This article was first published in the IIB Bulletin, Vol 2, Issue 2, pp9-10; Co-Author- Syed Md. Ismail
https://iib.gov.in/IIB/Articles/IIB%20Bulletin%20Q2%202015-16.pdf
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).
Exhibit 1
Exhibit 2
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