Sunday, September 14, 2008

Who killed health care" is a good reading

I have come across a book "Who killed health care" by Regina Herzlinger .Regina is a Professor in Harvard Business School and has covered various aspects of health care as well as health insurance industry in that country (USA).It is good to know that India is mentioned at various places in this book ,where health care of good level at a fraction of USA costs is possible.

If you are connected with Health Care,Insurance,Health Insurance industry then this book is a must for you.I forsee many things which had happened in USA will happen in India also over a period of time.

It is time for us to take corrective steps itself so that health care of poor people is not affected in the time to come .I know many poor people of Karol Bagh ,New Delhi who used to get treatment in Jessa Ram Hospital courtesy great Bhatia Family ,who were the trustees of this hospital.This hospital provided health care to Karol Bagh residents at practically no cost or fraction of the cost.Then this hospital became a part of leading hospital chain.Rates have gone up to market level.People remember Bhatia family.Hundreds of Bhatia's are needed to set up hospitals for those who are below the poverty line.

Regina has predicted that more and more US citizens will travel to India & Thailand for treatment.I wish beds are not made available to these foreigners at cost of Indian patients.It is time to add more and more hospitals ,medical collleges,nursing colleges in India.If the hospitality industry plans for hotel rooms and starts working towards the same we should also have a plan to add large number of hospital beds in next 5 years or 10 years.

West Bengal Govt is very liberal in attracting investment

West Bengal Govt is very liberal in attracting investment as they gave incentives to Tata Motors for Nano Project;
Land 645 acres or so for lease of Rs 1 crore /year
Electricity @ Rs 3 per kwh
Loan of Rs 200 crores @ interest rate of 1%

Now that Private sector is permitted to set up Medical Colleges can we expect the same benefit from West Bengal Govt .If yes they can attract 5 Medical Colleges in teh state and these can help the state with following;
More Doctors
Better health care
Medical Tourism
More jobs for people

Other states can also take the lead.Decision taken in 2008 will be appreciated by the masses when the fruits will be reaped.

Health Policies of Life insurance co's collectRs 100 crores

We have the first data available on the health insurance policies premium collected by Life insurance co's and this figure is Rs 100 crores.This figure is small but we know that these products were introduced by most of insurance co's during this year only.

We are familiar with inflation figure which is released by govenment agencies from time to time .First figure which has become available for inflation in health care is 17%.This means that if you wish to maintain the coverage of your health care then at the time of policy renewal you should increase it by 20%.That makes sense.

In the event of no claim being made during the year the cumulative bonus of 5% increase being given by your insurance co is not at all sufficient.Choice is yours.

Wednesday, September 10, 2008

TPA's to expand in Tier 2 cities

According to a report of Financial Chronicle September 08, 2008 TPA's will be growing in Tier 2cities as more and more people are being insured in these cities.Till recently were having on an average service network of about 10-15 branches in the country, most of which being in state capitals. In contrast, the general insurance companies, which control nearly the entire health insurance product portfolio, are present in an average of 400 locations. This huge disparity requires TPAs to aggressively expand their operations to meet the needs of the burgeoning health insurance market, industry experts believe. Besides, implementation of various government-sponsored health insurance schemes such as RSBY (Rashtriya Swashthya Bima Yojana) demands enhancement of service administration capabilities from TPAs. One of the larger TPA players, MediAssist, is planning a major expansion in tier-ii cities, both in terms of number of centres and employees, and is also looking to service various government-sponsored health insurance schemes.Let us hope that expansion does not result in deterioration of the service level.
Labels: Service level, TPA's to expand in Tier 2 cities

One should not try to be smart with Insurance company...

One should not try to smart with Insurance company One should not try to smart with an Insurance company Ekta Elreja has come out with an interesting investigating story in 'Metro Now'' about how a smart person has been trying to cheat Insurance company with false claims.The story in brief is ;For those of us blessed with perfect health, taking out a health insurance policy seems like giving away money. Akash Sharma is one man who decided that it was time to make the insurance companies pay. Using different names, he swindled the ICICI Lombard General Insurance Company to the tune of several lakhs of rupees before being found out and arrested.But the icing on the cake of this fraud was that not only did he take out policies under different names, he also created a fictitious hospital to manufacture the papers required for a mediclaim. Imagine the shock of the vigilance official from ICICI Lombard who went to track down a Sympathy Hospital in Indira Puram in Ghaziabad (UP) only to find a three-storey house in its place.Akash’s scam was almost perfect. He had it all planned down to the last letterhead for 'Sympathy Hospital’ and the ‘pathology reports’ to buttress his claims. What he failed to account for was the vigilance checks carried out by the insurance company.“Initially we never suspected anything because the amount in the claims was always under Rs 50000. Had he made a big claim, he would have been put through greater checks and would have been required to submit more document. Between January and June of this spokesperson for ICICI Lombard General Insurance said.”Moral of the story is " Do not try to be samrt .You will be caught.Labels: Akash Sharma is caught, Metro Now, Sympathy Hospital
Labels: Akash Sharma is caught, Metro Now, Sympathy Hospital

Tuesday, September 9, 2008

Bench Marking is done for Cataract & Asthma by FICCI

Insurance companies have been worried about the payment they are making to the hospitals for treatment of insured clients.It is a common statement in India that moment hospital comes to know the patient is insured their billing meter starts moving at a higher rate.This point has attracted the attention of FICCI and they have been working on it.

Teena Jain has covered this in an interseting manner in Mint, published from New Delhi.

As health insurers struggle with issues related to inflated billing, the insurance and health committees of industry lobby Federation of Indian Chambers of Commerce and Industry (Ficci) are developing yardsticks to establish minimum standards of treatment and costs for some diseases.
These standards are expected to give some indicative lines to insurers for settling bills with hospitals. The committee has completed its benchmarking for cataract and asthma.
“Once guidelines are developed for all the diseases, it will help insurance companies in pricing their products, settlement of claim disputes and in packaging new kinds of products,” said Jyoti Viz, director of financial sector at FICCI.
When all the standards are available, the Insurance Regulatory and Development Authority will decide whether they should be made mandatory or left to the discretion of the companies, Viz added.
For the last six months, the committee has been developing these standards along with the regulator and the General Insurance Council, or GIC, an umbrella body of general insurers.
A senior official at a public general insurance company said some sort of arrangement with hospitals would be required to control costs through such protocols.
“The benchmarking can be successful only when underwriters commit that they will patronize only hospitals which accept these benchmarks for billing purposes. Apart from this, volumes generated by insurers from health insurance business need to increase manifold,” said Niraj Kumar, general manager of The Oriental Insurance Co. Ltd. “No standard has come to us so far.”
Cases against insurance companies, especially involving the health insurance segment, account for the highest number of cases in consumer courts.
After standards are available, FICCI will run them through medical associations to ensure their accuracy.

My comments on Shobhana Chadha news in Economic Times Sep 7,2008

Shobhana Chadha, has covered an interesting story in September 7, 2008 issue of
The Economic Times on HEALTH INSURANCE

Never let bad choices spoil your future. You surely cannot correct your past mistakes, but definitely secure future by taking right decisions now. Take, for instance, Ramakrishna Pandya who learned from a stumble. The 50-year-old PSU employee, despite covered under a health plan, had to shell out a hefty sum of Rs 2 lakh while undergoing treatment for a bypass surgery in a private hospital.

Pandya’s fault was that he had picked up a health insurance plan which had sub-limits imposed on room rent, doctors’ fee and diagnostics. He could have easily saved himself from such a huge financial loss if he would have opted for a right health insurance policy, which fulfilled his requirements. To make sure that you don’t suffer due to an inadequate cover, here’s an insight into how to select the right medical insurance.

How to choose

First and foremost, insurance experts advise you should make sure that the health policy you opt for provides the right kind of coverage, which is in line with your family history of ailments and professional hazards. It’s a daunting task, keeping in mind that there are a host of health insurance products available in the market that differs widely in coverage and cost.

Says Sanjay Datta, head, health and accident insurance services, ICICI Lombard: “Contact insurance companies call centre or ask your agent to show you policies from several insurers so that you can compare them. Make sure the policy protects you from large medical costs, and beware of single disease insurance policies.” According to Datta, there are some polices that offer protection for only one disease, such as cancer. Thus, if you already have health insurance, your regular plan probably already provides all the coverage you need. Do check for the coverage you have before buying any more insurance.

Must haves

The basic purpose of health insurance, according to health insurers, is to protect you against health problems that impact you financially. “Therefore, your plan must insure you for three major categories — critical illness, hospitalization and surgeries,” says Sitesh Prasad, vice-president, Tata AIG General Insurance. Another thing, points out insurance experts, you should look before buying a health plan is cashless facility, which gives you the freedom of not making any advance cash deposits in case of hospitalization.

Datta believes the cashless facility serves as a boon for those times when you need finance the most. You have to simply use your health ID card at any of insurance providers’ network hospitals to avail of cashless service. “It is important for you to know that all insurance companies do not provide this facility,” says Datta. According to insurance experts, an Rs 1 lakh plan for a 30-year-old that provides coverage for all the three categories (mentioned above) should result in premium of not more than Rs 3,000-5,000 a year.

Scan the riders

For starters, you must remember that not every disease comes under the purview of a health insurance plan. Generally, a health insurance plan covers major diseases or illnesses such as cancer, bypass surgery, myocardial infarction, kidney failure, paralysis and so on. But with a rider — they do not protect from illness/ injury existing before the inception of the policy for the first four years.

Other cases when you can not count on your health insurance are — allopathic treatment, pregnancy and childbirth-related diseases, cosmetic aesthetic and obesity related treatment; expenses arising from HIV or AIDS related diseases, use or misuse of liquor, intoxicating substances or drugs as well as intentional self-injury; any medical expenses incurred during the first 30 days of inception of the policy, except accidents; congenital diseases; war, riot and strike-induced hospitalization.

Further, you should review the room and boarding cost thoroughly before you opt for a plan. Most of the insurance policies cap room and boarding costs at 1% of sum insured a day and at 2% a day for those in an intensive care unit. Thus, when you sign up on the dotted lines, do check if the insurer has assigned a substantial sum for these expenses.

There’s also a chance that your company is providing a health cover under a group plan. Group health insurance is a benefit that companies, private bodies and trusts provide to their employees or a homogeneous group of people and enables them to receive private medical treatment quickly and at low cost. However, what you must make sure is that you are adequately covered under a group plan. If you are not, then you should buy a health policy immediately. Remember, penny wise, pound wise!

Some of the points where I find contradictions are;

Pandya Case: If he is working for a PSU the he is covered under Medical Rules of the company, which are very liberal. Full costs are borne by companies like Indian Oil or NHPC .Even Helicopter evacuation of the employees is covered by NHPC ,if employee
is to be evacuated from a remote dam site to a metro for treatment. Even the best health Insurance policy does not cover Helicopter evacuation .If Pandya had to pay Rs 2 lakhs then it is not because of sub limits but may be because of under insurance i.e. he was not covered for sufficient amount.

Sanjay Dutta suggests contacting Company call centre or agent: If you contact company’s
Call centre they are ready to give their rates /policy details. They do not have competitors data or they don’t want to reveal it. This means that you do not get choice. Same way agent also is handling only 1 company and does not give comparative quote. It is always better to go to site like or consult an Insurance brokerage firm which is handling products of all insurance companies.
Sanjay mentions Rs 3000 to Rs 5000 for a person 30 years old for sum assured of Rs 1 lakh.This is possible for Rs 1400 or even less in case of Reliance General.

Allopathic Treatment: there is no policy which does not permit Allopathic Treatment.
In fact treatments which are not covered are Homeopathy, Naturopathy, and Magneto therapy.
Treatment by Magneto therapy has been accepted in USA. Homeopathy is widely practiced in Germany .We even have Homeopathy colleges and hospitals in India then why we are not covering it under Health Insurance Policy. Is it that we under pressure of
Allopathic lobby? Let us see who makes the beginning.