How insurance industry is aiding the national vision of affordable and accessible healthcare

While health insurance is now witnessing greater awareness and acceptance among the masses, its penetration rate is still abysmally low, contrasting with India’s huge population. Fortunately, the authorities are taking a holistic approach towards healthcare affordability and accessibility. This has also been the key focus of the PM’s Mann Ki Baat series, which aired its 100^th episode recently. A significant way to ensure affordable healthcare includes reducing out-of-pocket medical expenses that have been afflicting the country for decades, especially the middle and lower-class population. These expenses cannot only potentially drain a family’s finances but are also an obstacle to democratising quality healthcare access for everyone.

The historically lower awareness regarding health insurance in India has largely contributed to the high ratio of out-of-pocket expenditure. The industry is, therefore, at a juncture where is constantly evolving to make health insurance more affordable and accessible and thereby reduce these expenses. Here are a few recent strides in the health insurance sector that are helping make the insurance-for-all vision a reality:
 

• OPD coverage
  
  The ambit of health insurance was traditionally limited to hospitalisation coverage. However, patients end up spending a fortune on medical bills even without getting hospitalised. Now, OPD or outpatient department expenses are also being accounted for in one’s health insurance to shield them from costs incurred on doctor’s consultation, pharmacy, diagnostics, telemedical consultation and much more. OPD as a category has gained a lot more traction in recent times which is a huge milestone towards ensuring comprehensive coverage.
   
• Facilitating cashless hospitalisation
  
  Cashless hospitalisation in health insurance is crucial in reducing out-of-pocket expenditure as it eliminates the need of arranging a huge sum at the time of distress. IRDAI has recently boosted cashless hospitalisation by letting insurers empanel the hospitals that meet the standards and requirements prescribed by the board. With a wider network of cashless hospitalisation, it has become far more convenient for consumers to seamlessly access quality care without having to think about the medical bills or the reimbursement criteria.
   
• Inclusion of mental health coverage in health insurance
  
  Mental health issues are often brushed aside and not treated with the same gravity as physical ailments. However, the taboo around mental health started to wane during the pandemic and it was brought to the limelight. Fortunately, authorities also gave the matter its fair share of attention and formulated policies that ensured wider coverage for mental health issues. IRDAI has mandated the coverage of mental health issues as part of comprehensive health insurance policies. One can get coverage for doctor consultations too in their policies if they opt for OPD coverage in their policies.
  
   
• Broadening the ambit of senior citizen coverage
  
  Senior citizens comprise a considerable consumer segment that most need health insurance protection. Nonetheless, the scope of coverage was traditionally quite limited for them. With industry innovation, new products are being launched to specifically target this segment and cater to them effectively. These products come with minimal to no waiting period, a reduction in co-payment, lower or no sub-limits and an increased sum assured upon every year of renewal. Additionally, there are now plans available for adequately covering super senior citizens (those above 80 years of age) too.
  
  Insurance for the masses is not just a vision but the need of the hour. The recent initiatives to turn this vision into a reality are indeed commendable. These forthcoming policies and guidelines are what India’s underpenetrated insurance market needs right now. As India’s protection gap will get narrower, we will get closer to achieving affordable and accessible quality healthcare for all.