Poor Spread of Health Insurance
PreviousLack of Reliable Data for Policy and Medical ResearchNextPilferage, Corruption, Fraud and Inefficiencies
Last updated
Last updated
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The maturation of insurance market in any economy is dependent upon availability of large amount of data. In India, the health insurance industry, among other things, is hobbled with the lack of such data. The insurance companies do not feel confident to pursue this segment aggressively because they are not sure of the market size, its needs, distribution and their economic status.
Even as government-provided insurance has spread, many are unable to take full advantage of it due to unawareness of the schemes, unfamiliarity with the procedures for claims, and delays in reimbursement. Experience with the existing schemes introduced in different states has revealed similar problems, including frauds, incomplete or erratic documentation and delayed reimbursements. It is reported that the existing schemes do not provide any significant financial protection for those covered. Private hospitals commonly refuse to treat patients at the because government mandated rates are not based on market realities, which is a result of rates being set with insufficient data. Inefficiencies and errors in different processes related to insurance also have consequences beyond simple delays and financial stress for the participants, the delays lead to increased hospital stays and risk of nosocomial infections.
Each state that implements such scheme has to create its own software system(s), to manage different aspects of healthcare, which are often poorly designed and buggy, creating an additional layer of inefficiency and inaccuracies. An EMR system which has insurance capabilities baked into it being provided to all state governments will obviate the need for each state or district to create their own insurance management system.
Government's plans for using insurance companies to implement its own insurance schemes has also come under . It is alleged that these "middlemen" siphon away a large chunk of the money that government allots for insurance payments. With a system like IndiMR, it is conceivable that entire insurance schemes could be run without any middlemen, including the insurance companies.
Most of the insurance related processes, such as pre-authorization, verification of identities, validation of cases, and reimbursement to the doctors can be automated.