Knowing some of the health insurance facts

Currently, according to a report by professional services firm PricewaterhouseCoopers, there are an estimated 13 million health insurance policies issued. These cover some 450 million Indians. And this number is growing rapidly. According to data sourced from IRDAI, the health insurance market in India collected premiums worth Rs 34,572 crore ($4.7 billion) in 2016-17, registering a 26% year-on-year (YoY) growth. An increase from the 21% YoY growth registered in 2015-16.

Ideal Health Data Characteristics

This should ideally mean that a treasure trove of health data is already present within the current system. Both thanks to check-ups at the time a policy is sold, as well as through subsequent claims. The reality, however, is that neither of these avenues passes muster.

For the former, it only gives insurers limited visibility, as Sai Srinivas points out. Srinivas is the appointed actuary and president of Bajaj Allianz Life Insurance. “The insurer only knows the current health situation of the customer; not the past, not the future,” Srinivas explains.

And while forward visibility is something that should ideally come as claims are filed by policyholders, here, too, there are issues. Most significantly, the fact that only a very basic level of data that can be collected from the current healthcare set-up. According to Rohan Kumar of Toffee Insurance, health insurers are already collecting data on customers whenever a policyholder files for a claim. But this is not personally identifiable data. Collating information through insurance claims only provides a demographic picture, rather than a healthcare portrait of the policyholder.

An additional amount 

To make up for this myopia, insurers have resorted to tacking an additional “loading” amount onto a policyholder’s yearly premium. This helps cover unforeseen losses that may be suffered by an insurer on account of a policyholder suffering from unknown health risks. This is neither fair to policyholders nor foolproof for insurers.

The answer to their problem is a nationwide EHR. The Indian government had previously attempted this when it set out to build the Integrated Health Information Platform (IHIP), a platform that functioned as a repository of health data. However, it needed doctors and clinics to go digital for this, which proved to be difficult.

While the government tried to enforce this by publishing a draft EHR standard, this remains voluntary and has no statutory backing.

“The law does stipulate the health record creation format and the codes and standards applicable within…not many abide by this as it has not been enforced in full force,” says Rohit MA, managing director of Cloud Nine Group of Hospitals.

IHIP is now a distant memory, and in its place, Niti Aayog, the government’s policy think tank, has emerged with the National Health Stack (NHS). NHS seeks to be a “single source of truth for and manage master health data of the nation”. According to Niti Aayog’s strategy and approach document on NHS, NHS aims to have the digital health records for all citizens by the year 2022.

But even as this unfolds at its own pace, stakeholders have already begun taking matters into their own hands. They’re looking to create their own EHRs.

DIY EHRs

This move is spearheaded by online healthcare platforms such as Practo, 1mg, Jio HealthHub, and others. Slowly but surely, they have built up a network of doctors, clinics, and diagnostic labs, allowing them access to patients’ test reports, health history, prescriptions, consultation reports, and the like. A wealth of information that was hitherto untappable because of a lack of digitization.

Insurers, meanwhile, are looking at partnerships with diagnostic chains, fitness centers, yoga centers, and wearables device manufacturers. These, they hope, will give them an insight into the health of policyholders.

For Bajaj Allianz’s Srinivas, an obvious place to start is wearables. “Using wearable devices, if I can get the health status on a regular basis, that can actually help me price the product accurately,” he says. This, he says, is about appropriate pricing. If a customer’s wearable data shows a health improvement over time, she could be eligible for a discount at the time of renewal. If the customer’s health worsens, the premium goes up.

And Bajaj Allianz isn’t alone. Other insurers such as MaxBupa and Aditya Birla Health Insurance are taking similar approaches.

MaxBupa’s digital insurance program GoActive, for example, works with three different companies to build its product. All of these tie-ups aid in creating more holistic profiles of policyholders’ health.

 

Leave a Reply

Your email address will not be published. Required fields are marked *