This article was first published in the IIB Bulletin, Vol 2, Issue 2, pp9-10; Co-Author- Syed Md. Ismail
Many studies have indicated that Indians are now more vulnerable to non-communicable diseases than communicable diseases due to changing lifestyles and income levels. Cardiovascular diseases have displaced communicable diseases as the biggest killer in India and, according to a 2010 University of Toronto study, the leading cause of death in middle aged men is heart disease, even in poorer states such as Uttar Pradesh and Bihar.
A sub-set of the claims data for the Financial Year 2013-14 available with IIB was used. The selected data comprised of claims where the diagnosis code (ICD10) and the pincode of the hospital was provided. The selected claims consisted of both Group as well as Individual policies. The effects of Sum Insured or gender or age are not considered in this analysis. The claims selected amounted to Rs.3,355 crores of claims paid for 11,22,652 claims.
The analysis shows that circulatory diseases have the highest average claims paid among all disease categories, accounting for 13% of claims paid analyzed (Exhibit 1).
According to a report published by the Indian Association of Prevention and Social Medicine, “Decline in morbidity and mortality from communicable diseases have been accompanied by a gradual shift to, and accelerated rise in the prevalence of, chronic non-communicable diseases (NCDs) such as cardiovascular disease (CVD), diabetes, chronic obstructive pulmonary disease (COPD), cancers, mental health disorders and injuries”. The top 5 disease categories (out of 22 broad disease categories as per ICD 10) which account for 51% of claims paid, in the sample under study are, apart from circulatory disease, Injury (10%), Digestive (10%), Urology (9%) and Neoplasm (8.5%) (Exhibit 1).
The same report states that “though there have been substantial achievements in controlling communicable diseases, still they contribute significantly to disease burden of the country”. The amount of claims paid is relatively smaller for Infectious diseases, but they account for largest number of claims as per our analysis (Exhibit 1).
It was also noticed in our analysis that Mumbai accounts for the largest number of health claims, accounting for 27% of the 11,22,652 claims studied, amounting to 30% of the claims paid. The other large cities which account for significant number of claims paid are Delhi (19%), Kolkata (14%), Bengaluru (12%), Chennai (11%) and Hyderabad (10%), with others accounting for the remaining 5% only (Exhibit 2).