COMPARITIVE STUDY OF HEALTH INSURANCE PRODUCTS. SHREERAJ DESHPANDE. COUNTRIES HEALTH CARE EXPENDITURE. % OF GDP PUBLIC PRIVATE JAPAN 7.3 5.7 1.6 GERMANY 10.4 8.1 2.3
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% OF GDP PUBLIC PRIVATE
JAPAN 7.3 5.7 1.6
GERMANY 10.4 8.1 2.3
FRANCE 9.8 7.7 2.1
U.K 6.7 5.7 1.0
IRELAND 6.7 5.1 1.6
NETHERLAND 8.5 6.2 2.3
SINGAPORE 3.3 1.5 1.8
AUSTRALIA 8.5 5.8 2.7
CANADA 9.2 6.3 2.9
USA 14.1 6.6 7.5
INDIA 5.6 1.2 4.4
PUBLIC% MUTULLES% COMMERCIAL%
JAPAN 100 # #
GERMANY 88 # 9
FRANCE 99 65 14
U.K 100 5.3 11
IRELAND 100 30 0
NETHERLAND 70 54 40
SINGAPORE 100 0 0
AUSTRALIA 100 0 40
CANADA 100 0 #
USA 42 # 69
INDIA * 0 0.3
*ESIS & CGHS NOT INCLUDED
Fundamental Causes of Increase in Health Care Costs
A) Rapid Medical Technological Progress
B) Increasing Demands for Better Care and
C) Ageing Populations.
In Some Countries Is Also Partly Attributed to
A) Rising Levels of Remuneration for Medical Personnel and
B) Practice of "Defensive Medicine" Due to the Increasing Level of Medical Malpractice Litigation.
Difficult to Measure Rate of Medical Inflation but Observers Suggest That Health Care Costs Are Typically Increasing at Two to Five Times the Rate of General Price Inflation.
Health Insurance Coverage - Two Categories
Which Is Reimbursement Coverage / Service Contracts / Managed Care
Provides Payment When the Insured Is Unable to Work As a Result of Sickness or Injury
Health Insurance Is Transacted BY
Provides One or More of the Following
Maternity Benefit Optional and Policies May Contain Inbuilt Subsection Limits or an Overall Limit.
Is Broadly Classified As:
A) Basic Medical Expenses Contract
B) Major Medical Expenses Contract
C) Comprehensive Medical Expenses Contract
B) Co-Insurance/co-payment :
Insurer Pays a Specified Percentage (80%) of the Eligible (Covered) Expense in Excess of the Deductible.
(C) Stop-Loss Limit:
After a Fixed Dollar Amount of Medical Expense Is Incurred, Usually Above the Deductible, by the Insured, the Co-Insurance Clause Does Not Apply and the Insurer Pays 100% of the Remaining Covered Expenses
Medical Expenses Policies Also Differ on the Terms of Their Renewal
Coverage Can Be Provided
Policy Features Cover Services Such As:
Policies Are Characterised By
EVOLUTION OF HEALTH INSURANCE
Increasing Healthcare Costs Compelled Employers to Insist That Insurance Companies Evolve Their Role From Risk Distributors to Risk Managers.
- Moral Hazard
- Large Investments in Health
- Malpractice Issues
Managed Care Encompasses a Variety of Innovations in Both the Delivery and Financing of Health Care That Are Intended to Eliminate Unnecessary and Inappropriate Health Care and Reduce Costs.
AND MANY MORE
(A) Short - Term Disability Insurance
(B) Long - Term Disability Insurance
Types of Benefits
Waiting or Elimination Period