V. Jayalakshmi Siva Sivani Institute of Management Hyderabad

1. The Burgeoning Indian Health Insurance Industry……Yet miles to go !!! IIRM - National Seminar on “A Decade of Experience: Health care Insurance…. Present Scenario”, 24th January, 2012 V. Jayalakshmi Siva Sivani Institute of Management Hyderabad

2. Presentation Outline Indian Health Insurance – bare facts Objectives of the Study Methodology Household Survey Analysis Summary and Conclusion

3. Brief Background • Indian Economy : LPG ………year 2000 • Insurance industry ‘engine for growth’ • Consumers today have choice and variety

4. Health Insurance Facts • Rs 7,803 crores in year 2009-10, CAGR of 25-30% • Poised to grow to Rs. 28000 cr industry by 2015 • Out of the total population 15 % - covered under all prepaid schemes 2 % - covered under private insurance • Total healthcare expenditure constitutes 5% of GDP • Public Funding – 1% of GDP • OOP spending – 76% • HEALTH INSURANCE – A NECESSITY TODAY

5. Health Expenditure in India by Source of Financing OOP – SIGNIFICANT AND BURDENSOME

6. Universal Truths & Facts • Private health care expenditure is greater than that of public health care • Little preference for Government health delivery system vis-à-vis the private • Reliance on the government need to be reduced • Voluntary health insurance schemes – globally acceptable model • Health insurance plan - income protection plan

7. Key Stakeholders “ Policyholders” – missing

8. General Insurance Premium composition [2003 – 09] Health insurance significantly contributing ………..

9. Health Insurance Premium Growth [2003 – 09]

10. Indian Health Insurance Market- 2010-11 • INDIA RANKS : • 78th in terms of insurance density • 52nd in terms of insurance penetration • OOP expenses met out of * Borrowings / * Sale of assets / * Past Savings * Current incomes

11. Huge market to tap……

12. Indian Heath Insurance Estimates at a glance NCEAR (2008) Survey Report: Penetration 1.2 per cent (US – 4.2%) ASI of Rs 98,604 per policy Population covered – just 15% Population covered by Private Health insurance companies – 2% Huge untapped market

13. Total Healthcare spending at a glance at Macro level…….. Total health care spending in India - 1.7 lakh crores [2007-08] Insurers’ payouts barely Rs. 5,000 crore!!! Rs. 1,00,000 crore - OP Treatment (non-hospitalization) expenses and Rs 70,000 crore - hospitalization expenses Insurers’ claims - 100-105 % claims [ 2007 - 2009]

14. Micro level .............. Out of an average annual income of Rs 62,114, an Indian household spends 6.7% (Rs.4,079) of income on for routine medical expenses 37.4 %(Rs.23,237) of income for major sicknesses Huge Out-of-pocket spending!!!

15. But then, ……………Why? Indian HHs not taking health insurance policy to mitigate huge OOPs? Are the existing insured HHs satisfied ? Why are few HHs discontinuing their policies ? Health insurance has not yet achieved the desired levels of penetration?

16. Present study makes a humble attempt to find answers to these question through a household survey

17. Relevance of study Insured households in AP only 0.62 % ( National Average 1.2%) AP Health Index Rank - 20th with 0.46 score (National 0.54) Average annual HH income Rs 45,372 Annual health expenses - Rs 19,566 (43% of HH income) 9 % households surveyed faced major sickness, with average expenditure being Rs 16,463

18. Objectives of the Study Examine perception of HHs towards Health Insurance Study factors influencing health insurance purchase decisions Identify coverage needs, reasons for discontinuation or unwillingness to purchase health insurance Help insurers tap potential market

19. Policyholders’ Perceptions on Health Insurance

20. Methodology, Sample Source& Size Household Survey – primary data Questionnaire Twin cities of Hyderabad & Secunderabad 221 Households

21. Data pertaining to…. • Socio-economic and demographic profiles • Health Care Facilities and Preferences • Insurance awareness and Coverage

22. Data pertaining to…. • Willingness to Purchase Health Insurance • Factors influencing Health Insurance purchase decision

23. Analysis of Household Survey

24. Socio-economic & Demographic Profiles of Households

25. 70 percent of respondent were between 35 years to 45 years

26. Gender & Marital Profiles

27. Around 86 percent of Households were educated

28. Family Profiles / Insurance

30. Occupational Profiles/ Insurance

33. Health care Provisioning and preference

36. Healthcare Expenditure Experience of Households

37. Hospitalization/ Acute / Chronic Diseases

38. Duration/ Reasons for Hospitalization

39. Range / Impact of Medical Expenses

41. Treatment Preference/ Satisfaction Type of Medication • About 65% of Households preferred Allopathic treatments • Homeopathy • Ayurvedic

42. OP Experience of Households ………….

43. Sources of Finance for OP & IP Care • Current income being major source • Drain of liquid income • Huge OOP spending …………….. Potential market

44. Insurance Awareness Of Households

45. Awareness / Sources of Information • Life insurance awareness significant • Agent’s role very prominently seen

46. Perception on Health insurance …………. • Although Health insurance is perceived as necessary by majority • Almost half of HHs Uninsured !!! • Understanding and evaluating reasons important • Family Floater policies significant

47. Health Insurance Claims Experience • Unpaid claims significant • Delays in claims settlement to be efficiently reduced • Result in disinterest to continue or unwillingness in puchase

48. Reasons for rejections • Part rejections, discouraging factor • No Claim reflects lack of understanding of insurance fundamentals • Insurers’ quality tested through claims settlement………………

49. Policy Coverage desired • Perception shift in purchase and continuation observed • Coverage desired if integrated will reduce Out-of- pocket spending

50. Preference of Households Willing to Buy New Policies Low Cost policies for a longer term more than one year from Public Companies seem to be the choice of majority HH willing