Health Insurance in India: strategies for synergy among insurers and providers

Abstract

In the last decade several incidents have occurred in the Indian health insurance arena such as: introduction of IRDA, opening of insurance market for the private players, growth in health insurance premium, de-tariffication, introduction of TPAs, introduction of cashless hospitalization benefits, increase in health insurance claim ratio, introduction of standalone health insurance companies, launch of innovative health insurance products, increase in health insurance premium , increase in healthcare cost, minor improvements in the health indicators at the country level, increase in the number of cases going to insurance ombudsman and recently the stopping of cashless facility by the PSU insurers. Looking at the current state of the health insurance industry, it seems that it s not going in the right direction. There are few baby steps and efforts made by the regulators and the industry bodies that would have a positive impact on the growth of the industry. But all these steps and efforts cannot be successful without bringing in synergy among the two most important and critical players in the whole game of health insurance i.e. the insurers and providers. Health insurance industry is like an orchestra where there are multiples players (stakeholders) and if they don t play in coordination they would not be able to create music (value) for the audience (insured customers and community at large). The ultimate aim of this thesis was to develop strategies for synergy at different levels that could be implemented by insurers, providers and other stakeholders and also to develop indicators to measure them. The current study contributes significant enhancements to the current framework for developing strategy for synergy among insurers and providers; which is not only required for the healthy growth of the Indian health insurance sector but also for the benefits of the community at large. The objectives of this research were derived from the existing problems and gaps in the literature.