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Thursday 18 December 2014

Hospitalization claims for fever high, insurers encouraging return to GPs

While heart diseases are India's biggest killers, the country's health insurance map shows that the largest number of claims is made for hospitalization due to commonplace fever and infections. 

The other three diseases that got the maximum claims include eye-related problems (excluding cataract), heart ailments and gastrointestinal complications. 

"In 2014, we had the maximum number of claims for fever followed by respiratory diseases,'' confirmed Amit Bhandari of ICICI Lombard, the country's largest private insurance company. 

Experts said inflation in the medical arena has dropped, which could mean little rise in insurance premium. A senior official of a private insurance company said while premiums had risen between 15%and 20% in the last two years, it's likely to increase by barely 2% in the coming year. 

The biggest development in insurance-paid healthcare is the emergence of private primary healthcare providers. The term stands for the now corporatized option for general physicians. 

Metropolitan cities such as Mumbai have in the last decade witnessed a sharp drop in the number of general physicians as many doctors prefer to super-specialize. Moreover, use of tertiary (super specialty) hospitals is up among patients. ICICI data shows such use increased from 43% to 49% among its customers from 2013 to 2014. 

"This leads to overcrowding of super specialty hospitals by patients who could easily have been managed in smaller centres,'' said Bhandari. 

In response, companies such as Nationwide in Bangalore and HealthSpring in Mumbai have come up to provide an alternative to the disappearing general physicians. Insurers are now offering the option of cover for out-patient department consultations. "The idea is to get patients to visit a general doctor instead of a specialist at the beginning. Why should, for instance, a super specialty hospital look after a malaria patient who can be managed on an out-patient basis?" said Bhandari.

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