Today is World Health Day and all the newspapers are carrying news on various aspects of global health. The most relevant article I read was by Dr Devi Shetty, Chairman of Narayan Hrudalaya Group of Hospitals who has been promoting insurance based health care for the masses. He started with the Yashaswini scheme in Karnataka, which has had mixed success. This was followed by the Rajeev Arogyasri scheme launched by the late chief minister of Andhra Pradesh, YS Reddy, which became popular in quick time and now a majority of the private hospitals are accepting the low income group patients who carry the cards as designated by Arogyasri. I had a brief opportunity to analyze the scheme when I was doing a PPP assignment in Andhra Pradesh and and I could see that the scheme has tremendous potential to uplift the healthcare provisions to the poor. The scheme outflow has rapidly increased from Rs 300 cr in first year to over Rs 1000 cr today, which is a 300% jump in three years! It will therefore be very important to ensure that the scheme gets its due attention in terms of getting the premium payments done to the insurer in the long run, considering the fact that it has become an instant hit with both patients as well as hospitals. The government is trying to leverage the scheme for their hospitals too, but is finding it difficult to lure patients coming to them for such a scheme. The internal cost Management Information System system will also need strengthening as otherwise government hospitals find it difficult to even raise an invoice. There is a dire need therefore to have an intelligent Hospital Information System system to be in place if we have to submit bills to the insurance companies which is a basic requirement. This will also help the government to generate much required income to fund its healthcare infrastructure and operation expenses. In the absence of such systems the patients tend to go to only corporate hospitals which unfortunately are only in the bigger cities. Now Tamil Nadu and Maharashtra are also planning to start similar schemes. It is therefore vital that all financial aspects of such schemes are studied well and integrated into the scheme so as to ensure that it succeeds, and does not go bust.
Filed under - Healthcare-General
1 Comment
Tags: Dr Devi Shetty, Hospital Information System system, World Health Day
Health Insurance concept is really important for any country, If implemented properly and in utmost good faith which is the basic principle of Insurance schemes, the risk is shared and and spread over the existing population and doesn’t pinch much. Unfortunately there is not much education about insurance , and not much regulation which has been imposed. People’s mindset about health insurance is not as it is for life insurance. In health insurance the premium paid is not reimbursable unless one falls sick and gains in terms of healthcare service. No of inclusions and exclusions are not clear. Country doesn’t have ample number of trained underwriters and claims managers. There is no regulatory which is stringent about documentation , 2 years back IRDA had taken some initiatives to make ICD coding mandatory , but it has not progressed. I came across a situation where , the MRD technician bough the ICD coding book and was struggling to get the cost of the book reimbursed from the hospital accounts department. let alone implementing the ICD -10 software and integrating with the HIS . These things become important when faster processing of insurance claims have to be administered along with networking with the health administration teams and Third party Administrators.