Shahid Nazir(35), Marketing Head in a Delhi based consulting company, had his family’s health insured for Rs 4 lakh. So, when doctors advised bypass surgery to treat his mother’s heart condition, he did not worry about the Rs 2.5-lakh price tag.
But in the days that followed the surgery, he had plenty to worry on account of post-operative complications and ‘authorisations’ (money sanctions) from the TPA (third-party administrator of the insurer) that came in little instalments after stressful delays.
The TPA took seven hours to give the final authorisation, the hospital tab being Rs 4.7 lakh—Rs 70,000 more than the sum insured. Nazir settled the extra amount on discharge, heaving a massive sigh of relief.
But Nazir’s experience is hardly reflective of the myriad issues that face commercial health insurance in India. It is, in fact, a happy-in-the-end story. But it does underscore the vulnerability of the country’s teeming millions in the face of spiralling healthcare costs, given the fact that industry is just beginning to get serious about creating financially sustainable ‘third-party payment systems’ for health—such as insurance.
Commercial health insurance in India is still in its infancy, having begun in 1986 with Mediclaim, the first hospitalisation cover introduced by four public-sector non-life insurance companies. (Mediclaim and its private sector look-alikes make up 90-95 per cent of the total policies sold today.)
Things started changing from 1999 when insurance was opened to the private sector under the supervision of the Insurance Regulatory and Development Authority (IRDA). In the last three years, health premium collected by the general insurance industry has been growing by at least 30 per cent per annum.
Total health premiums grew 44 per cent to Rs 3,198.83 crore in 2006-7 from Rs 2,222.09 crore in 2005-06. The growth seems to have accelerated this year to over 50 per cent.
In fact, health, along with motor insurance, is now one of the two fastest growing businesses, thanks to the booming retail market for individual policies (as opposed to group health plans).
“Last year saw over 3.8 million health policies being sold, over 16.3 million people insured, and over one million claims filed,” points out D.V.S. Sastry, Director General (R&D), IRDA.
Currently, insurance contributes only about 2 per cent of India’s health expenditure and less than 15 per cent of Indians enjoy some form of ‘third-party payment system’ (which subsumes ‘health insurance’ but can also mean a free/cheap benefit provided by an employer) for their health spends, says Aloke Gupta, a Delhi-based insurance consultant.
But Kartik Jain, Head (Marketing), ICICI Lombard, says he sees the contribution of insurance in total healthcare-spend going up to at least 10-12 per cent in the next 10 years.
Jain’s optimism stems from the ongoing phaseout of the regulated tariffs in the general insurance industry, which promises to dis-entangle health from other lines of business.
Health’s ‘general’ problems
“Group health insurance has historically been held hostage by general insurers’ other lines of business. In selling fire and other policies to their corporate clients, insurers were not allowed to offer any discounts on regulated tariffs.
So they would offer group health policy as a cheap add-on. That turned health into an ‘accommodation’ business even though it was outside regulated tariffs,” explains Gupta.
This ‘cross-subsidisation’ of group health policies with other businesses (and not rationally assessing the risks in health) has meant that health remains to this day a loss-making business for all general insurers. The typical loss ratios of the health business have been more than 100 per cent, meaning that just the claim pay-outs—not to mention operational expenses— have been wiping out all premium income.