A standalone OPD health plan will take a long time to execute in India, Revealed by Insurance Companies. Reported & compiled by Swiss-Re.
Overview Global insurers revealed, More than 75% of medical spending in India, out-ofpocket. One of the leading reasons is, of course, low penetration of health insurance in India. Only 15% of the population holds some form of health insurance and but 40% of hospitalized are pushed below the poverty benchmark line or into life-long debt due to lack of financial planning. Also, primary care or outpatient services and preventive care, whose requirement and frequency of occurrence are much higher, is still not covered by most mediclaim cover or health insurance policy. So, even those keeping insurance health policy, a patient has to pay from own pocket for such expenses.
Dependency The medical inflation sustaining in double-digits as yet and 70-80% dependence on private hospitals. Moreover, unregulated and variable pricing system, even the yearly small - ticket expenditures such as minor treatments and check-ups can be a financial worry for many. While some of the insurers such as ICICI Lombard and Apollo Munich have introduced out-patient, or OPD
but with its insurance policy only. There is a retail product in the OPD segment is being offered by Root India Healthcare on its website. That would provide specifically cover expenses related to treatment or medicine cost. What is the Option Whatever is available comes packaged with a health indemnity scheme and is either too costly or have too many sub-limits and conditions. Wherein, Root India OPD care plans are very much affordable with very fewer terms and conditions. Although Insurers react that is because the market is still struggling with basic health need and has not yet developed for secondary coverage like OPD. So, they haven’t thought about this area yet. Also, the present system doesn’t fall in favor of such a product to become a viable business for them.
What is hurdle for Insurers Insurers add that not thinking small billing practice since they are working on basic health insurance coverage instead of OPD. Our focus shall always be our Mediclaim Plans. According to K K Mishra, CEO, TATA AIG GIC, " it is also the primary option of the customer. If you do not have basic mediclaim, there is no point think about an OPD cover,”
Sudhir Sarnobat, Managing Director and CEO at Medimanage Insurance Broking company, aggress with Mishra that OPD expenses are uncatastrophic in nature and However, this is not a compulsory cover at this stage in India where basic hospitalization cover perception is so low. “Our resolutions should be focused to spread that basic cover more than creating variants which do not come under ‘catastrophic loss’ category,” he told.
What is the fear behind? Also, one of the greatest challenges in covering OPD treatments under health insurance lies in the operational section of it.
“Insurance companies see it hard to administer the high possibility of overuse or misuse. The insurers will be more convenient in covering such treatment once the primary healthcare system in India reaches more organized. Once that appears, companies can even bargain with the clinic chains to offer rebates to customers. However, insurers might insist that the treatment should be performed at only clinics or medicines must be purchased only from their affiliated network on the panel or they may restrict it to 4 doctors’ visits in the year,” remarks by Sevantika Bhandari, Director (Marketing) at Max Bupa Health Insurance Company.
Why not Feasible Also, there is a lack of actual data pool on OPD treatments. Even the protocols and procedures under OPD are yet to be standardized. This means the insurers think it difficult to underwrite and price this kind of products, the primary understanding of why OPD is a costly product. Initiatives like Electronic Health Records are measures towards making the sector more organized and transparent.
“Product costing is dependent on data as well as experience, both of which are short at this stage. Also, the primary health care system in India needs to be more structured to insurers for OPD covers to be priced competitively,” says Mishra.
Conclusion Currently, there is only an option where patients are not getting any restrictions regarding to choose the doctor or from where they have to buy the medicine. Undoubtedly that is Root India Health Care company. It is an innovative and unique health option for primary care. Very less condition to
follow. Why someone chooses it for their primary care. There is the following reason to describe it well:
1. This plan is not insurances product. 2. No medical check-up required 3. No waiting period just buy and you are covered 4. All critical disease and pre-existing cover 5. Best part it covers maternity expense 6. Prior appointment intimation no longer required 7. Submit soft-copy of bills on email or provided a link.