Preventive care and the flexible options definitely give a patient the best possible chance to have a better quality of life. While it is clear that these modern methods of treatment are indeed beneficial to patients, making them available and covered by insurance is the current challenge, writes Dr Harit Kumar Chaturvedi, Chairman, Max Institute of Cancer Care.
It is estimated that nearly 70 percent of India’s population is covered by some form of health insurance, including state government and social insurance schemes as well as private insurance. This shows 30 percent of the country's population, which is more than 40 crore people, absolutely lacks any form of financial protection for health and are left with no option but to meet unexpected medical expenses out of their pocket.
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And another hard truth is that currently insurance products are geared mostly toward people with higher incomes and that too often do not cover a variety of modern medical treatments. The other salient feature of India's existing health insurance policies is that it come into play only once the patient is already unwell.
What is the change required
In order to make health insurance more beneficial to people and to ensure a much wider coverage, the industry should work with people on preventive healthcare. For instance, getting people screened for some common ailments, subsidised health check-ups or even subsidies on premiums when a patient gets a health check-up regularly. This would not only work to prevent common ailments and catch diseases early in its progression but also benefit the Insurance companies by lowering their pay-outs. It would also help drugs and healthcare providers as they would have a larger patient base.
In terms of treatment of already developed disease conditions, insurance policies must allow patients to choose the best option for a better quality of life, especially those methodologies that offer a plethora of benefits including, quicker recovery, better outcomes and in-turn better quality of life.
These options are more relevant now with the advent of robotic-assisted surgeries that help better precision of the surgery, especially in oncological surgeries, less traumatic tissue dissection that significantly improve surgical outcome, etc. The new surgical options are also a lot safer with a minimum amount of blood loss, and added benefits like faster recovery and shorter hospital stay.
Preventive care and the flexible options definitely give a patient the best possible chance to have a better quality of life. While it is clear that these modern methods of treatment are indeed beneficial to patients, making them available and covered by insurance is the challenge. To that end, the few solutions that could be implemented are:
One way to address this asymmetry between insurers, providers (the hospitals), and patients is for providers of these modern treatment methods to actively collaborate with various stakeholders to capture the value of the treatment modality they are providing.
Cost versus benefits
Additionally, to make these treatment options available to insurers is to first weigh the cost of the treatment, such as robotic-assisted surgeries, and quantify its impact in terms of patient outcomes in a local context. Showing that the pros far out weight the cons of a higher insurance cover.
Connect with payers
Providers and developers of these modern treatment modalities can actively reach out to payers to demonstrate the value of robotic-assisted surgery and address the evidence needed to remove the sub-limits or cap on modern methodologies such as robotic-assisted surgery.
Parallelly, creating awareness at the hospital level about the emerging coverage landscape will help address the access and coverage barriers to innovative modern treatment methods in India.
Changes in government policies
Further, partnering with the government to bring in policies that will help infuse the concept of value-based care for health insurance reimbursement.
Finally, health insurance is a key component in providing the best and latest care to all patients. This is especially true to those who have a serious illness or one that necessitates modern methods of treatment. Therefore, it is plausible to expect that one’s health insurance policy would allow them to get tested for the diseases much early and also to get the best treatment available for the developed diseases.
However, the solution lies in making health insurance policies more patient-centric, so as to open the doors to modern treatment methodologies. While it is clear to see that governing bodies are taking note and making changes to the concerned laws and regulations, it’s time to speed up the process to make universal health coverage a reality at the earliest.
—The author, Dr Harit Kumar Chaturvedi, is Chairman, Max Institute of Cancer Care, New Delhi. The views expressed are personal.
(Edited by : C H Unnikrishnan)
First Published: Mar 18, 2023 12:20 PM IST
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