Around 35% Of The Population Is Covered Through Some Form Of Insurance: A Vaidheesh, President, OPPI

At the Ayushman Bharat Healthcare Summit organized by BW Businessworld and India Virtual Hospital, various stalwarts of the healthcare industry gathered in New Delhi to discuss the various aspects of the healthcare industry and healthcare provision, and to bring together various stakeholders and decision-makers of the Ayushman Bharat scheme. At the event, there was a session on ‘Insurance: The Game Changer’, moderated by Dr Sanjiv Malik, Chairman, Mediworld Group India and Prism Ventures, UK, Former National President of Indian Medical Association and Member, World Medical Assembly of World Medical Association.

“There have been cases of misuse of RSPY cards. I think it was excellently ideated, the RSPY scheme. Talking of the bottom of the pyramid, it is important to reach the last man and the last mile. But how do you get the doctor and hospital there? Knowing the paucity of doctors and paramedics, how do we address the problem? The scheme is ambitious. We all should give our views to the government, honestly, practically and based on experience. When we talk of insurance, whenever we have to plan of anything, we should plan to put aside some money for health issues. Health insurance as it exists in the country today is a minuscule percentage of coverage. The PPP model comes in and takes over district hospitals but there are challenges and an acute shortage of manpower. Doing an institutional delivery, is it primary healthcare? If you have a roadside accident, should the primary healthcare take care of it? We need to give our thoughts honestly and boldly to give a roadmap of the government“, said Malik.

A Vaidheesh, President, Organization of Pharmaceutical Producers of India, said, “We all need to be proud of the fact as a country. We generally tend to look at the negative side, but we have done a few things well. 1945, when we gained independence, the longevity of an average Indian was 46, but now it’s 67. Today if you really ask me from a healthcare perspective, India is doing a fantastic job. People do not die of stomach ulcers anymore, and not even heart attacks. As a country, we have progressed. We need to appreciate the ecosystem which has made it possible. Private players have also made a lot of contribution. I spent some time in the health insurance industry in 2006. The premium was then 3000 crores, and it’s going to touch 40,000 crores. More people have money to pay their medical bills through insurance. Around 35% of the population is covered through some form of insurance. India is very uniquely positioned in terms of the healthcare system where 60% of the healthcare is being given by private players. Acute care is being managed by the government very well. The biggest advantage which India has is the billion population. When you have a large population, you are able to underwrite the health risk better than other countries. By pooling the risk, healthy people are paying for unhealthy people. The challenge is going to be the availability of healthcare delivery. There has to be an incentive for places where there is no doctor available. I didn’t expect a meeting 8 or 9 years back about a national insurance plan, but I am glad to see it is happening”.

“Insurance is going to be a game changer, provided the following things are being followed. As when a vehicle is going to be insured, insurance coverage at the birth should be the policy. Every citizen should be insured. Primary and secondary care are the doorsteps. All the hospitals and service providers, they are at the doorsteps of the beneficiaries. We should cover all the clinics and the organizations to give care to the beneficiaries. The tertiary care has to be given by the tertiary care centres. They should only contribute to the tertiary care. We should focus on the shift of the outflow of the peripheral care to the primary and secondary care providers. The government to service provide a model should be the preferred. We can save 30-40% of the budget which could be concentrated. The strict monitoring of the service providers is a must. The people who are really in the need of the service are not being provided. A proper grievance redressal system with major service providers and organizations like IMA should be there. Subsidies should also be provided in this sector. Income tax exemption for the Ayushman Bharat Scheme or any health insurance scheme will also provide incentives. Selective empanelment may lead to bribery“, said Dr A K Ravikumar, National Coordinator (Insurance), Indian Medical Association.

Vivek Srivastava, Co-founder and CEO, Healthcare atHOME, said, “We have a hospital at home kind of service, so delivering from primary to tertiary at home. We also work with pharmaceutical companies to create awareness, diagnostics, collecting outcomes and so on. Ayushman Bharat is a great scheme as it tries to cover the last man, the poorest of the poor. Home care turns out to be cheaper than hospital care. So that becomes one solution in the overall scheme of things because even if we try hard, we can’t have enough capital expenditure to serve the last mile. We need to have programs which are technology enabled, so we can prevent hospitalizations from happening”.

“The consumer and the use of technology are critical to us. Enrolment has to be looked at when looking at insurance in the Aysuhman Bharat scheme. Second is the clean settlement and the third is feasibility which has to be looked at. A quick clean settlement will help create a viable business model for health care providers, and it has to be feasible and viable for the insurance providers as well“, said Dhruv Sarin, Director and Head of Operations, Policybazaar.com.