Novel health insurance plan for low resource countries: Medical Complication Insurance (MCI) based on Sandesh-Triple insurance (S-TI) concept.

Abstract

Medical care is associated with unexpected complications increasing the treatment cost causing financial burden on the patient especially when the patient doesn’t have a health insurance or when the treatment cost exceeds the sum insured limit of a health policy. A novel insurance plan – “Medical Complication Insurance (MCI)” based on a unique Sandesh Triple Insurance (S-TI) concept is described. It is a contract between three parties; Doctor, patient and the insurance company (hence the term ‘triple insurance’) providing coverage solely for the complications arising due to a medical/surgical treatment. A patient attains this policy when a treatment is decided, but before its commencement. The sum insured/premium/treatments covered/types of complications/chances of occurrence of complications/ severity etc. are decided based on mathematical and statistical calculations by the insurance companies after extensive consultations with insurance actuaries and doctors. MCI can be implemented as a sole policy or as addition to a regular health insurance. It can be comprehensively extended to all doctors/hospitals or can be restricted to those with certain credentials. Elderly patients can be included. Its transparent feature decreases the chances of insurance frauds. MCI could undoubtedly become effective scheme especially in the underdeveloped/developing countries which have an enormous market potential as most of its residents do not have a health insurance, when compared to a developed nation where its citizens are insured with unlimited health cover. Also, most medico-legal litigations in these countries commonly happen because of resentment to monetary losses causing a rift between the doctor and the patient. Hence the MCI based on triple insurance concept would benefit the doctor, patient and the insurance company (triple benefit), improves the doctor patient relationship and results in a healthier country.