NEW DELHI: Lack of standard clinical protocols in India are adding to medical inflation in recent times, and hence pricing of health insurance products, says Bhabatosh Mishra, director underwriting, products & claims at NIVA BUPA Health Insurance. He pointed to lack of standard clinical protocols as a big reason for high medical inflation in India.
He cites examples of introduction of a few drugs – very high doses of antibiotics, etc -- for treatment of diseases, which have not been proved based on evidence that they cure the disease more effectively than a lower dose of the same drug. “When you do not have standard protocols, any clinician is driven by the practice of their experience. But experience is not necessarily evidence-based,” he says.
He cites another example of robotics surgeries. “If you do a non-cancerous fibroid removal of the uterus by a robot versus laparoscopic surgery, the robot does not offer any additional clinical advantage but they cost three times more,” says Bhabatosh Mishra of Niva Bupa Health Insurance.
In countries like the UK, there are independent bodies which evaluate every new test, every new procedure, etc from a health economic perspective. “In India we do not have that. Here, if we get an entirely new machine, we do not know if it is better than the current equipment we are using or is as good as the existing one,” he says. Mishra also points to a new practice of hospitals adding new line items in hospital bills.
“I have certain bills from some hospitals where I have noted that patients who underwent angioplasty for stenting, these hospitals started charging a seperate line item called stent implanting charges. But stenting itself means putting the stent to the coronary artery, then why this additional charge,” he asks.
He says such innovative practices by hospitals lead to higher scrutiny of health insurance claims, which he says if not done would become a practice. Mishra also points to a worrying trend of health insurance awareness that was created during the first couple of waves of Covid-19 going back to the pre-covid levels as fear of Covid subsides.
“In terms of awareness what percentage of the fear eventually translated into real awareness about insurance being a financial risk mitigating tool is very small,” says Mishra adding that not just demand, but even enquiries about health insurance – google search, visit to health insurance websites – have gone back to pre-covid levels. He sees a similar trend in digital health adoption.
“Digital health adoption went up substantially during the Covid peak, health insurance demand went up substantially during Covid peaks, but once the peaks were gone, the level of demand has also gone down,” Mishra pointed out.
However, he refuses to attribute this fall to either stricter underwriting norms or higher pricing of products. He says underwriting became more relaxed during Covid. Health insurance companies shifted their pre-policy health check-ups to simple tele underwriting as it was simply not possible then to ask policyholders to go to hospitals and get their check-ups done physically.