seminar on micro insurance presented by : apv reddy ceo family health plan ltd. 15 th oct 2005
TRANSCRIPT
Seminar
On
Micro Insurance
Presented by :
APV Reddy
CEO
Family Health Plan Ltd.
15th Oct 2005
Healthcare Spending
Source: Peter Berman 1996
Govt.
Municipalities
Out of pocket
ESI
External Aid
Other sources
Employers
75.2%
20.7%1.4%
1.2%
0.5%
0.5%
0.8%
Over 75% out of pocket payment..…Indicator of potential for Health Insurance
• 2% of APL Indian fall into BPL every year
due to Health care indebtedness- Express Healthcare Management 2004
• Health care expenditure is the second cause for Rural Indebtedness - NCAER
• 24 % of Hospitalized Indian are pushed into indebtedness due to Healthcare expenditure
- World Bank
Traditional Insurance (Mediclaim) 1%
ESIS & CGHS 3%
Railways 1%
Social /Mandatory Insurance 4%
NGO/CBHI (Self funded) 1%
Around 9% population is covered……
How does the Health Insurance Industry looks today
How does the Health Insurance Industry looks today
• ESIS 253 Lakhs
• CGHS 43
• Railways 80
• Defence Employees 66
• Ex Servicemen 75
• Mining & Plantations 40
• State Sponsored Schemes 5
• Employer Reimbursement schemes 140
• Community Based H S 30
• Health Segment of Life Inc 2
• Health Ins PSU 100
• Health Ins Pvt Cos 30
• TOTAL 864
Market place
Indian Population
70% APL30%BPL
Public Hospitals/Trust
Low cost Hospitals
50% lowerMiddle class
40% UpperMiddle class
10% Elite class
Moderate cost,high tech
High cost,high tech, Frills
Economic levels are major drivers in the Health care industry
Rural -73 %
Urban -27 %
So far…… emphasis of organized health
insurance
has been in Urban areas for multiple reasons
Indian Population – Rural Vs Urban
URBAN
270 mn
Above Poverty Line
COVERED
Above Poverty Line
UNCOVERED
Source: Census India
90 mn lives
90 mn lives
MediclaimCGHSESISPSUsState Govt.Defense
BPL
UNCOVERED
90 mn lives
Self EmployedEmployed but not covered
Urban Poor
Urban India- Segmentation
RURAL
730 mn
Above Poverty line
530 mn
Below Poverty Line
200 mn
Organized
360 mn
Unorganized
170 mn
Unorganized
70 mn
Organized
130 mn
Source: Census India
60% ( 430 mn)
Farmers
Rural India - Segmentation
Innovative Product
•Community based products
•Social Insurance
•Coverage for Out-patient
•Integration of Inpatient & Out-patient
What India needs for a achieving a significant Health Insurance coverage
Photo ID Card
Cashless Network
Claims Management
Call Centre
Medical Pre-authorization
TPA
MIS
What India needs for a achieving a significant Health Insurance coverage
Healthcare Spectrum
Preventive care
In-patient care
Out-patient care
Medical
Surgical
All the existing Models cater to the In-patient requirement only
VaccinationCheck-upsHeath camps
Consultation
Pharmacy
Investigations
Suggested Plan
Surgical treatmentRelevant Medical treatment
•Govt has to play a role in social & preventive medicine
•Govt. hospitals capable of handling medical treatment
•Surgical treatments are expensive
•Lack of surgeons in Rural Hospitals
Hence Health Insurance cover for……
Medical Surgical
Number of cases
58% 42%
Expenditure 23% 77%
Co-operative SocietiesBanks/ NABARDCo-operative Banks
Suggested medium
30% rural Indians avail Banking services ( 41.6 million families)
Almost 100 % villages are covered under co-operative fold
67% of rural household are members of Co-operative institutions
7% of the Farmers have Kisan credit card
Over 35,000 branches of 560 banks located in 563 districts in 30
states
Source:NABARD.microfinance.2004
Provider of healthcare services
Govt. Hospitals
Private Hospitals
Nursing Homes
Network of hospitals - both private and government - across the country to facilitate delivery of treatment to the
rural poor at their door step……
Public Private partnership
1600Surgical procedures
Free Outpatient Consultation
Largely Discounted Lab Tests
100 % Cashless treatment
In Top Quality Hospitals
Standard rates at Private Hospitals
Easy AccessUser friendly
Yeshasvini - Features
Registered member of State Co-operative society for minimum 6 months
Dependant family members
Age limit- Upto 80 yrs
Membership for
Product features
Cost of Medicines & consumables during hospital stay
Cost of Operation Theater ,Anaesthesia, Surgeons fee
Professional charge: Consultant fee, Nursing fee
Accommodation
Entities involved
Network Hospitals
FHPL
ImplementAdminister
Govt. ofKarnataka
Dept. of Co-operative
Implementation of the Scheme
Trust
Family Health Plan Ltd(FHPL)
Governing Body
Fund maintenance & Disbursement
Periodic review
Administration
Claim processing
Services to member
Reporting – MIS
Periodic review
Dept of Co-opMember identification
Membership protocol- collection of Fee
Feed Back
Provider of healthcare services
Network hospitals
Cashless treatment
Special discounted tariff for medical treatment
Preferential treatment
Free Out-patient consultation
Discounted Lab charges
Exclusive front desk counter
2003-2004: -114 Hospitals
2004-2005:- 137 Hospitals
Hospitals spread across 30 Location
All hospitals follow single rate list for defined surgical procedure
STATISTICSYeshasvini Co-operative Farmers Health Care Trust
Jun 03 - May 04 Jun 04 - May 05 Total for 2 years
Numbers Value Rs. Numbers Value Rs. NO’s Value Rs.
No of Mems Enrolled 1,601,152 2,021,661
Contribution collected 96,909,491
119,755,440
Govt Contribution 45,000,000 35,788,000
Interest 3,743,622 4,880,368
Cont frm CO OP soc 6,296,177
Contrbution from SBM 300,000
Total Amt Collected 145,653,113
167,019,985 312,673,098
Claim Status
Claims Settled 8,996 105,385,417 13,632
162,317,166
Bills Pend for pyment 12 97,000 1,232
16,971,6
03
Total 9,008 105,482,417 14,864
179,288,769 23,872
284,771,186
0.56 0.74
Free OPD Treatment 35,814
50,171
85,985
Facts & Figures Year 1 Year 2 Year 3 ( 4 months)
Sensitization 6 months
News paper/ TV/ Radio Jingles
2 months
News paper/ TV/ Radio Jingles
2 months
News paper/ TV/ Radio Jingles
Enrollment drive 6 months 2 months 4 months
ID cards Not issued Partly issued Partly issued
Number of hospitals 114 137
Group size 16 lakh 21 lakh 14 lakh
Membership fee
Govt
Rs.60/- PA ( 9.6Cr)
Rs.30/- PA (4.5 Cr)
Rs.60/- (11.9 Cr)
(Total 4.56 Cr)Rs.3.45 Cr Govt. +48 L (interest) + 62.9L( Co-op) +3L ( SBM)
Rs.120/- (16.9 Cr)
Nil
Total Corpus Rs.14.19 Cr Rs.16.5 Cr 16.9 Cr
Renewal rate Not applicable 35% 43%
Claims settled 9008 14864 1937 ( Pre-auth)
Total claim payout Rs.10.53 Cr 17.9 Cr 3.39 Cr( Pre-auth value)
Avg Claim value 11689/- 12042/-
Incidence 0.56% 0.74%
Free OPD 35814 50171 9356
•Strong Govt. initiative & support
•Large identifiable groups
•Defined & extensive network of hospitals
•Largely discounted rates at Private hospitals
•Effective administration by TPA
Success factor
Thank you