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Minimizing Cost of Treatment

Healthcare, over the last few years has also become highly commercialized, especially if one looks at the industry from the viewpoint of a common man, who also has to bear the burden of inflation.

Our motto is to provide quality healthcare at a cost that doesn't pinch the pocket. This is possible by minimizing the cost of controllable resources involved in healthcare. MEDISAVE card is the answer to this gamut of problems. The intention is two-fold:

1) In still a belief in all consumer groups that quality healthcare is possible.
2) Take the solution to the last depth of consumer-group and geography.

Transparency in Healthcare

With the advent of modern technology in Healthcare, the cost of treatment has gone up substantially. Additionally, the focus of most organizations has been on the recovery of invested capital and operating expenses of equipments/infrastructure/facilities. As a result, medical services have been priced at a premium, at such levels that can only fit the pockets of the affluent or the higher income middle-class at best.

This serves as a deterrent to the promotion of healthcare as a culture among those who are economically less well-off. This is an unfortunate situation as this class forms the highest percentage of Indian population and hence the challenge is compounded.

Significant energy has been invested in developing health care price and quality information in hopes of engaging consumers to be more active when making health care choices. Although research shows that provider quality can vary greatly, many Indian still rely on friends and family when choosing a physician or hospital.

For public and private players seeking to encourage consumers to use quality information when choosing physicians, hospitals and other providers, a critical first step is to raise consumer awareness of the existence and serious implications of delivery quality gaps.

Hence, until consumers are motivated to use quality information to choose providers, this problem cannot be solved. The main value of public quality reporting will likely be to motivate providers to improve their performance with quality and transparency in Health care.

Health Insurance Awareness

The condition of health insurance in India is dismal. 88% of Indian population does not use health insurance to finance their medical expenditure. These people pay for their medical expenditure from their pocket. Neither banks nor insurance companies are taking any initiative for expanding insurance cover. As an example- the premium funding model for health coverage is very popular in USA & UK.

As a result, many of these uninsured individuals either end up with poor quality healthcare or have to bear financial hardships. The financial stress that is engendered due to rising medical expenses is believed to affect the lifestyle of all family members for years.

Thus, there is significant need to increase the number of insured persons in India. While the features and coverage very across insurers, it should be encouraged that people buy cover to remove future inconveniences of care.

However, in order to achieve this objective, every individual, every Health Facilitator and every health insurance company should play an active role. At the same time, the Government and all the associated bodies should all offer their support in spreading health insurance awareness so that Indian citizens are aware of the right to seek quality healthcare without any financial thought.

The Government should educate people about the rise of medical costs and the importance of these products. Regulators should bring change in the guidelines in the health insurance market to encourage insurance premium funding model. Health insurance providers should design products, according to health needs of target customers and encourage people to buy them. The collective efforts of all these agency will surely bring some improvement.

Claim Control Management

Health Insurance (both retail and Group Health Insurance) is one of the fastest growing sectors in General Insurance and constitutes about one fourth of the total gross premium income for the Companies.

Health insurance is one of the most important upcoming segments in the non-life sector and the business in Health Insurance is only going to increase in the coming years. However, growth in the premium portfolio cannot be at the expense of the bottom line and would make the entire Health Insurance Sector unviable in the long run.

It is, therefore, necessary that a proper mechanism be put in place whereby an appropriate pricing framework for pricing Group Health Insurance is adopted which takes into consideration the following factors:

1) The existing ICR.
2) Management expenses.
3) Medical inflation.
4) Reducing commission structure.
5) Likely increase in the quantum of claims due to ageing of the covered group.
6) Underwriting costs.
7) Claim investigation mechanism.
8) Standard package rate for IPD procedure.
9) Quick approval system.
10) Discount on early payment mode.
11) SLA for controlling ICR.

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