India is majorly reliant on private healthcare systems when it comes to the medical needs of the patient. Around 58% of hospitals in India are privately owned and around 81% of the doctors are there who serve at these hospitals. This leaves a very narrow space for people who are unable to afford medical services at a private hospital. Around 63% of Indians pay from their pockets when they've got admitted into hospitals or for any healthcare treatment.

Dr. S. Prakash is the Managing Director of Star Health Insurance in India. India's first stand-alone healthcare insurance company in India with over 14 thousand and more network hospitals, also has got a widespread presence across the world with around 850 branches. They offer right from cashless treatment benefits to hospitalization expenditures also medical check-ups, critical illnesses, and Ayurveda treatment.

Currently, India spends 1.15% of the gross domestic product (GDP) on health, which remains one of the lowest in the world. Healthcare cost is not like before, there are more private hospitals now. The cost of healthcare has risen up with the latest advanced treatments. Now even advanced treatments for deadly diseases are available with advancements in Science. But the sad reality is over 80% of health financing is private, much of which is out-of-pocket payments and not by any prepayment schemes. High out-of-pocket costs make health services inaccessible to a significant proportion of Indian households. These out-of-pocket expenses of patients include diagnostic expenses and hospitalization costs. Thus, health insurance is the need of the hour.

Health Insurance Definition

Health insurance can be defined as insurance for future medical or surgical expenditures. In simple terms, it is a contract where an individual or group of people purchase, in advance, health coverage by paying a fee called the “premium.” Based on the type of insurance plan, usually, the insured person is either required to pay for the health expenses from his/her pocket, which is then reimbursed by the insurance company, or the expenses are directly borne by the insurance provider who pays it to the service provider (the so-called cashless facility).

As of 2017, only 44% of the 1.3 billion people in India have a health insurance policy, according to data. As a consequence, a large proportion of the country's population has to bear healthcare expenditures from their own pocket. In the near future, health insurance has to spread in a very rapid way in order to cover the entire population.

Awareness and Affordability of Health Insurance

Particularly after the pandemic, people have understood the importance of health insurance. People are now aware of the benefits of having health insurance.

Firstly, people should have adequate health insurance coverage. For an individual, it may be 5 lakhs but for the entire family, the minimum should be 10 lakhs. Secondly, people should find these health insurance policies affordable because they are buying for protection, they are not suffering from any medical ailments. People are buying health insurance policies for future health problems. People want insurance policies with minimum premiums. And to meet this demand, Star Health Insurance is trying to come up with exclusive products to extend support to this segment (the middle-class segment) of people. As insurance awareness is increasing, it should be made affordable too. Policies should be such that people can switch over to other policies with higher beneficial packages as per their pocket.

After the pandemic, there has been a growing demand for health insurance among people. Around 1.5 lakh people opted for life cover in 2020, and the same number rose to more than 4 lakhs in 2021. The number of health covers sold also got doubled between 2020 and 2021.  People have realized that their hard-earned money, their fixed deposits, and their savings will wipe away with one diagnosis of any health ailment if they don’t have insurance.

Star Health networks 

On being asked about the network, Dr. Prakash says, “The majority of the popular and big hospitals are in a network with Star Health. People are buying health insurance for major life-threatening health problems and these are better treated at big Multispeciality hospitals. Of these majorly are in tie-up with Star Health. For emergencies, in case they are going to any non-network hospital, after getting first aid, they can be shifted to network hospitals for further treatment.”

Star Health pays more than 80% of the amount to the network hospital and cashless system.

USPs of Star Health Insurance

• Star Health Insurance is the first company to have 820 + branches in all parts of the country.

• It is the first insurance company that offers solutions for people living with the disease. There are products for heart patients or cancer patients.

• They offer insurance coverage for newborn babies from day 1 after birth.

• They have insurance for infertility treatment, pain management, and rehabilitation services.

They have a wide range of products that covers diseases, affordable premiums, and experts, and the doctor to examine the claims. These doctors at the insurance company verify the whole process of treatment, and their opinions can be considered second opinions. This way the treatment plan is double-checked.

Insurance for Mental health

A patient suffering from mental ailments should be treated like any other ailment and should not be stigmatized.  Common mental disorders like anxiety and depression to complex ones like schizophrenia are a huge burden affecting 13-14% of the overall population. Despite the availability of effective care for these disorders, mental health patients take around 6 months to seek medical help or to accept the truth that they need help. These mental health patients are not willing to disclose that they have mental disorders due to the stigma attached to them. The majority of mental health care needs only outpatient care and insurance is primarily focused on inpatient care. However, Insurance companies are willing to cover mental illnesses. Normalizing the topic of mental health issues and inclusion of psychiatric disorders under the ambit of insurance would contribute towards reducing the treatment gap. 

OPD Insurance coverage

Outpatient coverage is very popular across the globe. Star Outpatient Care Insurance policy is proposed to pay for the outpatient consultation, diagnosis, and treatment expenses incurred at any Network Facility in India. Star Health has a network of practicing doctors and ties up with 2000+ diagnostic centers and pharmacies. They are designing a strong platform for OPD patients where they can consult doctors with a card-based system, get their tests done and pharmacies will supply drugs to their houses. Star Health is trying to build this digital mission which will essentially help people to buy the out-patient cover and get benefitted out of it.

While talking about ABDM, Dr. Prakash emphasizes, “It can prevent a lot of medical errors. It gives lots of confidence to the patient and doctors can make decisions for the right treatment plan.”

Group Health Insurance

Group Health Insurance provides coverage to a specific group of people such as employees of a company (which includes family members) or members of an organization. Also known as corporate health insurance, is popular in major corporates and groups but not in small or medium enterprises. Thus, the awareness regarding this has to penetrate more in small and medium enterprises. Group health insurance also promotes wellness which further reduces the chances of health complications in employees. Irrespective of the advantages of group health insurance, it is always better to also have an individual policy with private insurance. So, even if the employee changes his job, he has his individual health insurance policy. If the medical expenses are higher, two policies can easily take care of it.

The health insurance policy should be adequate and should cover all family members which include spouses, children, and parents.

Importance of having health insurance

Dr. Prakash concludes, “According to data, 7 crore families are pushed into poverty because of health expenses. Medical advancements have found treatments for major diseases also. For example, if you spend 20-25 lakhs on heart disease treatment, you can come back to normal life.  With a multimodality approach, even cancer can be managed but all this requires huge money. And health insurance is a one-stop solution to this. Health insurance is collateral security for all your savings.”

(Edited by Renu Gupta)