This article was first published in the IIB Bulletin, 2015, Vol. 1, Iss. 3, pp6-7https://iib.gov.in/IRDA/Articles/IIB%20Bulletin%20Q3%202014-15.pdf
Of late it has been noticed that the trend has been shifting from communicable diseases to non-communicable diseases. As the IRDA Chairman, Shri T.S. Vijayan pointed out in FICCI’s 7th Annual Health Insurance Conference: Health Insurance 2.0: Leapfrogging beyond Hospitalization on December 5, 2014,
“The shift to non-communicable diseases is profound and impacts the elderly more than the average person, particularly in India”.
We found that people above the age of 60 had the maximum number of claims for Circulatory diseases. This category of diseases not only has a higher average claims paid, it also results in higher number of days spent in the hospital on an average. Arthropathy and Nervous are other category of diseases which result in high claims amount paid but the number of claims are not very high.
While Circulatory diseases result in higher average claim paid, the number of claims for infectious diseases is the largest. Number of claims was found to be the highest for children below 5 years of age under the infectious diseases category.
India has one of the highest reported cases of communicable diseases amongst the BRICS nations. According to a report by the Organization for Economic Co-operation and Development (OECD), India witnessed 253 deaths per 100,000 persons, in 2012, due to communicable diseases alone. This is much higher than the global average of 178 (Source: OECD Health Statistics 2014).
Top 10 Diseases for FY2012-13: Number of Claims, Average Claims Paid and Total Claims Paid
Source: IIB Data
Clinical Findings refer to ICD10 code R00-R99- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
Only claims where the amount of claims paid is greater than Rs5,000 are considered for this study. For a large number of records, disease codes were not filled appropriately and hence they were ignored.
Tuberculosis, Malaria, Dengue, Hepatitis and many other infectious diseases are a major threat in India. Many of these are “zoonoses”, that is diseases which pass from the animals to the humans. Lack of toilets leading to defecation in the open, open sewers, general lack of sanitation, clean drinking water, food and surroundings are some of the main reasons for the spread of such diseases.
Out of pocket expenditure on healthcare in India is very high when compared to other nations, at about 60-70% of total health spending. The government spending, as a percent of Gross Domestic Product (GDP), was only about 4.8 percent in 2012, in India. People who are most prone to infectious diseases are the ones who are the least aware about the need to buy Health Insurance. This might explain the high average number of deaths due to communicable diseases in India, as reported by OECD.
Better awareness and improved GDP per capita income is leading the growth of the Health Insurance industry. The industry has grown at a Cumulative Average Growth Rate (CAGR) of over 30 percent in the past seven years and is expected to continue growing at a fast pace in the coming years too. However, a concerted effort on the part of all stakeholders is required to spread awareness about not only Health Insurance, but also the need to maintain better hygiene standards. In large cases, development of basic infrastructure would be required before basic hygiene standards can be met.