Data Analysis Resuls

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rajaram

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May 18, 2013, 9:07:24 AM5/18/13
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Hi 

Data received till now (Please pay close attention to the last link. A govt scheme has experiemented with outpatient insurance in a few cities (Puri ) and is doing a pilot in a few more


197511 Bangalore Urban BPL Population - Source - http://www.rsby.gov.in/Statewise.aspx?state=29
49604 Bangalore Rural BPL Population - Source - http://www.rsby.gov.in/Statewise.aspx?state=29
1.5 Average Number of Appointments in a year Per Person (Last Link)
100 - Cost per appointment (checked with my main on how much her doctor charges)
300 - Average cost per prescription ( Medicines accounted for more than 3/4th of the spending - http://articles.timesofindia.indiatimes.com/2012-03-16/india/31200601_1_oop-expenditure-insurance-schemes2)

A few things we should check with the insurance contact

1. by including outpatient benefits, can the profits be improved for inpatient schemes (with a smaller increase in premium). Currently a lot of people cover outpatient to inpatient for coverage for tests like scans, etc...

2. the paper listed below (third link) also argues that by including outpatient benefits, preventive checks increases which reduces the inpatient burdens on policies

3. health insurance for our companies also includes annual health check ups for the same reason (not because they want us to live longer ;-)

Links

dr sakthivel selvaraj has done some research and we should google on him for more data. If we can talk to him, great..... Please check on your li nked in network if you see some links :-)


Regards
Rajaram



karthik madhava

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May 18, 2013, 3:25:51 PM5/18/13
to rajaram bhaskaran, icpm-strategy-group

The last link is awesome. Gives us great amount of data. Thanks for sharing.

Abhijit Chaudhary

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May 18, 2013, 4:03:09 PM5/18/13
to karthik madhava, rajaram bhaskaran, icpm-strategy-group
Meet my cousin in St. John.
Policy in St. John is to give prescribe only generic drugs.
Class 3 and class 4 employees in St. Johns are mandatory covered under ESIS scheme.
Karnataka Doctor's List is available in medical council: http://karnatakamedicalcouncil.com/doctors_list.php
Yeshaswini scheme or Vajpayee Arogya scheme is not available in St. John's, but CGHS is available.
Regarding our free OPD use-case, he commented the following:
 * Should include outpatient procedure like vaccination, nebulization, etc.
 * Pharmacy should take original prescription while giving the free drugs.
 * Premium collection mode should include tie-up with bangalore-one apart from the online mode.
 * Hospitals part of the scheme should be of decent repute.
 * Few Pharmacies of every locality should be tied in.
 * Coverage of chronic illness should incur higher premium or don't cover it.
 * Higher premium above 55 years 
 * Get doctors list from Karnataka medical council.
 * Get drug DB from mimsonline
 *  He feels we should target all types of population, not only poor. For example, he himself is willing to buy the scheme for Rs 600. He won't mind going to doctor (chosen by insurer) for common-cold, seasonal fever, etc. He would go for specialized or well-known doctor if the disease is serious.
 * He feels if the scheme guarantees regular inflow of patient to the doctor, he will enroll as doctor. Adding some features like online appointment would be a value-add. 
He mentioned that Dr. Devi Shetty had launched Yeshaswini scheme (http://www.dhan.org/askmi/docs/Research%20and%20studies/Case%20Narayana%20Hrudayalaya%20(health).pdf) with a premium of Rs 90, govt paid Rs 30 and remaining Rs 60 was borne by patient per year. 1.6 million ppl signed up in first year by awareness created by govt. cooperative agencies. 2.2 million ppl signed up in next year. Each person was entitled coverage of Rs 2 Lakhs per year.  Assumption was that only 1-2% of any population would require major surgical procedures during the year, an actuarial assumption that is generally used in the West.
From an accounting standpoint, the scheme turned a profit. The total premium paid by 1.6 million subscribers was Rs 14.4 crores ($ 3.2 million). Subtracting the total number of surgeries (11.94 crores) and the administrative expenses paid to FHPL (Rs.59 Lakhs), the scheme generated a surplus of 1.86 crores which has been carried forward to the second year of operations. In addition, the number of free outpatient treatments done at various hospitals was large, a total of 35,814 occasions.
--
Linkedin - http://in.linkedin.com/pub/abhijit-chaudhary/0/66b/522
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