Bangalore Insurance Knowledge Foundation organised the National Seminar on Health Insurance on 11th October at NIMHANS Convention Centre, Bangalore. The theme of the summit “Setting World Class Service Standards in Health Insurance” was in keeping with the latest industry requirement and aptly captured the mood of the speakers and the audience. While welcoming the distinguished speakers and participants, Mr. P.C. James of Bangalore Insurance knowledge foundation emphasized upon the importance of affordable health care and insurance. He urged the healthcare providers, insurance companies and service providers assembled at the summit to discuss and suggest ways to establishing world class service standards in health insurance. He also stressed on the importance of changing regulatory laws keeping with the requirement of the time. He talked about the huge expectations that the customers have from the industry, rued the existing deficiency in the services delivered and felt the immediate need for service redesign and up gradation.

From left to right K. Sanath Kumar, Dr. B S Srinath, R Chandrasekaran, Dr. Madan S Gaekwad, Dr. Usha Manjunath, P Venugopal

In his Keynote address, Mr.K. Sanath Kumar, the Chairman cum Managing Director, National Insurance Co. Ltd., maintained categorically that health insurance would grow at more than 20% CAGR in the next five year. “The growth would be mainly driven by retail business and various government health insurance schemes in days to come. The general insurance penetration would for the first time reach the coveted 1% mark vis-a-vis GDP thanks to the initiatives of Fashal Bima Yojana. The RSBY experience was very rewarding and the use of smart card revolutionized the health insurance scenario in India. The other government schemes added layer to it.  The entire health insurance ecosystem faces major challenges from adverse selection and moral hazards. Possibly technology can be harnessed to address the above two issues. Every stakeholder is sitting on huge data base but unfortunately they work in silos. The time has come to integrate the data available, thereby, facilitating robust statistical analysis like predictive data analysis to serve the industry in a much better manner.” he added. In his special address, Mr.R. Chandrasekaran, Secretary General of General Insurance Council felt that the recent explosion of health insurance was people’s realization of the need to opt for voluntary health insurance. He stressed on the importance of technology linkup and cashless claim for the growth of health insurance sector in India. He also maintained that the mandate of the GIC Council was to foster better management practices in every sphere of insurance business. ROHINI data base would be the harbinger of many good practices in days to come. He urged each hospital to join the ROHINI Network. In his special address, Dr B.S. Srinath, Managing Trustee Sri Shankara Cancer Foundation, enlightened the audience about the reservations that doctors had with regard to health insurance. He was of the view that the delivery of healthcare was a complex issue and therefore needed specific interventions. He, however, lamented at the same breadth that health insurance mainly served the elite and educated people who can afford health insurance. He stated categorically that the government was responsible to provide health insurance to people particularly living in rural areas. “Health policies should be designed in a sensible way so that people can access it. Hospitals would not cooperate if policies are not framed sensibly. There is more need for day-care and OPD interventions -thus reducing the increasing load on hospitals. Concentrate your efforts on small hospitals and don’t get bulldozed by bigger hospitals.” He cautioned the audience. He signed off by stating that the time has come to negotiate with pharmaceutical companies to bring down the MRP costs of medicines. Dr. Madan S.Gaekwad, Private Hospitals and Nursing Homes Association beautifully explained   the transition of healthcare from prescriptive to promotive, then to participatory and finally devolving to present predictive stage. The session 1 comprising impressive panel members in  Mr. Soumya Mukherjee, General Manager, Oriental Insurance Company ltd., Mr. Anurag Rastogi, Member of Executive Management and Head Retail UW & Claims, HDFC ERGO General Insurance co. Ltd.,Mr. John Pulinthanam, Director & General Manager, National Insurance company Ltd and  Mr. D.V.S.Ramesh , General Manager (Health) ,IRDAI . The session moderated by Mr. M.Ramaprasad, ex member, IRDAI discussed Health Insurance Service Initiatives for the Future. Mr.M.Ramaprasad started the panel discussion by giving a vivid picture of health insurance scenario in India. He mentioned that the general insurance market, particularly the health insurance in India has been growing at a rapid rate.  Mr. Soumya Mukherjee felt that the knowledge transfer to the intermediaries should be done by the providers so that they can provide the requisite information to the customers, thereby, building trusts within the community.  He also highlighted the importance of universal health insurance coverage similar to United Kingdom leading to higher penetration and in the process reducing the healthcare cost by reaping the benefit of economies of scale. He felt that the central government RSBY scheme was a precursor   to universal health insurance approach. “Customers in India are not rational and, therefore, universal health coverage should be made compulsory”. He reiterated. Mr. D.V.S. Ramesh felt that customers today had wide choices as they were getting products with varying features. Mr.Anurag Rastogi felt that the pricing of group insurance had gone haywire in India. “The cross subsidisation between group and retail has been hampering the growth of health insurance”. He added. Mr. John Pulinthanam felt that regulator should make people aware about the various regulatory initiatives. The Session:2- discussed the role of hospitals in enhancing the insurance experience . Moderated by Dr. Madan S.Gaekwad, the panel discussion threw up plenty of takeaways. The panel felt that all reimbursement claims should be settled within 7 days by initially paying at least 80% of the admissible amount and remaining may be paid after obtaining additional documents, clarifications, and resolving disputes, if any. PPN rates must be revised in tandem with inflation rates.PPN rates should be ideally fixed on the technology investment and sophistication and not based on the size or the hospitality quotient of the hospital or Metro/non-metro criteria. The panel also felt that PPN enrolment must be made within a fixed time limit and rates revised regularly in tune with rising costs. Mr.P.C.James, and Dr.B.G.Muralidhara,Chairman & Chief of Cardiology ,Trinity Hospital and Heart Foundation participated in the above panel discussion. The session:3-saw panel Speakers debated at length  about TPA service excellence paradigms. Mr. H.S.N. Rao of Bangalore  insurance Education Foundation moderated the session. The Session:4  on  Regulatory  roadmap for service  excellence was very absorbing . Mr R. Chandrasekaran moderated the session beautifully by his probing and incisive interventions. Dr. Alexander Thomas, President, Association of Healthcare Providers of India, explained  in detail about the accreditation standards – a quality journey started way back in 2006 with the lunch of NABH. NABH aims at standardising the quality of care delivered across the country. Dr.Thomas also mentioned that NABH had modified the stringent accreditation standards by introducing the Pre-accreditation limit, progressive level standards and certification to encourage more hospitals to join the quality journey. Mr.Kunnel Prem, CEO, Insurance Information Bureau, elucidated the importance of data analysis in health insurance. He reiterated that IIB would not only be a repository of data but would provide data for analysis particularly predictive analysis that can immensely help the insurance industry. Prof(Dr.) Abhijit K.Chattoraj ,Professor and Chairperson, Centre For Insurance &Risk Management –Birla Institute of Management Technology(BIMTECH) in his summation note felt that the boundary of health care needed to be first determined  for setting world class service standards in health insurance. ‘Health insurance at the moment is heavily centred on curative care. The above trend needs to be altered. Healthcare needs to be focussed around Primary care.’ He added.

Book Release of Mr P C James on Health Insurance

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