Seminar on 'Best Practices in Health Insurance - Strategies & Accountability'

India Infoline News Service | Mumbai |

Treatment meted out to the patient with or without insurance is different when they approach the hospital. Presently, patient has to stay in the hospital for 24 hours to get an Insurance claim that can be settled in a few hours said Sunil Gupta, Director, General Insurance Corporation

The Insurance companies can play a vital role in improvising the current state of Health sector in order to eliminate the difference in the facilities available to elite and poor class. He urged to provide fair and equal treatment to everyone across the country.

 

Treatment meted out to the patient with or without insurance is different when they approach the hospital. Presently, patient has to stay in the hospital for 24 hours to get an Insurance claim that can be settled in a few hours said Sunil Gupta, Director, General Insurance Corporation in a Seminar organized by Health Committee of PHD Chamber on 17th of May at PHD House, Delhi.
 

He recommended the Day Care & pathology tests to be covered in the insurance policy to prevent hospitalization. This indeed will cut off the un-necessary hospital admissions and save the resources.

 

He agreed to the suggestion that inclusion of alternate system of medication such as Ayurveda/ Homeopathy and Naturopathy has to be covered in the insurance policy. The government and insurance companies should work together and there is a need of inflation oriented insurance policy as the expenditure on the health care is increasing every year he added.

 

Dr Kamat mentioned that RSBY (Rashtriya Swasthya Bima Yojna) Scheme is spreading out to cover most of the poor segment of the community.

 

Dr. Praneet Kumar, CEO, B L Kapur Memorial Hospital emphasized on the issues and challenges being faced by the primary stakeholder in settling an insurance claim. The Customer-Provider-Insurance/TPA inter relationship seems to have been changed these days and there is a lack of trust amongst them.

 

The current practice of non standardized processes & Non standard documentation was brought into the attention, which in turn results in substantial delays in issuance of a claim, said Dr. Praneet.

 

Sanjay Seth, Executive Vice President, IFFCO TOKIO General Insurance Co Ltd spoke about Settling of claims and emphasized on the inter-relation between the Business ethics and profitability. He insisted on building up trust with primary stake holders as Customers prefer dealing with the organizations they trust.

 

Access to the insurance policies should be made online and the insurers must have a competitive knowledge of the industry as to let the customer make a rightful choice said S.K. Sethi, Director, Insurance Brokers Association of India.

 

Raunak Jha, Member, Advisory Group on Health Insurance, Institute of Actuaries of Indialaid stress on the role of actuaries in filling the gap between the policy holder and Insurer. Several conflicts like Cost of treatments, data sharing, scope of insurance cover among Policy Holders & Insurance Companies -& Care Providers.

 

Insurer’s business and focus has changed amidst of a high competition where large amounts have replaced large numbers with a higher cost of service and man power and time said

Dr George E Thomas, Associate Professor, College of Insurance, Insurance Institute of India,

 

Dr. Saini, Hony. Secretary General, Indian Medical Association recommended insurance companies to develop products for the poor at reasonable and low premiums. Government spends 0.9% -1% of GDP towards Health sector, where as Private Sector exceeds up to spending 5% of GDP towards the same. That is where Insurance companies should pool in and health care services can be rendered by everyone across the society. Also, special policies for rural population should be made where the cost of medication is low.

 

Some experts participated in the technical session raised following pertinent issues in the seminar:

 

- Need for innovative plans to cover different groups of people exposed to specific risks

 

- Having affordable plans on policies for senior citizens and retired corporate employees

 

- Corporate and Group policies should be allowed to carry forward in case of transition to another company

 

A collective suggestion was made by the panelists and experts to form an advisory board to take up issues and send recommendations to the department of financial services and Delhi government.


 

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