Hospital Administration


Case Discussion

Health Insurance   Posted By Brijesh Babu K G    Date : 24-Dec-07   10:04 AM     Reply

Health Insurance More and more insurance companies are entering into the Health sector. The developed courtiers have already switched over to a mandatory health insurance schemes to the people. The increasing cost of medical treatment in the tertiary and secondary health care centers had contributed to the implementation of the mandatory health insurance in these countries. Common man will find it very difficult to avail treatment without the insurance. Health Insurance in India. More and more companies are coming into the health Insurance Sector in India. A Major share of the Upper Class, Upper middle class and Middle class people have already joined various health insurance schemed initiated by different companies. Various schemes are available starting from policies covering from 5000 Rs. The premium starting from Rs 100 .This itself is a clear indication that even the insurance companies are targeting the People below poverty line. This is also giving a clear cut indication that even the low income group of people is aware about the importance of the health insurance. The increasing health consciousness of average Indian man has also contributed to the acceptance of health insurance in our country. The companies are competing among themselves t o give highly attractive medical benefits to attract and retain their employees as a part of their Human Resource management. More over the companies are giving medical insurance schemes as special offers along with their products and services. This marketing strategy was proved a success by some leading newspapers in the country to increase their circulation and retain the existing subscribers. The Chain The Parties primarily involved in the health Insurance are 1 Individuals 2 Companies 3 Insurance Company 4 Third Party Administrators (TPAs) 5 Hospitals termed as Providers The Medical Facilities are primarily of two kinds Medical Reimbursement The policy holder avails the treatment from the hospital of their choice and they submit the claim forms along with their bills to the insurance company. The insurance company conducts an investigation and after a tight scrutiny they reimburse a percentage of the claim to the Policy Holder

Disadvantage to the Policy Holder " In majority of cases policy holder gets only a percentage of the Cost incurred and does not cover up his complete expenditure. " The Policy holder has to initiate the claims processing and the necessary documentation " Time Consuming Health Card (Cash Less) Insurance Companies issues a health card along with the policies to the policy holder along with the details of the Providers or Hospital from where they can avail their treatment. The policy holder directly goes to the listed hospital and avail treatment without to spending anything from his pocket. Advantages to the Policy Holder " Cash Less Treatment " The claims processing will be done by the Provider " Can avail treatment without any deduction Policy Holder - Insurance Co-Provider " The Insurance company issue a medical insurance policy to the insured under a set of predetermined conditions and Limitations including the scope of coverage. " The Policy holder gets admitted to any of the hospital listed with the insurance c o . " The Hospitals takes pre approval for the treatment from the insurance co. " At the end of the months the provider(hospital )submits the claims for the month along with the bills and supporting documents. " The insurance company after scrutinizing the claims reimburses the hospital for the treatment cost. Role of TPAs The third party administrator work as a link between the insurance companies and the providers. The TPAs enters into rate contract with the providers for providing medical care to their clients. The insurance companies avails the service of the TPAs .The TPAs arrange treatment for the policy holder s in the providers under them. They undertake the claims processing and scrutiny on behalf of the insurance company. They take a service charge for their services from the company which may be a percentage of the total business.

Brijesh Babu K G M.H.A Operations Manager Dr Hassan Ghazzawi Hospital Al Azzeeziya Dist Jeddah Post Box 2387 Kingdom of Saudi Arabia -21451 Mob +966540381778

Replies to the above case discussion :

Re : Health Insurance - Vishal 25-Dec-07    10:13 AM

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