Health Insurance. Dr Sanjay Arya

Transcription

1 Health Insurance Dr Sanjay Arya

2 Definition A contract where individual or group purchase in advance health coverage by paying a fee called premium. Also defined as, including all financial arrangements where consumers can avoid or reduce their expenditures at the time of use of the services. (RameshBhat,DaleepMavalankar)

3 Why Health Insurance?

4 Basic Figures (GDP-related) Country Total Health expenditure as% GDP Public expenditure as % of the total health expenditures Covered insurance expenditures as % of the total health expenditures Out of pocket expenditures as % of the total health expenditures India 5.2% 13% 2.4% 84.6% Singapore 3.1% 35.8% % UK 5.6% 96.9% % Germany 10.5% 77.5% 11.3% 11.2% USA 13.7% 44.1% 39.3% 16.6% Source : WHO/2000

5 Status of health care Financing Out of total health spending : 87% - Private financing 13% - Public financing 15% Centre (.9% of GDP) 85% State

6 Bare facts Average cost of hospitalization : 58% of annual income 40% of hospitalized sell asset or borrow heavily 25% fall below poverty line after spell of hospitalization

7 Private vs Public sector 1978 : 70% bed in public sector 1998 : 80% bed in private sector 60% OPD private sector 60% Indoor public sector

8 Expenditure on care is 2-5 more in private sector Over years, for each % increase in per capita income, private health expenditure has increased by 1.47% Government run set up free, so people did not demand quality and better access & people turned to private set up.

9 Why Health Insurance? Government has difficulty in cost recovery. Government unable to provide more resources. WTO agreement forced govt. to open up health insurance

10 Healthcare Services Growth Healthcare services expected CAGR of 11 to 13%

11 % of payment from pvt voluntary insurance Financing models in select Countries 100 Switzerland USA Policy Choices Meet demand for prepaid care by: - A- Allowing growth of pvt voluntary insurance B- State assumption of responsibility 50 A Alternative directions B Switzerland Thailand Mexico France Sweden INDIA % of payment from social insurance or public finance

12 Expected Benefits An alternative means of health care financing. Expected to bring capital into health sector Expected to improve access.

13 Private Health Insurance

14 Pre -requisites Capacity to pay premium Network of credible service provider Tight regulatory framework

15 How Are We Placed? In India, only 315 million people (35%) are insurable with capacity to spend Rs. 1000/- premium per annum. 70% population : Rural Lack of Health care providers in rural areas.

16 Current Status Total Health Expenditure : 3 Lakh crore Hospitalization Cost : 1 Lakh crore Health Insurance Premium : 6,000 crore

17 Current Status Health insurance coverage of urban population is higher Claim ratio/pay out > 100% Health care spending of population with insurance is thrice that of population without insurance

18 Regulatory Framework? Skimping: Insurers deny benefits to the sick by having several exclusion clauses. Skimming: Practice of insuring well off people.

19 Adverse Effects Adverse Selection: The sick seek a coverage and the healthy does not. Moral hazards: Behaviour of the insured is effected by insurance.

20 Result All adverse effects are visible None of the stated benefits are visible. Impact of liberalization so far : Escalation of cost

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23 What Is The Way Out?

24 Insurance is not an intuitive concept for most people. D. Kehneman & A.Tversky have shown that: People tend to accept large uncertain risk in order to avoid small sure losses and Underestimate low probability event as if probability was zero.

25 How to overcome this Barrier? Some countries have overcome this misconception by implementing universal health insurance cover.

26 Micro health finance Options for Government Government pays premium Government make scheme for middle class with subsidy to poor Affiliating health insurance to employment status

27 Employer based insurance : 20 million with reimbursement Employer provide care : 30 million Community Health Insurance (CHI) - A form of micro finance : 5 million

28 Micro Health Insurance Works on the principle of the reduction or elimination of the uncertain risk of loss for the individual or household By combining a larger number of similarly exposed individuals or households who are included in common fund That makes good the loss caused to any one member (ILO )

29 Community Health Insurance A voluntary, non-profit insurance scheme formed on the basis of solidarity Collective pooling of health risks Members participate effectively in its management and functioning

30 Provision of tailor made health insurance product involving low premium and modest benefits Resource mobilization from targeted population Intermediary agency to over come informational disadvantages and high transaction costs

31 Social Insurance Compulsory participation. Contributions from employers and employees. Contributions proportional to the earnings of the employees.

32 Social Insurance Coverage is without a means test. Scale of medical benefit is not related to contribution.

33 Epilogue Health insurance is not merely private Insurance. Many developing countries have reaped the benefits of the concept. The concept has great possibilities for our country.

34 One of the greatest investments which we can make is to invest in health, for there is no other investment like it.. Health is life insurance, success and happiness insurance. Mahatama Gandhi

35 Thank you