Only 27% Indians are covered by health insurance

Only 27% Indians are covered by health insurance

Urgent need to widen access to quality healthcare and insurance

New Delhi, 19 December 2017: As per a recent report, only 27% of Indians have health insurance coverage. The Indian healthcare sector is largely under penetrated with government expenditure constituting approximately 1.4% of the country’s GDP. The private sector expenditure constitutes 70% of the total healthcare expenditure. Of this, about 62% is out of pocket and only 8% is covered through pre-financed instruments.

There is a significant gap in the coverage offered by current products and the need for a comprehensive ecosystem of financed healthcare. Healthcare costs are increasing by the day primarily due to lifestyle diseases. The only way to bridge the gap between rising healthcare costs and affordability is through developing a sustainable and viable mechanism in the insurance sector.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Health insurance is essential not just for the physical health of a family but also for their financial well-being. It enables access to appropriate health care while reducing the impact of an untoward health event on a family's earning and payment capacity. Out-of-pocket expenses today account for nearly twice as much as institutional expenses. Thus, there is a need for an all-inclusive solution towards healthcare in the Indian market. The need of the hour is a centralized health savings scheme managed by a government-nominated body or privately managed by insurers with centralized fund management. This will ensure availability of funds for accessing healthcare services to more people, which will further go a long way in realizing the goal of providing healthcare to all.”

As per the Indian constitution, Article 14 and 21, health is the fundamental right of every Indian citizen. Under the Directive Principles of State Policy, the state governments are entrusted with the responsibility of ensuring good health of their people. It is the state government’s responsibility to look after emergencies and primordial prevention.

Adding further, Dr Aggarwal, said, “Quality always comes at a price. Quality treatment is costlier but in the long-term, it is economical as it is associated with fewer hospital-acquired infections, complications, adverse drug reactions, re-hospitalization, as well as fewer system failures. Quality is always preferred but it may not always be feasible because quality care may increase the cost of treatment. This necessitates the need for insurance.”

Every hospital or health care establishment must try to improve and maximize quality within the resources that are available to them and with the best use of those resources. Poor quality service indicates poor utilization of resources. Both quality and affordability need to be balanced, especially in a country like ours, which has one of the highest out of expenditures on health in the world. 

IMA supports insurance for death due to mosquito bite

IMA supports insurance for death due to mosquito bite Recommends an all-encompassing effort from the community as a whole to address this issue New Delhi, 15 May 2017: According to the South Delhi Municipal Corporation, 79 cases of chikungunya and 24 cases of dengue have been reported in Delhi just three months since 1 January 2017. Of these, 11 patients acquired the infection from neighboring states. It is a fact that we have collectively failed last year in controlling the mosquito menace and consequently, the mosquito menace is back this year. There is a need to over report and act in time and not only when the cases start appearing. Failure to act can be attributed collectively to Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the private sector. It is time that last year's failure is converted into success this year. Speaking on this issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "The mosquito menace requires a community approach which involves every component of the society. Every premise must display that it is mosquito-free. When you are invited to somebody’s place, you should ask 'I hope your premises are mosquito-free' and when you invite somebody, write 'Welcome to my house and it is mosquito-free. This should become a routine in a premises. Just like we do not clean our premises once in a week, it is important to look for and clean the breeding places daily." The fact that mosquito bites are a serious issue has been reiterated via a recent judgement by the National Consumer Disputes Redressal Commission (NCDRC) which ruled that the wife of a man who died due to a mosquito bite was eligible for claiming insurance. The commission ruled that 'It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act of omission on part of the victim'. It further said that death caused by mosquito bite is an accident, and directed the insurer to honor its policy to the widow. Adding further, Dr Aggarwal, said, "The need of the hour is a paradigm shift in the approach towards the dengue menace. We need to follow the formula of 20 to identify dengue fever: if there is a rise in pulse by 20; there is fall in upper blood pressure by 20; if there is a rise in hematocrit by 20%; there is a rapid fall in platelets to less than 20,000 with a rapid rise in hematocrit by 20%; if there is a petechial count of more than 20 in one inch after tourniquet test and a difference of less than 20 between the upper and lower blood pressure, then such patients should be given at least 20 ml of fluid per kg immediately followed by continuous fluids till they pass urine. This is one of the most immediate steps to combat the condition." IMA recommends the following approach to target the mosquito menace: Ghar ke ander maro aur ghar ke bahar maro; din me maro, sham me maro aur raat me maro; deewaron ke niche maro aur deewaron ke upar maro; chote pani ki collection me aur bade pani ke collection me maro; eggs ko maro, larve ko maro, pupa ko maro aur mosquito ko maro; chath me maro, kamre me maro, veranda me maro; container me pani ke niche maro aur container me pani ke upar maro, aedes ko maro, culex ko maro aur anopheles ko maro.

IMA committed to improving insurance policy in India

IMA committed to improving insurance policy in India Calls for stringent examination at the time of joining an insurance policy, among other suggestions New Delhi, April 15, 2017: The IMA (Indian Medical Association) organized an Insurance Workshop along with the Hospital Board of India for deliberations on Improving Insurance Policy in the country. It came out with many suggestions for the Insurance Regulatory and Development Authority (IRDA) and has written to them for the changes. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, " One of the main reasons for the low penetration and coverage of health insurance in India is the lack of competition in the sector. There is also a need to include more stringent measures at the time of a person joining an insurance policy. Once the policy is issued, no claim should be rejected on any account whatsoever. Currently, insurance policies are issued upon declaration by the patient. This can lead to errors as the most of the time; the patient may not possess the requisite medical knowledge. This workshop was organized with a view to addressing these and many other policy changes needed at various levels." It was concluded that in most settings, it was mandatory to provide treatment during hospitalization to claim insurance. However, this should not be mandatory. IMA's policy and the international approach today is to say no to intravenous and intramuscular drugs and focus on shifting intravenous drugs to oral route. It is also a strange fact that a doctor cannot treat his relation himself when it is true that they can provide the best treatment to them out of their own specialty. The MCI also mandates that a doctor should consider waiving of charges of other colleagues and according to the IMA policy, a doctor cannot charge his/her near relations any consultation fee. Dr Aggarwal also said, "Issuing a bill for surgery should be made mandatory irrespective of whether a person is under Mediclaim or not. There is a need to create awareness at every level and one of the first steps towards this is to print the insurance. We also believe that there should be a concept of monthly insurance. Here, an employer will pay insurance of the employees and the government will pay the insurance of all those who cannot afford it." It was also noted that the TPA has the tendency to cancel a cashless claim if the investigations do not reveal any diagnosis. Denied claims are not in the interest of a community policy. Another point that came out was the agreement on deployment of Ayush doctors to judge the claim of modern medicine. Not only will this open new avenues for medicine but also encourage people to adopt alternative modes of treatment.