Health Insurance In India Research Articles

Private Health Insurance in India

Health care in India is severely underfunded and neither the Government nor the common citizen has the financial ability to pay for quality medical care. Given this situation, private health insurance should have a wide acceptance in the market and play a significant role in meeting the health care funding shortfalls. But in reality, the sector has been mired in restrictive regulations and outdated business models and continues to operate under losses, in an unsustainable mode. Consequently, the health insurance industry needs to relook their business models and evaluate emerging concepts in health care that can help correct the imbalance and help the industry operate in an effective manner. Some of the models which the health insurers need to evaluate are the managed care model, integrated model and the accountable care model (ACM). These models will help the health insurers address the core issues of health care costs and quality management and help the sector respond to the industry challenges. Although, these models have been in use in other countries, Indian health insurers need to factor in the local con-text and ensure that models work effectively for all stake holders and successfully meet the country’s health care challenges.

Health Insurance in India—A Study of Provider’s Perceptions in Delhi & the NCR

This study examines the Indian health insurance market by empirically observing the provider’s perceptions and its relationship with the insured, the insurer and the third party administrators (TPAs). The study tries to find out the awareness level among the insured population and their attitude towards treatment cost. It then examines the role of TPAs and the impact of cashless services on the cost of treatment by studying a few cost drivers. Apart from studying the provider’s per-ceptions it also tries to look at some of the evidence of moral hazards and that of fraudulent activity. The findings suggest that the awareness level regarding policy terms and condition is low among the insured population and most of them do not care for the cost of treatment. The providers increase their rates quite frequently and prefer the middle income group for extending cashless benefits. The TPA model has not been successful in bringing down the claim cost but has helped in providing unbiased services including cashless benefits. The price structure of healthcare services are linked to the room rent category and most of the insured patients, who are more demanding, prefer staying in higher category rooms. The concept of cost-sharing by the insured will help tackle this issue to some degree. The Indian health insurance market is not immune from supply-side moral hazards and fraudulent activities and there is a need to craft different strategies to tackle them. There exists an opportunity for the insurance companies to build long-term relationships with the preferred healthcare providers by using technology and by understanding each other’s roles in serving the common client.

Health Insurance in India: Is it the Way Forward?

In India, despite the rhetoric of a publicly provided health care at affordable cost for all, an overwhelming 75% of the health care needs is serviced by the private sector. Moreover - owing to the low levels of government financing in health coupled with a lack of risk pooling mechanisms, out of pocket expenses is the predominant mode of financing. Thus the poor are largely unprotected from the risk of bankruptcy arising out of catastrophic illnesses. In fact the National Sample Survey founds that expenditure during bouts of illnesses that require hospitalization is the second major cause of people lapsing into poverty.This paper examines the case for insurance financing of health care in India.We find that in view of the fiscal constraints for government to provide universal access to free/low cost health care, insurance can be an important means of mobilizing resources, providing risk protection and perhaps, improved health outcomes. However for such an effort to be successful, it must be accompanied by appropriate systemic reforms.

Ethical questions regarding health insurance in India

Improved health and healthcare are of vital concern to the welfare of Indian society. The nascent health insurance system of the country is experiencing an explosive expansion and various models of health insurance provision are under trial by different agencies. Since the country has been relatively late in introducing health insurance, it can study the effects of different systems of healthcare and insurance and develop a system of health coverage which addresses the unique social character of our country as well as the ethical questions of comprehensiveness and inclusion. This article seeks to explore these issues in detail.

Health insurance in India: the need to come together for a common good

Health insurance in India: the need to come together for a common good

ORAL HEALTH INSURANCE IN INDIA

Comprehensive Dental Insurance in India is non-existent entity Dental insurance is one of the major areas of medical insurance in the western world. Almost all the developed countries in the western hemisphere have a substantial population of their covered under the scheme of dental insurance. As a part of the medical coverage, dental insurance in India though is yet to be widespread. However, in keeping with the increasing awareness of the need for dental insurance and coverage, the process has started. More and more people today are opting for insurance in India. Similarly, new and new policies are being framed by the medical insurance companies in India who offer the policy of dental insurance also.

P.R. Sodani and S. Sharma. What poor need in benefit package in health insurance in India? Journal of Insurance & Risk Management, 2009; VII(14): 13–20

<b>P.R. Sodani and S. Sharma</b>. What poor need in benefit package in health insurance in India? <i>Journal of Insurance &amp; Risk Management</i>, 2009; VII(14): 13–20

Health Insurance Market Penetration in India - An Analysis

This paper is an overview of health Insurance in India, its stake holders, distribution channels and penetration levels; an observation on further requirements of data sets and items for future research and a statistical trend analysis with projected indicative alarming situation.

Health Insurance in India: A Review

Health Insurance in India: A Review

The landscape of community health insurance in India: An overview based on 10 case studies

The Indian health system is mainly funded by out-of-pocket payments. More than 80% of health care expenditure is borne by individual households. Only about 3% of the population, mostly those in the formal sector, benefit from some form of health insurance. Several Indian Non-Governmental Organisations (NGOs) have initiated Community Health Insurance (CHI) schemes within their existing development programmes. This article describes the principal features of the design and functioning of a selection of 10 CHI schemes and presents a brief overview of the current landscape of CHI in India. The schemes explicitly target the poorest and most vulnerable households in Indian society—scheduled tribes, scheduled castes and poor women. Three CHI management models can be distinguished. The first model consists of local NGOs acting as both insurer and provider. In the second model, the NGO is the insurer but does not itself provide care, which is then purchased from a private provider. In the third model, the NGO neither does provide health care nor acts as an insurer: the NGO, on behalf of a community, links with an insurer and purchases health care from a provider. The benefit packages generally include both primary and secondary care and most of the providers are in the private sector. Most of the schemes require external resources for financial sustainability. There is currently little information on the impact of CHI schemes on the performance of local health systems and more research is warranted in that respect.

Ellis, R.P., M. Alam and I. Gupta. Health insurance in India: Prognosis and prospectus, Economic and Political Weekly, 2000, 35(4), 207-17

Ellis, R.P., M. Alam and I. Gupta. Health insurance in India: Prognosis and prospectus, Economic and Political Weekly, 2000, 35(4), 207-17

Private initiatives and policy options: recent health system experience in India

In the recent past the impact of structural adjustment in the Indian health care sector has been felt in the reduction in central grants to States for public health and disease control programmes. This falling share of central grants has had a more pronounced impact on the poorer states, which have found it more difficult to raise local resources to compensate for this loss of revenue. With the continued pace of reforms, the likelihood of increasing State expenditure on the health care sector is limited in the future. As a result, a number of notable trends are appearing in the Indian health care sector. These include an increasing investment by non-resident Indians (NRIs) in the hospital industry, leading to a spurt in corporatization in the States of their original domicile and an increasing participation by multinational companies in diagnostics aiming to capture the potential of the Indian health insurance market. The policy responses to these private initiatives are reflected in measures comprising strategies to attract private sector participation and management inputs into primary health care centres (PHCs), privatization or semi-privatization of public health facilities such as non-clinical services in public hospitals, innovating ways to finance public health facilities through non-budgetary measures, and tax incentives by the State governments to encourage private sector investment in the health sector. Bearing in mind the vital importance of such market forces and policy responses in shaping the future health care scenario in India, this paper examines in detail both of these aspects and their implications for the Indian health care sector. The analysis indicates that despite the promising newly emerging atmosphere, there are limits to market forces; appropriate refinement in the role of government should be attempted to avoid undesirable consequences of rising costs, increasing inequity and consumer exploitation. This may require opening the health insurance market to multinational companies, the proper channelling of tax incentives to set up medical institutions in backward areas, and reinforcing appropriate regulatory mechanisms.

Development Of Health Insurance In India

Development Of Health Insurance In India

Pessimism in Planning, Social Insurance Planning in India and Health Insurance in India

Pessimism in Planning, Social Insurance Planning in India and Health Insurance in India