Health Insurance and the ‘Humpty Dumpty’ syndrome

By prabuddhajagadeb | April 3, 2015



Health Insurance and the Doctor

We all know that popular nursery rhyme about Humpty Dumpty. You know, the one where Humpty sat on a wall, had a great fall, then couldn’t be put together again.

Well, that pretty much sums up the precarious financial situation of a large number of Indians. With medical inflation skyrocketing, statistics show that the average Indian is just one major ailment away from plummeting into financial despair. And much like poor ol’ Humpty, without health insurance to cushion this fall, most might never quite find themselves the same again.

Health insurance helps people access quality healthcare by meeting policyholders’ financial requirements during times of medical uncertainty. Yet, health insurance penetration in India remains abysmally low. This, despite the existence of a competitive and growing health insurance industry providing affordable health insurance solutions to meet the varied needs of a wide cross-section of society.

Sitting on the wall

In the absence of state-run Medicare programs, medical expenses in India are generally met out-of-pocket i.e. from a patient’s personal income or savings. Sadly, Indian pockets aren’t fashioned to go deep enough. Startlingly, most Indians fund medical treatment either by selling off personal assets or taking personal loans. Sadder still is the fact that a sizeable number of people don’t seek medical aid simply because they can’t afford it.

Waiting for the fall

Medical complications are unpredictable, liable to strike at any time. Humpty certainly didn’t think he was going to fall off that wall. But, fall he did. Even as infectious diseases run rife (look no further than the recent swine flu and Ebola scares), non-communicable diseases viz. cancer, diabetes, cardiovascular ailments and chronic respiratory diseases remain the major killers. In fact, India leads global figures across a number of these ailments.

Health, Wealthy but Not So Wise

Despite the looming threat of medical problems in India, health insurance is a completely underutilised form of protection. We look at 6 reasons why people fail to get themselves adequately covered under a health insurance plan.

Low financial literacy and awareness: Awareness of the necessity and benefits of health insurance is low in India. Financially speaking as well, the idea of paying upfront for intangible benefits in the future has not really caught on.

Belief in fatalism:Many people still consider ailments to be misfortunes dealt unto them by the hands of fateand refuse to accept the probability of its natural occurrence in their lives.

Banking on public healthcare:People from rural areas and lower economic sections of society look at government hospitals as an option to get free treatment. As such, they do not consider it necessary to spend on personal health insurance from their own pockets (the not-so-deep ones, remember?).

Dependence on employer health coverage:Group health insurance schemes which cover employees and their families appear to be economical options. But, little do they realize that these covers are limited and are often inadequate.

Lack of cashless facilities at all hospitals: For those who do hold insurance, utilising it becomes a hassle if hospitals providing cashless services aren’t easily accessibly. People are inherently averse to paperwork and more often than not don’t follow through health insurance claims.

Lack of government initiatives: Although the National Health Insurance Scheme was introduced to extend affordable healthcare in India, the government hasn’t effectively promoted the program so as to make a meaningful impact.

It is evident that a number of issues restrict the spread of health insurance. While overcoming these obstacles is a mammoth task, the right impetus (along with the help of all the king’s horses and all the king’s men) will lead the Indian health insurance industry to achieving its full potential. Humpty could then pick up all the pieces with ease even if he fell.

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