Insurance Companies will negotiate with hospitals to cut back costs of surgical packages. The 4 PSU non -life companies, General Insurance Corporation, Life Insurance Corporation are promoting TPA's (third party administrator) to start in October 2013.
Today the Health Insurance market is worth about Rs.13000 crores and minus the government program; the state owned share is about Rs.7000 crores. The annual growth is 20% and the spending is mainly in cities - this gives the insurers the power to bargain.
Advertisement"We feel that this will go a long way in ensuring that not only customers get good service, it will also help us negotiate with hospitals and control claims cost by putting in systems to check claim amounts. Although claims ratio has come down, it continues to be high," said G Srinivasan, chairman, New India Assurance. He also felt that prices rose by 10% every year, irrespective to advance in technology or procedure which was moot. This put pressure on premium rates.
Of the 4 companies under GIPSA (General Insurance Public Sector Association) forum, National Insurance is the biggest.
Segar Sampathkumar, General Manager, New India Assurance - felt that it would be impractical to bargain for individual expenses - they were looking for "package rates" for surgical procedures. "At the initial stage, we will be looking at surgical packages. We can look at the procedures only when clinical protocols are in place in India," said Segar.
Private Insurance companies support the bargaining strategy without joining hands with the PSU's.
"It is possible to negotiate and bring down the costs with providers, based on volumes, as approved package rates for major surgeries etc," said Ravinder M, national head (rural, accident & health), Tata AIG General Insurance. "Our experience has been that some of the providers are open for such approved package rates," he added.
According to Sampathkumar "The single biggest item on the total claims paid out by insurance companies is for cataract operations, followed by coronary bypass." For cataract operation the cost could vary a lot since for those covered by Rashtriya Swasth Bhima Yojana it may cost just Rs. 3500/ whereas in hospitals it could cost Rs. 7000/ - 8000/ for the lens.
Srinivasan feels that the TPA needs to have a technology platform that can fulfill the requirement of the insurers, plus the disparity among the health care providers.
"Certification of hospitals is still very basic. Hospitals do not provide any indicators of quality such as success or infection rate," said Sampathkumar. The insurers are not too optimistic about high class tertiary care in hospitals which are overcrowded.
At the same time with increase in corporate hospitals and sufficient number of doctors in attendance they expect to bring down costs.
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