Overview

Global insurers revealed, More than
75% of medical spending in India, 
out-of-pocket. One of the leading reasons is, of course, low penetration
of health insurance in India. Only 15% of the population holds some form of
health insurance and but 40% of hospitalized are pushed below the poverty
benchmark line or into life-long debt due to lack of financial planning. Also,
primary care or outpatient services and preventive care, whose requirement and
frequency of occurrence are much higher, is still not covered by most mediclaim
cover or health insurance policy. So, even those keeping insurance health
policy, a patient has to pay from own pocket for such expenses.

Dependency

The medical inflation sustaining in
double-digits as yet and 70-80% dependence on private hospitals. Moreover,
unregulated and variable pricing system, even the yearly small - ticket
expenditures such as minor treatments and check-ups can be a financial worry
for many. While some of the insurers such as ICICI Lombard and Apollo Munich
have introduced out-patient, or OPD but with its insurance policy only. There
is a retail product in the OPD segment is being offered by Root India
Healthcare on its website. That would provide specifically cover expenses
related to treatment or medicine cost.

What is the
Option

Whatever is available comes
packaged with a health indemnity scheme and is either too costly or have too
many sub-limits and conditions. Wherein, Root
India OPD care plans are very much affordable with very fewer terms and
conditions. 

Although Insurers react that is
because the market is still struggling with basic health need and has not yet
developed for secondary coverage like OPD. So, they haven’t thought about this
area yet. Also, the present system doesn’t fall in favor of such a product to
become a viable business for them.

What is
hurdle for Insurers

Insurers add that not thinking
small billing practice since they are working on basic health insurance
coverage instead of OPD. Our focus shall always be our Mediclaim Plans.
According to K K Mishra, CEO, TATA AIG GIC, " it is also the primary
option of the customer. If you do not have basic mediclaim, there is no point
think about an OPD cover,”

Sudhir Sarnobat, Managing Director and CEO at Medimanage
Insurance Broking company, aggress with Mishra that OPD expenses are
uncatastrophic in nature and However, this is not a compulsory cover at this
stage in India where basic hospitalization cover perception is so low. “Our
resolutions should be focused to spread that basic cover more than creating
variants which do not come under ‘catastrophic loss’ category,” he told.

What is the
fear behind?

Also, one of the greatest challenges in covering OPD
treatments under health insurance lies in the operational section of it.

“Insurance companies see it hard to
administer the high possibility of overuse or misuse. The insurers will be more
convenient in covering such treatment once the primary healthcare system in
India reaches more organized. Once that appears, companies can even bargain
with the clinic chains to offer rebates to customers.

However, insurers might insist that
the treatment should be performed at only clinics or medicines must be
purchased only from their affiliated network on the panel or they may restrict
it to 4 doctors’ visits in the year,” remarks by Sevantika Bhandari, Director
(Marketing) at Max Bupa Health Insurance Company.

Why not
Feasible

Also, there is a lack of actual
data pool on OPD treatments. Even the protocols and procedures under OPD are
yet to be standardized. This means the insurers think it difficult to
underwrite and price this kind of products, the primary understanding of why
OPD is a costly product. Initiatives like Electronic Health Records are
measures towards making the sector more organized and transparent.

“Product costing is dependent on
data as well as experience, both of which are short at this stage. Also, the
primary health care system in India needs to be more structured to insurers for
OPD covers to be priced competitively,” says Mishra.

Conclusion

Currently, there is only an option where patients are not getting any restrictions regarding to choose the doctor or from where they have to buy the medicine. Undoubtedly, that's Root India Health Care company. It is an innovative and unique health option for primary care. Very less condition to follow. Why someone chooses it for their primary care. There is the following reason to describe it well:

This plan is not insurances product. No medical check-up required No waiting period just buy and you are coveredAll critical disease and pre-existing coverBest part it covers maternity expensePrior appointment intimation no longer requiredSubmit soft-copy of bills on email or provided a link.

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