RISE OF HEALTH INSURANCE IN INDIA

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1 RISE OF HEALTH INSURANCE IN INDIA WHAT S S DRIVING YOUR REVOLUTION Healthcare Conference 2007 International Finance Corporation April 20 th, Washington DC

2 Presentation Outline Revisiting The India Story The Context For Health Insurance Past & Present Drivers Of Growth Challenges Opportunities

3 Revisiting The India Story GDP Growth : 8.5 % - 9 % Government Support For Healthcare Demographic Drivers: Burgeoning Middle Class Rising Incomes Need For Healthcare : $ 70 Bn $ 90 bn Opportunity

4 Health Insurance In India - The Context Total Population Of India 1200 Million Middle Income Group Covered Under Private Health Insurance Premium Collection Market Size Estimated 356 Million 17 Million US $ 500 Million ( ) US $ 5 $ 7 Billion

5 Healthcare Financing Overall Healthcare Financing in the country 1.2 billion Total Population (December 2004) (-) 17,000,000 Private medical insurance (Mediclaim) (-) 38,000,000 Employees State Insurance Scheme (-) 40,000,000 Central Govt Health Scheme (CGHS) (-) 7,000,000 Indian Railways (-) 55,000,000 Public Sector Enterprises (-) 50,000,000 Community insurance 986 million Uninsured

6 How It Worked Nationalization Of Insurance Companies 4 Public Sector Insurance Companies Mediclaim Tariff Driven Market Retail Health Insurance Premiums Driven By Market Agreement Group Health Insurance Cross Subsidized / Accommodation Business

7 How It Works Now De-tariffing 1 st January, 2007 Cross Subsidies Is Past Tense New Products Drivers Of Health Insurance Stronger

8 Health Insurance Penetration % Population Y ear

9 Current Status - Revolution In The Making! Growth Of Health Insurance Year Premium (USD Mn) Premium (USD) Prem ium Premium (USD) Year CAGR Over Last 5 Years : Approximately 35 % P.A.

10 Number Of People Covered Lives Covered (Mn) Covered Members (Mn) Lives Covered (Mn) Year

11 What This Means Very High Annual Growth Rates Indicative Of High Demand Increasing significance Of Health Insurance In Insurers Portfolio Mix Expanding Market share of Private Insurers Health insurance projected to be a key growth driver of the non life insurance sector

12 Three Main Learning's 1. High Growth Potential 2. Currently Loss Making 3. Increasing Importance In Overall Business

13 Drivers Of Growth Forced Revolution?? Force Drivers! Government Spend On Healthcare is small Government Spend Of Healthcare In Its 5 Year Plans Rise Of Private Healthcare Public V/S Private Healthcare - 25 % v/s 75 % Private Healthcare is becoming predominant in Urban Areas

14 Drivers Of Growth Forced Revolution?? Changes In Disease Pattern In The Country Costs are high for people in India based on Per Capita Income (Comparison with US Costs) Ageing Population

15 Drivers Of Growth Forced Revolution?? Awareness about need to cover major healthcare expenses Increased exposure through media, most importantly the internet, leading to increase in demand for better medical facilities Cont... Increasing ability to pay Employee Benefits increasingly becoming a retention tool leading to a spurt in demand for health insurance coverage.

16 Challenges Concerns Related To Insurers Providers Regulations

17 Challenges - Insurers Product Market Driven By Single Product Type Sub-Optimal Pricing Oligopoly At Play Portability Continuity / Renewability Pre-existing conditions Low level of awareness - Absolute Terms

18 Challenges - Providers Lack of transparency Over diagnosis Over utilisation Over charging Absence of LOS, surgical/clinical protocols Absence of standardised billing procedures Absence of Regulation and Accreditation Medical inflation

19 Opportunities Penetration & PPP Effects Of Detariffing on price adequacy Demand For New Products Preventive Care, Out-patient coverage, Long Term Care New Regulations!!? Lower Capital Requirement Risk Based Capital /Solvency margin Increased interest of international insurance companies DKV / Munich Re Swiss Re Aetna; Bupa; Cigna

20 Health & Insurance Integrated Consulting Market Research Tends & Analysis Market Entry Strategy Business Planning Employee Benefits Revenue Cycle Management

21 Thank You

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