Beruflich Dokumente
Kultur Dokumente
(MBA,PGDIRM,FIII,PHD)
Dr Harish Sihare
Flow of Presentation Introduction of micro health insurance Micro health insurance in India Importance: Need of hour Moral Hazard & Adverse selection Moral Hazard & Adverse selection in RSBY Suggestions and Solutions Innovations in Health insurance
Insurance is a Mechanism that helps to reduce the effects of such adverse situations
MICRO HEALTH INSURANCE Micro health insurance is different from other traditional products in the market as its being a targeted instrument for inclusive insurance for low income households. According to IRDA Micro-insurance is insurance with low premiums and low caps / coverage. In this definition, micro refers to the small financial transaction that each insurance policy generates.
89.5
75.13
92.37
64
43.12 40.75
27.3
27.8
19.6 17.47
12.11
11.85
0-14
15-24
25-54
54+
Age Groups
Preferred category - Usually non-smokers/non-tobacco users with no health or occupational problems Standard category No health or occupational problems but may use tobacco products High Risk category Those with health problems, occupational
hazards
RSBY At a Glance. Launched on April 1, 2008 Beneficiary pays only Rs 30 as the registration fee PPP Model Death cover due to an accident @ Rs.25,000 Compensation due to loss of earning of the earning member @ Rs.50/- per day up to maximum of 15 days Covers 28states and about 80 million people Shared financial contribution by both central (75% ) & state government (25%) Base Premium and Bidding Process.
RSBY At a Glance.
was launched on April Rs 30,000 per BPL family 1, a family Total sum insured of 1, 2008 was launched on April on2008 floater basis Pre-existing diseases to be covered Coverage of health services related to hospitalization & services of surgical nature which can be provided on a day-care basis Cashless coverage of all eligible health services. Provision of Smart Card. IT-enabled (smart card ,preauthorization of admissions, claim submission and approval etc) Provision of pre and post hospitalization expenses. Transport allowance @ Rs.100 per visit upto maximum of Rs 1000
RSBY At a Glance. Freedom of choice between public and private hospitals Insurance company empanelment guidelines. Hospital empanelment guidelines.
Process Overview
Claim Ratio(in %)
100 90 80
70
60 50 40 30 20 10 0
Bihar
Chattisgadh
Delhi
Gujrat
Kerela
Maharastra
UP
Punjab
Nagaland
Haryana
Claim Ratio(in %)
2.39 Gujrat
0.28
Gatekeeper approach
Moral hazard & Adverse selection eventually benefices the consumer. Access to healthcare through RSBY is morally good for the poor. 1. Disease Burden 2. Improved standard of living 3. Social Security for poor.
Better off as Health Investments than Expenditure i.e. Health Saving accounts
100% of sum assured not in lieu with loss. Entrance of Preventive/ wellness health packages
Thank You