Professional Documents
Culture Documents
HEALTH SYSTEM
HEALTH PROMOTION REQUIRES HEALTH INFRASTRUCTURE HEALTH SERVICES HEALTH FINANCING STEWARDSHIP NEED TO MOVE FROM OUT OF POCKET TO POOLING
HEALTH INSURANCE IS :
RISK TRANSFER Ind. Family Org. Community
Taxes Compulsory Social or Community Insurance Private Insurance Medical Saving Schemes
75% of the population works in the informal sector 25% of the population below poverty line 70% of the population in rural areas Under insured country Health insurance an ill understood subject
Policy Holders
HEALTHCARE PROVIDER
Insurance Company
Need for a variety of products Clarity in policy terms, conditions, exclusions Need for Services Cashless, toll free nos., quick response Curtailment of Costs
CONCERNS IN HEALTH
Patient Care / Safety Patient Rights / Service Quality Costs
Technology / Specialization Prescription Drugs Medical Inflation Moral Hazard / Adverse Selection Usage Increase New treatments Unnecessary treatments
Policy condition problems Customer Ignorance Pre-Existing Condition Issues Disputes with hospitals / insured Delays
Lack of Infrastructure There are no holidays in Health care yet offices not open on holidays, telephone access unavailable, etc No qualified doctor / staff Delay in settlement Deduction in bills without basis Increased paperwork
IRDA Initiatives - Data Management & Warehousing - Standalone Health Insurance Cos. - Policy innovation / removal of customer difficulties - Regulation/guidelines - Third Party Administrators
Focus on rural / micro insurance Dialogue between Providers, Insurers, TPAs. Increase in numbers & premiums Working with Government
INSURER INTERVENTION
a) Managed Care Gate keeping Second Opinions Case Management Care Review Cost Negotiation
b)
Sublimits - Capping Amount per procedure Deductibles Co payment Restricted Covers High Premium rates Rejections
GOVERNMENT STEWARDSHIP CREATING HOLISTIC LINKAGES MICRO-INSURANCE SCHEMES FOR THE POOR MONITORING COSTS SUBSIDY AND TAXATION INCENTIVES
CONCLUSIONS
Creating awareness & meeting the demand for health care & financing Creating modules for aligning the services of all concerned Focusing on enhancing affordability & reducing costs Rapid coverage and health benefit to all
Thank You