Structured OPD covers can prevent 44 percent of hospitalization cases: FICCI

The working population in India spends about 60 percent on the out-patient healthcare treatment annually from their pockets due to the skewed primary care system in India. Despite this, India has the lowest number of primary care visits by individuals hence leading to hospitalization cases.

According to a FICCI-Feedback Consulting report, it is found that there is a demand and supply need for primary and preventive care insurance. It also suggests the business potential for the insurers and government stakeholders by introducing OPD insurance covers for primary care. At present, this has not been an area of focus for the Insurances, wowing to various issues that has been discussed in the report.

As per the findings, about 16 percent of the urban population with paying capacity & existing policy holders would be potential target group to purchase OPD covers if the primary care system is framed in a proportionate way with right government intervention.

Insurers suggest that the biggest barrier for offering OPD covers in India is the lack of data for pricing the covers and unorganized regulatory guidelines for primary healthcare.

As per the report, an early detection, regular health check-ups and preventive methods, could result in preventing a proportion of 44 percent of hospitalization cases.

IRDAI chairman on Thursday during the launch of the report had said that there is a strong need to include primary and preventive elements in health insurance products. It has not made much headway given the concerns relating to likely misuse and overuse.

"This paper has come at an opportune moment giving scope for discussions not only regarding the supply and demand side aspects of primary and preventive care but also the environment within which these aspects operate," added IRDAI chairman.

Primary care practices in selective countries such as Brazil, China, Turkey, Thailand, Indonesia and South Africa have been analyzed to draw learning's from an Indian perspective.

The report also highlights local case studies about healthcare start-ups such as Practo Technologies, Qikwell Technologies and Portea Medical for insurers to galvanize the potential of primary care market.

Three major actions that can enable the OPD insurance market in India are capitation based products to allow risk sharing with aggregators and health administrators, electronic health records for frictionless platform to administer OPD claims and closed provider networks to align providers and insurer's interests.