Claim severity in cashless mediclaim higher: Irda

Insurance companies may like to deal with hospitals and third-party administrators (TPAs) more cautiously after going through the latest data on medical inflation.

According to data analysed by the Insurance Regulatory and Development Authority (Irda), the claim severity is 83 per cent higher in case of cashless mediclaim than reimbursement in the last two years.

Cashless mediclaim allows policyholders to get treatment without paying for it at the hospital. The insurance company settles the bill directly with the hospital.
 

SHEDDING LIGHT NUMBER OF CLAIMS
	2007-08	2009-10	% Chg
Arthropathies	14,500	20,330	40.21
Blood Diseases	1,435	1,972	37.42
Circulatory	35,776	49,687	38.88
Digestive	25,881	36,420	40.72
Ear	1,466	2,371	61.73
Endocrine	5,591	6,426	14.93
Eye	6,298	12,623	100.43
Infections	9,759	12,969	32.89
	2007-08	2009-10	% Chg
Injury	24,508	33,400	36.28
Neoplasm	21,999	31,475	43.07
Nervous	4,152	6,030	45.23
Pregnancy	15,391	28,539	85.43
Respiratory	8,425	13,824	64.08
Skin	2,255	3,410	51.22
Urology	22,028	33,407	51.66
TOTAL	199,464	292,883	46.84
Source: Irda

The report said the overall claim severity had increased by 27 per cent for 2009-10 as compared to 2008-09, while circulatory disease had gone up by 56.99 per cent.

The intensity of claims varies according to the disease, reflecting the complexities of treatment. Similarly, claim severity increased in all cases, except for endocrine, eye, infections and respiratory diseases, the report said.

There were, however, no major variations in the average number of days of stay in hospitals under cashless and reimbursement heads for settlement of claims.

The report found that in case of above average hospitals, the severity of claims was 70 per cent higher than the industry average.

The report said the medicine cost to surgery charges varied in case of reimbursement and cashless systems.

Medicine cost was also higher in cashless mediclaim.