In India, the home health-care industry has been on a rapid growth path, shifting gears in the last few years. Reportedly, the industry is projected to reach $6.2 billion by 2020 at a cumulative growth rate of 18%. In fact, home health care has the potential to replace unnecessary hospital visits in India by up to 65% and reduce hospital costs by 20%. However, growth in the sector must be backed by an inclusive approach towards home health care in the insurance sector.
The exclusion of insurance coverage remains a roadblock in establishing a robust ecosystem. Though the government has realised the urgency of pushing primary health-care facilities under the Ayushman Bharat Nirman, there is still great inefficiency because of poor insurance coverage. Current insurance models are heavily skewed towards tertiary and in-hospital care. In the absence of adequate primary health-care facilities and no out-of-hospital coverage, people are forced to move towards tertiary care. The convergence of health insurance and home health care can bridge the gap for post-hospitalisation and improve overall health outcomes by avoiding unnecessary readmissions.
While Denmark, England, Germany and the United States have successfully formulated policies to avoid hospital readmissions, India is yet to catch up. Germany’s re-admission policy introduced Diagnostic Based Grouping (DRG)-based payments to avoid unintended consequences. Hospitals receive only DRG-based payment covering both initial and re-admissions. In Denmark, readmission rates are publicly reported while payments related to the same remain unadjusted. There is immense tracking of readmission in the West in order to minimalise it; this is not the case in India. Improving home health-care facilities and coverage is one such route to constrain pre- and post-hospitalisation.
While insurance companies have adequately collaborated with hospitals in the country, they have not tapped into other aspects of health care. The process consists of extensive management of partners and networks, evaluation of hospital delivery and periodic auditing to evolve. Hence, in defence of insurance companies, these operations have already been structured at their end and allow for a rational degree of trust.
Focus on demographics
Home health care has flourished in the last few years becoming organised in the process. The truth is that it can only benefit the stakeholders involved. For instance, a lack of adequate insurance has restricted home health-care services to the relatively prosperous urban population, resulting in minimal or no penetration as far as rural and semi-urban populations are concerned. Extending insurance to these demographics will prove beneficial for patients and insurance companies alike.
The urgency of expanding insurance coverage is critical to the industry’s prospects. According to the World Health Organisation (WHO), India has merely 0.9 beds for every 1,000 Indians; a number far below WHO’s recommendation of 1.9 beds per 1,000 population. There is a misconception among people that home and personalised care is costlier. However, the the average monthly cost of in-home care is 20% less than that incurred in other health-care facilities.
Thus insurance can cover domiciliary treatment, pre- and post-hospitalisation, and out-patient department (OPD) and day-care treatments. Domiciliary treatment refers to treatment that needs hospitalisation but is addressed at home because of unavailability of rooms or patients unable/unwilling to approach hospitals. Pre- and post-hospitalisation involve services at home in post-surgery and chronic care conditions, while medical procedures that do not require hospitalisation or patients to stay in hospital for over 24 hours, such as cataract surgeries, chemotherapy, radiotherapy or haemodialysis, fall under OPD and day-care treatments. Insurance can be a separate or an add-on service to differentiate product offerings.
Meena Ganesh is MD and CEO, Portea Medical
