Is trust model under Ayushman Bharat a lost chance for insurers?

Posted on by KNBT

Photo: iStock

Photo: iStock

Malti Jaswal, former chief operating officer, Health Insurance TPA of India Ltd

Since a majority of the states have preferred the trust model, the benefits for the insurance industry are now likely to be more indirect compared to the direct role of underwriting and managing risk. For the industry, increased awareness, standardisation of healthcare provider practices, standard medical protocols and package prices, IT platform for standard codified data, paperless transaction and electronic health records and fraud control are key benefits.

The biggest opportunity lies in converting increased awareness among public to business—covering non-insured population with a similar standard product, offering top-up covers, ensuring continuity of cover to people and so on. The infrastructure, social networks and IT framework created by Ayushman Bharat shall help the industry in substantive management of cost and ensuring service delivery to the uncovered population.

Lastly, if the risk management and service delivery are found to be better under insurance and mixed model, it will force other state governments that have opted for a trust model to go for a more efficient route.

Bhargav Dasgupta, CEO and MD, ICICI Lombard General Insurance Co. Ltd.

From a long-term perspective, this scheme could change the way in which healthcare is provided and consumed. From an insurance perspective, in the long-term, it will develop a healthcare provider market which isn’t adequate currently. When the government becomes a payer, I as a patient have a financing option. I can now choose a hospital that I like, government or private.

With the government’s investment in this scheme, a demand for healthcare will be generated, leading to better private healthcare and more capacity. The standard treatment guidelines will also be a big positive. The scheme will bring standardisation, but it will be limited to the scheme. Will it be replicated in other areas? I don’t see that happening immediately.

Also, in the next 4-5 years, the trust model may turn out to be more costly than the insurance model because of the price discovery process through the insurance model and the incentive to eliminate misuse and fraud.

Joydeep K. Roy, partner and leader, insurance and allied businesses, PwC

Ayushman Bharat is understood to be an umbrella health cover for the underprivileged, like Rashtriya Swasthya Bima Yojana (RSBY). But it is not a restricted mini cover for surgery; it is a true full service health cover, irrespective of whether it works on a trust model or with insurers.

Inertia in buying insurance and lack of awareness of benefits have been the main impediments. With a universal scheme, people will ask for higher cover and value-added services. That is a massive opportunity for insurers for offering top-ups, advanced covers, and preventive measures to reduce morbidity. That market will be several times larger.

Sophisticated products for the top end and simple electronically dispensed products at the bottom will be the fillip for growth. Indian healthcare spends are in excess of $100 billion. The insurance coverage of that is less than $8 billion. Headroom is not an issue, the right kind of aspiration and strategy is the key.

Dr Bhabatosh Mishra, chief operations officer, Apollo Munich Health Insurance Co. Ltd

Ayushman Bharat NHPM is undoubtedly going to be the largest social security health protection scheme anywhere in the world. While more details will emerge, it is already apparent from what is available that a majority of the states have decided to adopt the trust or assurance model.

The average sum insured of the population covered under private insurance is well below ₹5 lakh, whereas for Ayushman Bharat, the sum insured is ₹5 lakh. This would nudge the remainder of the population to get adequate cover.

In the near term, the scheme addresses both issues of inadequate insurance and low penetration. In the medium term, it would drive innovation in product development. One challenge though would be its impact on the price of private insurance. If hospitals decide to subsidize ABNHPM by padding up costs for self-paying or insured patients, it would lead to an unfair burden on the rest of the population. But in the long term, an indirect reform in healthcare would be adoption of protocols, disclosure of outcomes, accreditations and overall transparency.

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