CII Communique - October, 2010

cover storyG. Srinivasan, K Sujatha Rao, Secretary - Health, Ministry of Health and Family Welfare; Manvi Dhillon, Resident Editor, NDTV, A Vaidheesh;Bhavdeep Singh, CEO, Fortis Hospitals Ltd.; Antony Jacob, CEO, Apollo Munich Health Insurance Co. Ltd.; and Dr. David Muiry,MD (Life & Health), Swiss Re Services Ltd, Londonfor the retail segment.In the session on ‘Social Insurance Schemes’ a detailedpresentation was made by the Session Chairman, Mr.Jerry La Forgia, Lead Health Specialist, The World Bank.Mr. G. Kumar Niak, Chief Executive Officer, VajpayeeArogyashri, Karnataka emphasized the need to strengthenthe public health system. He observed that sustainabilitycan be maintained with reworking prices.On Day 2, the Session on ‘Reforming group healthinsurance’ discussed group cover pricing and other bestpractices. Mr. G Srinivasan, Chairman and ManagingDirector, The United India Insurance Company Ltd, whochaired the session, pointed out that health Insuranceaccounts for 22% of total general insurance (Rs. 8,300crores) in India. Almost 50% of health insurance is ingroup business and there has been about 40% growthin health insurance premiums this year, he added.Mr. Krishnan Ramachandaran, Chief Operating Officer,ApolloMunich Health Insurance Company Ltd. made anelaborate presentation on the Group Pricing documentprepared by the CII Working Groups.The session on ‘Increasing Confidence in HealthInsurance’ looked at mechanisms to strengthen theinteraction between individual insurers and consumers,highlighting consumer building measures, standardaccountability, iformation sharing and robust redressalsystem. Mr. M Ramadoss, Chairman and ManagingDirector, The New India Assurance Company Ltd. chairedthe session.The highlight of the day was the ‘Discussion on CashlessIssue’, chaired by Mr. Vaidheesh. Mr. Ramadoss, and Mr.Srinivasan, participated from the PSU companies, whilethe provider side was represented by Dr. Naresh Trehan,Mr. Shivinder Mohan Singh, Managing Director, FortisHealthcare Ltd and Dr. Pervez Ahmed, Chief ExecutiveOfficer and Managing Director, Max Hospitals.It may be recalled that the cashless medical facility wassuspended by four PSU insurers—New India Assurance,United India Insurance, National Insurance and OrientalInsurance—from 1 July, after they alleged over-billing bycertain private hospitals. Dr. Trehan felt there should bestandardisation of rates for all hospitals. He noted thatthe occupancy rates at hospitals have not been adverselyaffected by the withdrawal of cashless treatment facilityby the PSUs but “it is the patients who are suffering.” Mr.Singh observed that “This is the opportunity to do theright thing. Most of the people don’t take insurance to goto nursing homes.” The hospitals have given us their ownversion of rates based on which we are working towardsarriving at a uniform rate structure, said Mr. Ramadoss.Categorisation of hospitals was suggested on the basison infrastructure facilities and other parameters, whichwould eventually lead to higher premiums for treatmentin super-specialty medical centers.The session on ‘Role of Enablers’ discussed the role ofvarious industry enablers ranging from data publicationsto transactional platforms to standards and legislativepolicies. Mr A. Reddy, Managing Director, FHPL, whowas Chaired the session, opined that IRDA is thebiggest enabler to promote health insurance. Mr. SheerajDeshpande of Future Generali General Insurance Co.Ltd, expressed concern that there was no penalty incase of fraudulent claims or malpractice by providers,apart from rejecting the claim. He wanted accountabilityfor every stakeholder.Summarizing the key outcomes in the concluding sessionon ‘The Way Forward’, Mr. Vaidheesh stated that theindustry had taken the following significant steps: from the General and Life Insurance Councils to health insurance dataMs. Sujatha Rao, Secretary Health, Ministry of Health andFamily Welfare, felt that costs of care in the industry weretoo high. She also wanted standards to be incorporatedin the industry, and public hospitals to be improved,while hoping that public insurance companies wouldcontinue to keep the insurance premium low, to beaffordable for the poor.16 | October 2010 Communiqué