Growth of Health Insurance in Pakistan by fxw33739

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									Growth of Health Insurance in Pakistan



        Rukhsar Ahmed
        General Manager and
            Project Director
           Health Insurance
 National Insurance Companyy Limited
    Contents
 Introduction
 What is Health Insurance
 Main Players
 Frustration and problems from TPA
 Proposed Medical Care Unit
 Monitoring
 Justification and audit
 Proposed Health Card
 Network Hospital
INTRODUCTION
 Health insurance is an emerging
 important financial tool in meeting
 health care needs of a common
 person in Pakistan
WHAT IS HEALTH INSURANCE?
      SYSTEM OF ASSURANCE TO MAKE CONTINGENCIES
       OF HEALTH CARE EXPENSES.

      TO PROVIDE PROTECTION AGAINST FINANCIAL LOSS
       BY UNFORSEEN SICKNESS.

      TO MEET COST OF GOOD MEDICAL CARE.

      RELIEVES ANXIETY AND TENSION.
An Indian Study
   Only 10% Indians have some form of health
    insurance, mostly inadequate
   Hospitalized Indians spend 58% of their total
    annual expenditure on health care
   Over 40% of hospitalized Indians borrow heavily
    or sell assets to cover expenses
   Over 25% of hospitalized Indians fall below
    poverty line because of hospital expenses
 Main Players

The health insurance market can be characterized by three main
players which are closely associated with each other. These are:

        The insured person and policyholder / patient
        The insurance company
        The medical provider (hospital, doctor, Lab, etc.)
   FRUSTRATIONS IN THE
        SECTOR
           Cashless Treatment
Policy
                                 Third Party
Holders
                                Administrator




             HEALTHCARE
              PROVIDER




              Insurance
               Company
PROBLEMS FROM TPAs
 Lack of Infrastructure
 “There are no holidays in Health care” yet
    offices not open on holidays, telephone access
    unavailable, etc
   No qualified doctor
   Delay in settlement
   Increased paperwork
   Extra load on policy holders.
Proposed Medical Care Unit
 A medical unit with dedicated doctors to
  support the health care delivery system at
  NICL.

 MCU can help enhance the quality of without
  increasing the cost. The medical services
  managers who are registered physicians they
  will carry out Integrated Healthcare activities.
CYCLE OF COSTS & CARE




         Claims           Premium

                  CARE



                  Costs
Medical Care Unit Monitoring

Licensing
Certification
Rating
Standardization
COSTS TO BE JUSTIFIED BY

 Clinical Audits
 Clinical Effectiveness Establishment of
  Standards
 Protocols
 Guidelines
 Medical Audits
 Clinical Governance
Proposed ‘Health Card’

A personalized insurance health card to provide
  the complete peace of mind. It features all of
  health insurance details, family information
  and emergency phone numbers. This card
  entitles to get the best possible treatment
  and rates which INSURANCE COMPANIES
  have arranged in network hospitals!
Network Hospitals
Insurance Companies will develop a network of
  hospitals that meet the quality criteria. We
  credential their doctors, i.e., we make sure
  that only qualified and experienced
  doctors/surgeons treat our policy holders. Our
  staff doctors will appointed as „Case
  Managers‟ who will take of welfare and
  healthcare whilst policy holder in one of our
  network hospitals.
Customer Servicing Unit

 Policy condition problems
 Customer Ignorance
 Pre-Existing Condition Issues
 Disputes with hospitals / insured
Market
 The prospected market of Health Insurance
  will be:

 Corporate/Group Health Insurance


 Micro Health Insurance
Micro Health Insurance
 It will provided to any common man of
  Pakistan with affordable/low premium for
  essential coverage.
Future prospects ?
Case Study
 An Australian Experience
Health industry growth has been high in Australia

 $8.1 billion dollar increase in last year
 Real health expenditure growth in last 10
  years of 69% –- 5.3% per year.
 Real GDP growth - 3.7% per year.
Hospitals are a very important sector

 7 million admitted patients in 2004-05
 36% increase in last 9 years in admitted
  patients
 2 million non admitted patient occasions of
  service
 $29 billion expenditure
Medicare medical services

 113 million services in 1984-85
 236 million services in 2004-05
 109% increase
 65 million GP services in 1984-85
 98 million GP services in 2004-05
 51% increase
Issues
 1. Product Development
 2. Marketing and Sales
 3. Build a network Hospital
 4. Issue the Health Card
 5. Underwriting the Product
 6. Arrangement of Re-insurance
 7. Monitoring the results
Thank you

								
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