Risk Management in Health Insurance – The Way Forward
Managing risk in health care and health insurance plays a seminal role in protecting the interest of policyholder, distribution and of course companies itself. People cannot predict the timing and health care expenses required during treatment and hospitalisation including cost of operation for which they buy health policy preferably cashless health policy which is meant for saviour to them during the time of crisis. Major risk is borne by of course the company where they undertake the risk of payment to the policyholder in case of any eventualities happens in rare case they repudiate the claim on the ground of pre-existing disease, suppression of facts or any other clauses which is duly mentioned in the policy schedule as exclusion clause. It is imperative that in the health care or health insurance organisation it should have qualified risk managers to identify, assess, develop, implement and monitor the risk management process within the well-defined spectrum of minimizing the risk exposure keeping in mind safety, patient care and mostly management of finance and image of the company since goodwill of the health insurance, its business and presence in the market depends how fast they settle the claim within the stipulated time frame. Market is fiercely competitive and every health insurance company is vying each other to take away other’s pie and share of market so companies are highly concentrating on claim management which involves legal tangle also since people are becoming more and more knowledgeable and they know how to get the claim through Ombudsman, Consumer Court, IRDAI and other legal accessories which companies are usually averse of getting into. It has direct bearing on market goodwill and certainly sales get affected. The Role of Risk Managers
- Identify risk in system or potential risk
- Analyse and evaluate risk in systematic manner
- Develop a well defined approach of risk management
- Implement the system in place
- Monitor the system ineffective manner
- Compare, be suggestive and receptive to any new innovative ideas
- Involve the employee, salespeople, even agents, experts to reduce and balancing risk
- Assimilate and integrate different departments to develop a full proof mechanism.
- Integrate the sales management process and the managers involve with the claim management process
- Educate and train the people time to time the whole gamut of system so that every people rather all the department run in tandem and align every one into one objective that is reduction of cost and better profitability not harming the patient’s interest and maintaining goodwill.
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