“In India, you should never take your good fortune and health for granted! If you are unlucky enough to stay in ICU of any of the corporate hospitals, you are a step away from bankruptcy,” a senior healthcare colleague of mine used to say. The statement is a true reflection of the status of insurance cover in India. According to the data available, less than 5% of the Indian population has medical insurance. It’s a stark contrast to the situation in the west where more than 85% of the population is covered under state or private insurance.

This glaring gap is and will be the main impediment for our efforts to extend effective and affordable health care for all in India. There are sweeping changes seen in the field of health care in India and we have seen multiple international health care providers entering our markets lately. Unfortunately, these investments and developments are confined to large corporate hospitals which are beyond the reach of the common man since he does not have the support of medical insurance.

In this changing health care scenario, insurance sector should play a major role in extending their services to as many people in as many customized forms as possible. It is imperative to explore all possibilities to bring the insurance cover for the entire gamut of medical services. For instance, in the current scenario, a person has to stay in a hospital for more than 24 hrs to even get qualified for claiming insurance. There are many ailments and medical issues that can be addressed in OPD with minor procedures. As many hospitals have started using advanced technologies for these procedures and treatments, the cost of these visits also can be prohibitive for many. This is one area insurance sector can give more attention.

In India, there is a large shortage of critical care beds in comparison to the medical beds available in hospitals. This is very taxing for the overall system as many patients who need just nursing supervision tend to occupy the critical care beds, there by denying the access to these for the needy. The recent development of home health care and post hospitalization in-patient facilities can play a major role in ‘de-congesting’ these beds in the hospitals. Currently, insurance doesn’t cover these health care services. Only the conventional hospital stays come under their consideration. Therefore, with the insurance sector bringing post hospitalization inpatient care and home health care under their cover, we could look forward to efficient utilization of our critical spaces. It also makes perfect economic sense for the insurance companies to bring these services under the care cover.

In the current scenario, many critical patients- those who need long-term nursing care, tend to get readmitted to hospitals due to multiple complications associated with unskilled nursing at home. These instances can put a huge load on the insurance outflow as hospital readmissions tend to be expensive each time. If these patients are made to go through a phase of supervised nursing after the main hospital stay, the no of days spent in tertiary care facility could be reduced and so also the readmissions due to later complications. In mature market models, patients are mandated by the insurance providers to spend a stipulated amount of time in a transition care facility after the primary hospital stay. They have indeed found the economic sense in the process and they are following this practice for several years.

To cover our billion-strong population by insurance is a humongous task, to say the least. The best way forward is to address this issue on two fronts. First, to cover as many people as possible under insurance; second, to cover all pre-hospitalization and post-hospitalization medical services under the insurance and not to limit them to ‘conventional’ hospital stay alone.

Dr Harish Kalathil, Director- Operations, SuVitas Holistic Healthcare

Link: https://health.economictimes.indiatimes.com/news/industry/how-insurance-sector-could-strengthen-indias-healthcare-consumer/65685131

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