- The two years of pandemic-related challenges encountered by Indian citizens must have been one harrowing experience for the majority of us. The non-existent healthcare infrastructure coupled with inadequate medical resources during the initial days of the virus spread only further exacerbated the challenges for the common man. The imposition of strict lockdowns did allow adequate time for the Union Government authorities to come out with measures to spruce up the healthcare infrastructure to a great extent. But the same was still not enough was brutally exposed during the ravaging second wave in April-June 2021 leaving several thousand dead for want of basic medical attention like drugs, beds, oxygen, and ambulances.
PC: Henry Asson
- Yet another aspect that stood out in the melee was the inadequacy of health insurance coverage denying thousands their rightful recourse to buffer the existential challenges. The economic downturn for the country as a whole and its citizens need no further elaboration. However, the way insurers attempted to wriggle out of the most challenging times failing to extend much-needed succour to the insured was a damning indictment of how regulators failed us. Needless to mention, the reforms in the insurance sector are long overdue and the regulators goaded by the Union Government must step in now. An aspirational society like India cannot let its citizens down when a basic amenity like insurance coverage is crying for reforms.
- Recently, a district consumer commission in Gujarat ordered an insurer to pay a health insurance policy with interest to a customer after it had denied the claim by saying the claimant’s vegetarian diet caused the underlying complication. This is just one example of the many tricks insurers employ to resist paying up, a particularly severe problem in health insurance. It’s no surprise therefore that even if about 515 million people were covered by health insurance policies in 2020-21, India’s out-of-pocket expenditure of around 55% of total health expenditure is shockingly more than the global average of 18%. Indeed, health insurance in India is characterized by multiple exclusions and co-payments.
PC: ET Now
- Further, the feeling of being short-changed is worsened by the claims process, which is often handled by third-party administrators. While GOI and states are collectively the largest buyers of health insurance policies for their group schemes, a substantial number of people remain outside their scope. They remain vulnerable to health emergencies in the absence of a first-rate insurance system. The main problems with health insurance are its tilt to covering only hospitalization, wide-ranging exclusions, and caps on coverage of hospital bills. This was visible during the pandemic as insurers failed many insured in their hour of need. Thus, the IRDAI should find a way to nudge the industry to enhance the quality of insurance policies forthwith.
