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.
"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
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.
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.