1. HEALTH INSURANCE HEALTH INSURANCE --INDIAN EXPERIENCE

2. PRESENTATION PLAN PRESENTATION PLAN INTRODUCTION HEALTH INSURANCE MARKET PRIOR TO LIBERALISATION HEALTH INSURANCE MARKET IN THE LIBERALISED MARKET LAW AND REGULATIONS ISSUES AND CONCERNS INITITATIVES OF FEW STAKEHOLDERS WAY FORWARD

3. INTRODUCTION PROVIDING QUALITY HEALTHCARE—A CONCERN GOVERNMENT ROLE IN HEALTH CARE HEALTH CARE FINANCING – INSURANCE AS AN OPTION

4. HEALTH INSURANCE MARKET PRIOR TO LIBERALISATION PRE-NATIONALISATION : Hospitalisation and Sickness Insurance POST NATIONALISATION: Prior to 1986 1986: Introduction of Mediclaim

5. HEALTH INSURANCE IN THE LIBERALISED MARKET Growth in Health Insurance premium Product Development Customer Service Market share

6. LAW AND REGULATIONS ‘Health Insurance’ defined Priority in licensing Other relevant regulations: IRDA Protection of policyholders interests, 2002 IRDA Advertisements and Disclosures Regulations, 2002 IRDA Third Party Administrators- Health Services Regulations, 2001 File & Use procedure

7. HEALTH INSURANCE: ISSUES AND CONCERNS ADVERSE SELECTION HIGH PAY OUTS PROVIDER MALPRACTICES ISSUES RELATING TO THIRD PARTY ADMINISTRATORS LACK OF INTEREST –BY INSURERS

8. INITIATIVES INITIATIVES PRIVATE INSURERS KEEN TO DEVELOP HEALTH INCE: PORTFOLIO DEVELOPED NEW PRODUCTS INCREASED THEIR MARKET SHARE LIFE INSURERS HAVE SHOWN INCREASED INTEREST

9. INITIATIVES …contd INITIATIVES …contd INTRODUCTION OF GOVT. FUNDED HEALTH INSURANCE FOR POOR STATE GOVTS. INTRODUCING SCHEMES FOR POOR IN PANCHAYAT ANDVILLAGE LEVELS INCREASED GOVT. SPENDING TO STRENGTHEN PRIMARY HEALTHCARE FACILITY IN SELECTED STATES. PRELIMINARY STUDY BEING HELD FOR EVOLVING HEATH INSURANCE SCHEME FOR URBAN AND RURAL POOR.

10. INITIATIVES …contd INITIATIVES …contd MORE TPAs LICENSED AND EXISTING TPAs STRENGTHENED THEIR OPERATIONS EMERGENCE OF COMMUNITY AND GROUP INSURANCE INVOLVEMENT OF NGOs AND MICRO FINANCE INSTITUTIONS

11. INITIATIVES…contd, INITIATIVES…contd, CONSTITUTION OF WORKING GROUP ON HEALTH INSURANCE BY IRDA DATA SUB – GROUP SUB-COMMITTEES: 1) Sub-group for Health Insurance data 2) Sub-group on Product Innovations in Health Insurance ( including arriving at a common acceptable definition of ‘Pre-existing diseases’) 3) Registration of Stand-Alone Health Insurers

12. RECOMMENDATIONS OF SUB- COMMITTEES Sub-group on Health Insurance Data 1)Collection of existing data 2)Collection of future data in standardized formats 3)Training of personnel in ICD 10 coding Sub-group on Product Innovation ( & definition of pre- existing disease Sub-group on Product Innovation ( & definition of pre- existing disease) Distinction made between pre-existing disease and condition and common definitions recommended Medical Savings Accounts recommended Creation of a pool for covering senior citizens Committee to study insurance cover for common man in rural area

13. RECOMMENDATIONS OF SUB-COMMITTEES…contd, Sub-group on registration of stand-alone Health Insurers 1) Minimum Required Capital of Rs.50 Crores recommended 2) Foreign Direct Investment of 51% suggested 3) Adoption of Risk Based Capital proposed 4) Besides health, it was recommended that companies be allowed to write Personal Accident and Travel Insurance

14. WAY FORWARD Insurers to – collect correct data,develop new products price properly, improve u/w and claims management Explore possibilities of setting up pure health insurance company with JV partners Insurers TPAs Data Warehouse to have common IT framework to facilitate easy data transfer Govt. to evolve National health scheme for common man in urban and rural area and Sr.citizen and terminally ill

15. WAY FORWARD….contd, Support health Insurance scheme for population below poverty line. Foster Public – private partnership Providers to to be more disciplined, bring standardization, accreditation etc Govt. to regulate the healthcare providers IRDA to set up data warehouse Implement other recommendations of the sub - group including

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