Much of Indian private health insurance seems, quite unfortunately, to be modeled on the insurance situation in the USA.
Perhaps, then it is time we realized that Healthcare is among the top three broken issues in the USA, along with immigration and social-security. In fact, the United States is the only developed country in the world that depends on private insurance to protect most of its citizens.
Healthcare in the USA is known the world-over as being a joke! A South Korean official, being interviewed by a TV channel was once asked if they ever considered the US model of health insurance for their country. And the official fell over laughing. This is a pertinent point because this is the very system that India is consciously emulating.
Why is private health insurance bad, you ask? There are plenty of reasons. But I will give you only TWO reasons. Here goes.
- Dramatic Increase in Health care costs:
As private insurers enter the picture, there is inevitably an increase in overall healthcare costs. EVERYTHING including diagnostic tests will eventually cost as much as 5 times the original cost.
This author once went to an American Orthopedic doctor in Dallas. This single doctor (it was not a clinic or hospital) had hired 4 people in his office exclusively to deal with insurance! That’s how difficult these insurance companies will make it for doctors and patients. And the doctor’s fee will naturally reflect the increase in his staff AND the possibility that some insurance claims are ultimately rejected by the insurance companies. Which means the fee per patient (whose insurance was accepted by the insurance company) will be subsidizing the cost that was incurred by the doctor because of rejected insurance claims.
This author, while working for the UT Southwestern Medical Center at Dallas, had a good friend who used to work for a major for-profit insurance company in the USA. And she let him in on a secret about her previous employer. All health insurance claims that were filed with her ex-employer (the private insurance company) are first automatically rejected by software. When the same claim is re-sent to the insurance company, it is will be automatically rejected again by the software. Only when the same claim is re-sent to the insurance company a third time, will a real-person even take a look at it. Unbelievable? Sure. Did this happen? Of course it did! Perhaps other private insurers were not as callous. And one can only hope that the squeaky-clean Indians do things better!
Millions of medical insurance claims are rejected every year in the USA! So the doctor or the hospital needs to keep tracking the insurance claims closely! Rest assured that the costs WILL skyrocket.
In fact most doctors will automatically give you a 30 to 50% discount on their fee if you choose to pay out-of-pocket (ie., if you choose not to pay using your insurance!)
- Doctors and Patients become slaves of money-minded Insurance companies
This is an aspect that the general public will very rarely realize.
The insurance companies, once they are entrenched, will wield so much power over doctors, medical care, and patients that it will look like a horrible sci-fi movie in and of itself, only worse. From dictating to the doctors WHAT medicine can be given and whether a procedure requires bed-rest at the hospital to WHAT procedure is allowed (if there is a choice of options to the doctor), the insurance companies WILL TELL the doctors what is going to happen. And that’s EXACTLY how it will happen.
Neither the patient nor the doctor can control the healthcare procedures and processes now.
Are you a conscientious doctor that will refuse to listen to the selfish, profit-minded, grim-reaper-like dictates of an insurance company? Then woe unto you! You will be struck off their “network.” And that will be end of your medical practice, quite literally. So there!
Have you not heard Barrack Obama’s personal story of how his family suffered at the hands of a private insurance company?
Ok, what should India do, you ask? Glad you asked! I was going to tell anyway!
- Banish the private insurance companies:
That’s right. We don’t need them.
In almost all developed countries, private insurance exists ONLY to supplement or complement a very comprehensive public insurance program that covers every single citizen. But in India, even this supplementary level of existence for these private insurance is unwarranted and in most cases unacceptable. Some State Governments (like that of TamilNadu) fund private insurance companies to the help the poor. This is definitely wrong on many levels. So yes, all private insurance companies must leave India!
- Build on the Government Hospitals:
India started on a wonderful notion of FREE public healthcare. That is God’s gift to India.
In almost all developed countries a free health-care system that is funded by the tax-payer, exists. This is based on the concept of “solidarity”, where the citizens say unto themselves that anyone can get sick and it behooves the nation to take care of the sick.
We, in India, need to continue this wonderful FREE public healthcare.
Build on the existing Government hospitals and public healthcare facilities. Improve them. Make them world-class. Rapidly increase the number of public healthcare centers. Allocate more resources and funding for these. And God and God’s People will be happy!
- Let the private practice continue:
Let the current private practices of doctors and private hospitals continue to exist. If someone prefers to go to these places, let it be their decision. If the Government makes the Public Hospitals very good, even the rich will choose Government Hospitals. By the way, you should know that most Government doctors are a million times better than private doctors! It’s a fact that most rich people in India will never realize!
The author, Arvind Rajendran is an entrepreneur, co-founder/CEO of indiaMedJobs.com. He can be reached at [email protected]. This article may be reproduced with prior permission from this author.