party administrators (TPAs) play a key role in the insurance industry by processing claims, maintaining provider networks, and facilitating cashless access to healthcare. However, issues remain like a lack of standardized treatment costs and morbidity data as well as over-utilization of services. In order to address these challenges and increase insurance coverage, industry experts recommend strategies like regulated health markets, self-funded corporate plans, and consumer-driven healthcare products.
Health insurance provides coverage for medical expenses and loss of earnings due to illness or injury. It depends on the conditions, benefits, and treatment options covered by the policy. Premiums are paid in advance for future health coverage. There are different types of health insurance plans such as group, individual, and family floater plans. While perceptions of health insurance in India are mixed, it has become necessary due to rising medical costs, the need to share health risks, and securing one's family's health. Government initiatives aim to increase health insurance penetration and affordability, but challenges remain around healthcare delivery and costs, consumer awareness, and claim ratios.
Epgp09 10 - term v - prm - group ii - pricing in-insurance_industry - project...Rajendra Inani
The document discusses pricing strategies in the Indian insurance industry. It first provides background on the current scenario of insurance pricing and perceptions about health insurance in India. It then discusses key principles in determining pricing, including risks considered and the product development process. The main pricing models used in the industry are described as claim propensity models, market situation models, and customer behavior models. Recommendations are made to improve pricing innovation and better meet customer needs through ease of claims, expanded hospital networks, and product innovations.
The document discusses the need for health insurance in India to move beyond only covering hospitalization and toward financing primary care and chronic conditions. Currently about half the population lacks access to any health financing. As India's disease burden shifts to non-communicable diseases, outpatient funding becomes increasingly important. The rising prevalence of chronic conditions also calls for insurance that provides long-term coverage rather than excluding pre-existing illnesses. The paper focuses on developing insurance frameworks for chronic disease management and elderly care.
Navigating the Health Financing Challenge in India: Lessons from Mutuals, Coo...HFG Project
This document discusses community-based microinsurance programs in India that provide health insurance to low-income households. It notes that while India has seen the growth of various government-funded insurance schemes and commercial insurance, it has also witnessed the rise of community-based microinsurance programs initiated by mutuals, cooperatives, and community organizations. These programs aim to address the needs of those at the bottom of the socioeconomic pyramid. The document highlights that such community-owned insurance models promote inclusion by tapping into community groups. It also notes that these initiatives often take a holistic approach to building community resilience. In less than 3 sentences.
This document presents information about the insurance sector in India. It discusses the privatization of insurance, the growth of major private players in insurance, and the key driving factors such as rising incomes and demand from semi-urban populations. It provides an overview of the types of insurance available and compares salaries and opportunities in private versus public insurance companies. Challenges mentioned include effective marketing strategies while opportunities include job growth, funds inflow, and new technologies.
This document presents information about the insurance sector in India. It discusses the privatization of insurance, the growth of major private players in the sector, and the key driving factors such as rising incomes and demand from semi-urban populations. It also outlines some of the challenges and opportunities in the Indian insurance market since privatization, such as the need for effective mass marketing strategies and leveraging new technologies. Overall, the privatization of insurance has led to increased competition, new products, and higher salaries compared to when it was previously dominated by state-owned providers.
This document discusses an overview of the Affordable Care Act (ACA) in 3 pages. It provides background on the ACA and its goals of making healthcare more affordable and accessible. Key points covered include expanding Medicaid eligibility, creating state-run health insurance exchanges, establishing essential health benefits, and implementing subsidies and penalties to increase insurance coverage. Frequently asked questions about the ACA are also addressed.
RBSA-RR-Demystifying Life Insurance Industry in India (1).pdfRBSA Advisors
RBSA Advisors is delighted to share its recent research on the Life Insurance sector in India. Pandemic across the nation had impacted the country's overall financial system. The unprecedented nature of this crisis created difficult circumstances, including economic shutdowns. The year 2020 was a watershed year in the Insurance sector. Insurer were forced to rethink their business operations leading to enormous changes in the industry. Currently, life insurance industry is at crossroad.
Through this report we are demystifying the life insurance industry in India and sharing our views on the industry outlook.
Indian Insurance Industry: Reaching out to Exponential Growth Resurgent India
From Insurance being seen as a basic protection instrument against expected losses, the Indian Insurance industry has surely come a long way to become an absolute critical driver of economic prosperity and growth. The sector has helped account for risks; provide funds for capital intensive national building efforts besides lending social security to the citizens. Over a period of decade and a half, the industry has witnessed phases of spurt growth and moderation, intensifying competition and expansion of customer and geographic coverage.
This document provides a glossary of terms related to individual health insurance. It defines terms like agent, annual deductible, coinsurance, network providers, pre-existing conditions, and premiums. It also provides contact information for Celtic Insurance Company, an individual health insurance provider. Celtic aims to offer consumers affordable and easy-to-understand insurance plans. The glossary helps explain insurance concepts and Celtic's services.
Mr Anil Swarup Dir General, Ministry of Labour & Development, Govt of India presented on the biggest health insurance scheme (RSBY) run by the government at a seminar hosted by CIRM in Chennai, India
This document provides an overview of health insurance in Bangladesh. It discusses key concepts like social health insurance and private health insurance. It notes that household out-of-pocket expenses are currently the main source of healthcare financing in Bangladesh. The document also examines the government's policies around developing health insurance, including a 2000 report that outlined steps to create an enabling framework. It analyzes the potential and limitations of different approaches like private insurance, social insurance, and community-based insurance in the Bangladeshi context.
The Cost Of Doing Nothing Health Reform ImplicationsDocJess
Under the worst-case scenario described in the document:
1) The number of uninsured Americans would increase to 65.7 million by 2019, growing by at least 10% in every state. The number of uninsured would increase by over 30% in 29 states.
2) Employer-sponsored health insurance rates would fall substantially nationwide, declining from 56.1% to 49.2% by 2019.
3) Medicaid enrollment would rise significantly across all states, increasing the national Medicaid rate from 16.5% to 20.3% by 2019, with enrollment growing by 13.3 million people. States would see Medicaid spending rise by over 75% by 2019 under half of the states seeing increases over 100%.
The document discusses the market structure of the health insurance industry and how it affects efforts to expand health insurance coverage and contain healthcare costs. It begins with an introduction that health insurance markets are linked to concerns about the cost, quality, and availability of healthcare. The market structure of the health insurance and hospital industries may have contributed to rising healthcare costs and deteriorating access to affordable insurance and care. Many features of the health insurance market can hinder competition and lead to inefficient outcomes. It then goes on to describe various aspects of the health insurance market structure and how it relates to other parts of the healthcare system.
An Investigation of the Factors Affecting Capitation Programme in Provision ...inventionjournals
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
This document discusses innovations in patient care including electronic health records (EHR), practice management systems (PMS), health information exchange (HIE), and personal health records (PHR). It then provides a detailed 7-page digest on the benefits of the Affordable Care Act (ACA) and how it can be used to educate voters on why they should support the ACA. The digest has been used in community meetings and to educate over 1,500 individuals.
Similar to Indian Cashless Health Insurance An Overview (20)
1. Chanakya Round 2
Team Unnati, Great Lakes Institute of Management
Nitin Pahuja: nitin.pahuja@greatlakes.edu.in, 09884070606
Ujjawal Jain: ujjawal.jain@greatlakes.edu.in, 09962082884
2. Objective and Scope as defined by the client
Macro analysis of the Indian and Western Health Insurance Market
Process dynamics of Cashless Insurance in both markets
Highlight key gaps in the Indian structure leading to inefficiencies
Identify key processes from the western model that can help bridge gaps in Indian market
Proposing plausible solutions to ensure seamless operation of Cashless
Health Insurance facilities in India leading to
Improve the quality of healthcare
Enhance the coverage of Health Insurance
Reduce the cost at all possible platforms
Facilitate development of a co-operative eco-system in the industry
2
3. Executive Summary
India is on the anvil of becoming an economic superpower leveraging its demographic
dividend. A dynamic & healthy workforce in context of our rapidly growing service economy
is critical. Ensuring that our young population remains healthy and continues to operate at
maximum productivity is an important imperative. World-class and inclusive healthcare
financing is critical for India‟s 2020 vision as most of the healthcare expenditure is still paid
out of pocket by individuals, leading to financial distress or inadequate care. In this context,
there is a clear need for a rapid increase in access to health insurance.
Indian Health Insurance Industry is still in its infancy and has just about reached a stage of
transition. In order to take-off on a trajectory of unprecedented growth in correspondence
with the economy‟s overall growth prospects, it is important for the industry to plug inherent
gaps and structural deficiencies.
Benchmarking the policies of the west comes across as an obvious choice in this context,
however doing it blindly can lead to serious consequences. The western markets have
failed in various respects like reducing the cost of health care and widening the cover of
insurance over a long period of time. It is therefore important to critically evaluate the best
practices across industry and customizing them to Indian markets‟ needs.
It is with this endeavor to lay out a plausible and actionable growth path for the industry
that we highlight the key leanings from the west that when customized to Indian needs can
deliver great results. This study has committed itself to the cause of identifying factors,
practices and strategies that can
1.Improve the quality of healthcare
2.Enhance the coverage of Health Insurance
3.Reduce the cost at all possible platforms
4.Facilitate development of a co-operative eco-system in the industry
4. Executive Summary contd…
Methodology
In this study we have outlined the key dynamics of the Indian Health Insurance market. We have covered critical
macro aspects of the Industry like its structure, potential for growth and key stakeholders. The macro analysis of
the industry is followed up by a focused overview of the basic processes involved in the functioning of „Cash-less
insurance‟ (being the primary area of exploration for this study).
The next segment of the report deals with key learnings from the western Health Insurance model. We have
outlined core competencies for a healthy health insurance industry drawing its origin from the US Health
Insurance industry. The penultimate section deals with an insight into the Indian industry with a focus on key
problems and their respective root causes categorized with respect to the following perspectives:
1. Insurance Companies
2. Healthcare Service Providers
3. TPA‟s
4. Industry as a whole (Macro Issues)
The last section deals with suggestions that can facilitate Indian Health Insurance Industry‟s evolution into a truly
world-class healthcare management system which is affordable, inclusive and flexible. The suggestions have
been elaborated under the following heads
• Grading of Healthcare Service Providers and products on the basis of service quality & premium charged
• Establishment of Standard operating procedures across the industry
• Establishment of internal controls alongside process audits
• Product innovation in the Indian health insurance industry
• Channel Distribution: Reaching out to “Bharat”
5. Indian Health Insurance: Need of the nation
Health Insurance a national need
•India currently spends about 6% of its GDP on health care.
•Out of this more than 70% is “Out of pocket expense.”
•Despite such high share of individual expenditure, provision of
health care not satisfactory.
•More than 40% of hospitalized Indians have to borrow or sell
assets to meet hospitalization costs.
•Around 25% of hospitalized Indians fall below poverty line in a
single year as a result of hospitalization expenses, causing a
rise of 2% in proportion of poor population.
Source: Mckinsey
Health insurance: current and future scenario
•Revenue attributable to insurance or Third Party Administrators (TPAs) has
grown significantly over the last few years
• Total credit billing is likely to increase further to 50 per cent by 2011-12.
• Domestic health policy premiums have shown significant increase in the in
the last few years
• The number of policies issued as Medi-claims, ESIS, and CGHS are
4,631,534, 8,400,000 and 1,040,000, respectively.
6. Health Insurance: Structure & Potential in India
Health Insurance
Structure in India
Social Health Private health Community Health
Insurance insurance Insurance
CGHS ESIS
Potential in numbers
Health Insurance - potential to become a US$ 3.8 Bn industry by 2012.
No. of elderly people in the Developing World will TRIPLE in 25yrs. (WHO)
In India, the no. of people above 60 yrs is about 8% today, with that no.
expected to hit 21% by 2025. (Asia Insurance Review)
•Source: NIA Library 6
7. Cashless Insurance: Stakeholders and Basic Process Flows
Cashless Heath Insurance : Basic
Process Flows
Cashless Heath Insurance : Stakeholders
Consumer
Strategic tie-ups that
give access to
discounted rates
and high volume
for respective
parties
Insurance Company Healthcare Provider
TPA
8. Cashless Insurance Process Flows: US vs India
Healthcare Provider with a tie up
with Insurance Co
Consumer gets Cashless service
and the Insurance co pays the
service provider
Cashless insurance
Process in the US
Consumer pays a certain percentage of the bill, which varies from policy to policy
COPAY: The consumer shares a
Consumer pre-decided percentage of the total
bill, the rest is paid by Insurance co
Healthcare Provider with no tie up
with Insurance Co
Cashless request Insurance TPA reviews
In case of approval the
Network submitted to Insurance the request and informs
bills are settled by
Hospitalization co at the time of the hospital with the
Insurance Co
admission authorization status
Cashless Insurance
Process in India
He can file a claim He can file a claim
request which if In case of rejection the request which if
Out of network Customer needs to
approved shall be customer needs to approved shall be
Hospitalization settle all the bills
reimbursed by the settle all the bills reimbursed by the
insurance co insurance co
9. Lessons to be learnt from the US market
Key takeaways from the western model
• Improving health should be the ultimate
objective: The U.S. life insurance
experience has shown that a secular
improvement in life expectancy has kept the
market profitable.
• Customer Engagement: Deliver
segmented customer driven products that
leverage trust generated through
transparency. Co-pay is an integral
Competencies for a healthy health insurance industry
innovation from the US perspective
• Dynamic Pricing: Dynamic, market-based
pricing is often the key enabler for Key Action points for the Indian Market
innovation in any given industry hence the
Product Innovation
Channel Distribution
Risk Management
Build an Build expertise in Strong processes
regulators shall provide ample scope of innovative set of managing retail governed by a
doing this. core health channels and stringent
insurance bolster their monitoring body
• Removing Supply Distortions: Broad products and an approach to that periodically
array of ancillary distribution by evaluates the
participation across different grades of products and improving their tested and
service offering and geographies is critical to services. branding and reinvented models
marketing. with regards to
the growth of robust heath services. latest
Therefore it is important to make the conventions.
industry more inclusive.
Source: Mckinsey 9
10. Indian Health Insurance: Key Issues and root cause analysis w.r.t stakeholders
Insurance Companies
Health Care providers
TPAs
Macro Issues for the Industry
11. Key issues and root cause analysis – Insurance Companies
Standard mediclaim
policy across all
customer segments
Different Prices charged by
different hospitals
Low level of consumer
Limited influence over healthcare awareness Claims > Premium
delivery mechanism
Collection
(Rs 6,991vsRs 6,734
crore)
High claim ratio
No incentive for the insured
to be vigilant on billing
Sources
http://businesstoday.intoday.in/bt/story/5874/1/the-cashless-insurance-row.html
12. Key issues and root cause analysis – Healthcare providers
Lack of process interaction amongst
insurance companies and hospitals
Lack of standardization and
High discount demand accreditation norms for
from insurance healthcare providers
companies
Limited Market reach and
Lack of purchasing
delay in payments
power and
Health insurance Multiple contracts with
penetration in differentinsurance
tier2/3 cities companies
Irregular and untimely
payments by insurance
companies
13. Key issues and root cause analysis – TPA‟s
Lack of standardization &
accreditation in most
healthcare facilities leading
Limited influence over healthcare to difficulty in judging the
delivery network authenticity and procedures
Lack of standardized
operating procedures
Limited funding support from
the insurance company Delays and issues in
impacting the claims claims processing
disbursement time leading to negative
perceptions by insurance
companies & consumers
about TPAs
14. Key issues and root cause analysis – Macro Issues
Insufficient data on Indian
consumers & disease patterns Poor check on pricing and
resulting in difficulty in product service quality
development and pricing Better Quality of
Health
Care/Coverage at
Mindset – cost considered lower prices
as a burden Limited medical
Negative perceptions – low
level of consumer infrastructure
awareness
14
15. Suggestions
Grading of Hospitals and Products
Integrated Standard Operating Procedures
Surprise Audit and Customer Feedback
Co-pay
Channel Distribution:Reach out to “Bharat”
16. Getting ready for Product Innovation: Grading of Hospitals and Products
Every customer has access to all network hospitals Industry Comments
irrespective of the premium paid
The problem is that there is a standard mediclaim
policy across all customer segments, it is only the
Standard
sum insured that varies. As a result, a policyholder
mediclaim with a sum insured of Rs 1 lakh and another
policyholder with Rs 5 lakh would get the same
policy across
A large portion of the population below the age of amount reimbursed for a Rs 40,000 procedure at a
all customer 45 left untapped (Preventive > curative) top-end hospital,”
segments “In cities like Mumbai and Delhi, most of the
policyholders are keen on being treated in only the
top four hospitals. This is why there has been so
much objection to the preferred provider network,”
Higher claims which lead to hiking of policy Source: http://economictimes.indiatimes.com/personal-finance/insurance/insurance-news/Cos-plan-to-segment-
insurance-mkt-to-ensure-cashless-facility/articleshow/6160895.cms
premiums
Recommendations Opportunity for Cognizant Potential Implications
Grade hospitals into dynamic classes (periodically revised) on Development of a dynamic grading Lowering of claim values for low
the basis of system that can take into account premium accounts
– Level of service offered customer feedback and other key Enabling better service providers to
performance variables charge a premium
– Pricing
Key Enabler Clear identification of high value
– Presence across multiple cities
Co-operation amongst service customers
Create a diverse product portfolio with new health insurance
providers and insurance companies to Better coverage across demographics
products based on
set price slabs for different procedures and regions
– Desired level of service and treatments varying in line with the
Increased penetration of health
– Availability Co-pay option service provider‟s grade
insurance
– Availability of preventive care options
Stimulate competition amongst players
to strive for better service offering
16
17. Risk Management through Integrated Standard Procedures
key issues
INS Absence of an integrated operating platform for
INS INS multiple parties which leads to high turn around
Co-1 Co-2 Co-3 time and poor service delivery
Negligible understanding of customer’s past
record and health history
High administration costs which translate into
higher premiums for the consumer
Lack of internal controls leading to operating
TPA
IRDA risks like
- Over billing
Consumer - Delayed payment receipt
SP -2 SP -1 SP -3 - Poor service
Recommendations Opportunity for Cognizant Potential Implications
Consolidation of multiple players from service provider and insurance Development of a linking operational • Improved performance of all parties in
into two representative bodies to enable platform for all parties with UIDAI or a terms of service quality and turn-around
Credit Information Bureau of India time
– Standard terms & conditions across industry
(CIBIL) like platform • Reduced administration and processing
Establish a regulatory body with members from IRDA and AIMA to costs
Establishment of progressive
– Establish Standard operating procedures for Health Insurance • Effective risk control across processes
Standard Operating procedures
– Ensure compliance and efficient service • A key input for grading service providers
Key Enabler
Create an industry wide web based operational platform to enable • Elimination of multi-party bargaining and
Co-operation amongst service contracts which led to confusion
– Link all the parties involved through a single channel providers and insurance companies to • Development of a co-operative model,
– Seamless communication amongst parties involved integrate their processes critical for evolution of the health insurance
– Clear establishment of authority and responsibility industry as a whole
17
18. Risk Management: Surprise Audit and Customer Feedback
Problem definition
Service Points Rank Lack of focus on quality as far as Heath
Provider Care service providers are concerned.
ABS 290 1 Absence of reliable rankings of service
providers for the customers to choose the
Audit Scores best options
GSF 265 2
Lack of incentive for Health Care Providers
BFG 210 3 to improve the quality of their service.
Dominance of few players with financial
Data Processing TCB 190 4 muscle to advertise heavily which has led to
Center the cartelization of the healthcare industry
at the top
Ranking published on web and
Customer insurance ads across platforms
Feedback
Recommendations Opportunity for Cognizant Potential Implications
Enable the regulatory body with members from IRDA and AIMA Creation and maintenance of a Well established controls on operating
to dynamic customer feedback system procedures
– Administer a panel of independent Doctors appointed by IRDA for that generates rankings for service An important source of information for
regular audit of the claim cases at various hospitals providers. insurance company to negotiate on
– The team shall be responsible for random checking and Key Enablers terms of strategic partnerships
authentication of various bills and claims made from a hospital Establishment of a strong and well Competition amongst service
– Mandatory audit of bills above 1.5 lacs post redemption of claims represented independent body providers to offer better service quality
– For default, if any, hospitals must be penalized for triple the Establishment of integrated Standard Transparent evaluation of service
amount of excessive charged plus an effect on the overall grade Operating Procedures across industry quality for the consumer
Customer feedback on website Creation of a compliance mechanism
with clearly defined rewards and
– Secure customer feedback on service satisfaction for different
penalties
service providers through internet, audit surveys and data
collected on the touch point of bill payment. 18
19. Product Innovation & Customer Engagement through Co-Pay
You have mild fever but Industry Comments
may be we should get a
CT Scan done
Consumers fail to remain vigilant on the
prescribed treatment in view of a cash-less
insurance facility
The IRDA chief said his information bureau,
where all mediclaim reports were archived,
showed that while average charges for a
medical procedure under the
reimbursement category was Rs 25,000, the
Loss for Insurance Rising premiums on same went up to Rs 33,000 in cashless
companies insurance policies scheme.
Don’t worry, I Source: http://economictimes.indiatimes.com/personal-
have a cash less finance/insurance/insurance-news/Insurers-set-10-day-cashless-
deadline/articleshow/6239744.cms
health insurance.
Let’s get it done
Recommendations Opportunity for Cognizant Potential Implications
All the state insurance companies should introduce health Provide Market Intelligence services Reduction in over-billing by healthcare
insurance policies with a Co-pay option in order to to the insurance companies, critical for providers
– Promote rational usage of insurance cover rational product innovation in the An incentive for the consumer to
Indian context. ensure rational spending on healthcare
– Reduce possibility of the hospitals overcharging
Key Enablers Expanded market because of relatively
– Improve coverage through relatively less premiums
Product innovation on part of the state lower premium
What is Co-pay?
owned insurance companies Expansion of the product portfolio
– A policy option whereby the customer is bound to pay a small
A standardized system to link co-pay A check on the rising health insurance
percentage of the total bill by his own pocket
percentages with premium paid cost in the long run
– The percentage is small enough to secure the interest of
consumer
– Consumer gets the insurance at a relatively lower premium
19
20. Channel Distribution: Reaching out to “Bharat”
Industry Comments
Inadequate and inefficient sales and marketing • India‟s general insurance business accounts for
manpower in the form of agents just 0.6 percent of the gross domestic product
(GDP), compared to the world average of 2.14
percent. India ranks 136th on penetration levels
Huge and lags behind China (106), Thailand (87),
Underutilization of channels such as PSU banks, untapped Russia (86)
SHG’s and other NBFC’s with extensive penetration market • The penetration of general insurance in India
remains low on account of low consumer
preference, largely untapped rural markets and
constrained distribution channels
Low usage of technology in expanding penetration
in the market Source: Crisil & Assocham
Recommendations Opportunity for Cognizant Potential Implications
Investing in a robust sales workforce Development of a performance Reduction in distribution cost which
– Efficient hiring, training and performance management process management and training system to will lead to wider market reach
manage the sales workforce. A comprehensive measure to check
– Usage of web technology to constantly track, test and train
employees Development and integration of selling the sales force performance which will
web and mobile platforms with those act as an impetus for further growth of
Strategic tie-ups with other organizations
of partner organizations. insurance companies
– Securing tie-ups with Banks, NBFC‟s, NGO‟s and organizations
Key Enablers Reduction in total cost of healthcare
like ITC e-Choupal.
Penetration of Broadband and 3G services on account of better
Focus on e-selling and m-Selling participation
technology into Tier II and Tier III
– Creating advanced selling platforms to enable sales through web cities. Increase in awareness about insurance
and mobile phones. with large number of channels
Strategic tie-ups amongst major
insurance and financial services
players. 20
22. Works Cited
1. CII, K. (2008). Health Insurance Inc: The Road Ahead. Health Insurance Summit 2008, (p. 18). Mumbai.
2. Ehrbeck, T., &Kumra, G. Sustainable Health Insurance. McKinsey & Company, Inc , Healthcare Payors and
Providers Practice . McKinsey & Company, Inc .
3. ICICI. (n.d.). Tips for Insurance Card Holders. ICICI Prudential Life Insurance Brochure . India: ICICI
Prudential.
4. KPMG & CII. (2008). (p. 31). Mumbai: KPMG, CII.
5. Levitt, T. (2004). Marketing Myopia. Harvard Business Review .
6. Lombard, ICICI. (n.d.). Popularizing Cashless Hospitalization. Delhi, Delhi, India.
7. Rao, K. S. (2008). Financing and Delivery of Health Care Services in India. New Delhi: Commission on
Macroeconomics and Health, Govt of India.
8. Singhal, S. (2007). Sustainable Health Insurance : Global perspectives for India. McKinsey & Company, Inc .
New Delhi: McKinsey & Company, Inc , FICCI.
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27. Acknowledgement
We are extremely grateful to the organizing team of Chanakya, 2010 at Indian Institute of
Management, Indore for their great support and help throughout the event. We would like to
express our gratitude to Cognizant for mentoring the event and making it a great learning
experience for us.
Nitin Pahuja Ujjawal
Jain
email@nitinpahuja.comujjawaljain@gmail.com
09884070606
09962082884
27