With shorter treatment durations becoming the order of the day, experts say there is a need to make health insurance cover for out-patient department (OPD) treatment robust, and reach out to the masses with affordable costs.
“So far, attempts by health insurance companies to cover OPD treatment have been patchy. It is part of group cover or lifestyle diseases such as diabetes to a small extent, and not on a standalone basis. We are making attempts to make this coverage robust,” said D. Rama, assistant vice-president, Product Cell, Star Health Insurance.
She was one of the panellists at a discussion on ‘Health Insurance–The Outpatient–Day care’ organised by TiE Chennai Healthcare Special Interest Group on Thursday.
She said one of the problems was lack of standardisation. “If there are some standards or protocols, it would be easy to evaluate whether a procedure is required or not,” she said.
She also highlighted the need to leverage technology in this process and establish partnerships between healthcare providers and payers to understand the needs of the customer.
As of now, insurance companies were linked to hospitals as transfer of information was easy due to availability of technology, she said. A pilot project of linking with individual medical practitioners showed that transfer of information of patients did not work out well, she said.
Vishwajeet Mohont, vice-president, marketing, Star Health Insurance, said one of the biggest challenges was penetration to the grassroots level.
“There should be access to good healthcare irrespective of location. And this is possible if OPD insurance is a normal coverage,” he said.
According to Ram Natesan, general manager, marketing and business development, Global Hospitals Group, patients preferred day-care treatment and simple procedures to get back to work as soon as possible.
“We are developing a mobile application that could be downloaded from the hospital website. Through this, a person can book his/her appointment, track reports that would be uploaded on the site, check health status and receive wellness tips,” he said.
Narayanan Ramaswamy, partner and leader for advisory business in south India, KPMG, and N. Raveendran, managing director, ALEgION Insurance Broking Pvt Ltd., were present.
