In an exclusive conversation with BW Healthcare World, Dr. S Prakash, MD of Star Health and Allied Insurance, sheds light on the evolving landscape of the health insurance sector, its remarkable growth trajectory, the inclusion of outpatient services (OPD), and the company’s strategic vision for the future.
Health Insurance Awareness and Post-Pandemic Dynamics
The pandemic has propelled an upsurge in health insurance awareness. Dr. S Prakash emphasizes that the fear of soaring healthcare costs has led people to invest in insurance policies. Simultaneously, the industry has displayed resilience, adopting technology to ensure seamless services even during emergencies.
The Growth Trajectory
Growth Factors
Several factors contribute to the sector’s growth, including rising life expectancy, per capita income growth, increased financial literacy, medical advancements, and heightened medical awareness. People are seeking insurance as a safeguard for their investments.
Star Health’s Retail Focus
In the retail health insurance sector, Star Health holds a remarkable 33% market share, outperforming the industry average.
Partnership with Hospitals
In-House Policy Handling
Star Health’s unique approach involves designing policies and delivering services in-house, eliminating third-party involvement for claims processing. This ensures efficient service delivery and customer satisfaction.
Medical Professional Engagement
The company actively engages with hospitals for not only claims but also continuous medical education programs. During health crises, clear guidelines are shared with hospitals.
Outpatient Services in Health Policies
Expanding Coverage
Health insurance has evolved from reimbursement to cashless payments and now covers outpatient services. Star Health is exploring OPD coverage, with a focus on technological platforms for automatic claims approval.
Telemedicine Integration
Telemedicine services can play a vital role in supervising OPD services, making them more accessible and convenient.
Maternity Care in Health Insurance
Addressing Maternity Care
Unlike the West, where maternity care is covered, Indian insurance faces challenges due to some individuals viewing it as an entitlement. Expanding coverage depends on increasing the number of insured individuals.
Tackling Insurance Frauds
Differentiating Fraud and Commercialization
Fraud and commercialization need distinct approaches. Dr. S Prakash highlights the importance of categorizing hospitals based on ethics and commercial practices.
Scoring System
Star Health is developing a technology-based scoring system to identify ethical, commercial, and fraudulent hospitals, ensuring transparency.
The Future of Health Insurance
Industry Projections
The general insurance sector is expected to exceed 10 lakh crores by 2030, with health insurance accounting for 40% of it.
Star Health’s Vision
Star Health aims to diversify its distribution model and introduce innovative products while focusing on profitable growth.
