According to World Health Organization, out-of-pocket healthcare expenditure in India is extremely high at around 62%. Since public investment on health has been stagnant at around 1% for many years, people have no option but to empty their pockets. Even the National Health Policy has admitted that nearly 63 million people are pushed into poverty every year due to healthcare expenses in the family, all paid through out-of-pocket expenses.
High inflation in input prices has meant that the cost of healthcare has been rising steadily at an alarming rate. For majority of the population, healthcare is increasingly becoming unaffordable. One can only pray that our family members don’t face critical health conditions.
In this climate of rising health care costs and low affordability, health insurance is becoming a crucial investment for everyone. Over last few years, the industry has witnessed over 20% growth in new premium collection. However, consumers are still unaware about the many benefits that health insurance policies offer. One of the biggest challenges in increasing awareness about health insurance products is the complexity the products. Today, policy coverage extends to out-patient treatments, diagnostic reports and several other healthcare requirements. But these policies also come with waiting periods and many exclusions. Customers need better understanding their risk coverage, as well as making optimal use of their policies at the time of need.
Claim settlement process also remains shrouded in mystery. Customers are often baffled why their claims were rejected or why certain deductions were made. The complexity of the insurance policies makes it difficult for consumers to fully understand the nuances of their policy coverage. In addition, some hospitals and a larger number of consumers avoid taking the insurance payment route at the time of hospitalization, as claim can take a long time to settle, with uncertainty of payments at the end of the settlement process. For hospitals, claims management process and reconciliation with related payment disputes can create further operational overheads.
“Cashless Insurance claims can help improve insurance adoption and reduce healthcare cost for families”
Insurance companies have tied up with hospital networks to provide cashless services and improve this customer experience. This means that the customer need not pay for treatment cost for the procedures, saving substantial direct out-of-pocket expenses. Insurance companies then settle cost of treatment directly with the hospitals. However, these processes also remain mired in procedural entanglements such as complex forms, onerous documentation requirements, and long waiting time for approvals.
While a lot of work has been done by insurers to improve cashless experience of users, simplifying the process further for both hospitals and the consumers is the only way forward. At the recently concluded 5th BW Businessworld Healthcare Summit, organised by BusinessWorld magazine in Delhi, Co-Founder & CEO of TrueCover, Ashish Chandra, said that technology can reduce the cost and we are in the business of creating awareness for customers about different medications, insurance policies. (Read full report here)
Through a digital claim management platform, hospitals can manage all insurance claims using a single, easy to use interface. Comprehensive data exchange can reduce the likelihood of payment disputes, thereby paving the way for cashless claims. It can be a win-win situation for everyone as this helps improve customer experience, as well as cash-flow for hospitals.
“Hospitals can improve their finances with higher bed occupancy ratios, reduced operating costs and faster payments.”
Digital, cashless transactions are the way to go in order to improving turn-around time and occupancy ratios at hospitals while reducing operating overheads in claims processing. By simplifying insurance, TrueCover aids hospitals in improving their overall finances. Although there’s still a long way to go, these baby steps are the right way forward in creating a truly digital experience in the healthcare sector.
When Prime Minister Narendra Modi assumed office, he put forward the idea of Digital India as the hallmark of the next phase of growth for the country. He believed that technology could help transform the nation and create more transparency across sectors – healthcare being one of them. TrueCover is working on this mission to make claim processing simple and fast for both consumers as well as hospitals using state of the art digital tools. We aim to be the catalyst in creating a secure future for the country.
(Abridged version of this article was first published in inaugural edition of BWHealthcareworld Magazine in October 2018)