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This may be an extreme case for the US, but when it comes to healthcare costs, India seems to be headed down the same path.
Take me, for example. I have paid Rs 1,62,500 as health insurance premium for my family of four. This includes something called ‘critical care’ insurance, where you get a lump sum if you are diagnosed with a life-threatening condition. Spread this over the entire year, and my monthly average cost of medical insurance comes to around Rs 13,500. And that doesn’t include outpatient visits to a doctor, or the medicines we buy for common illnesses, or the vaccinations we get from time to time.
What’s worse is that, even after paying such a hefty premium, there is no guarantee that your insurer will cover the entire cost of hospitalization. While Indian insurers have a good claim settlement ratio – the number of payouts per 100 claims – they often do not pay the entire amount charged by the hospital.
To understand why this could be a major problem for a patient, let’s consider a hypothetical, but highly probable, case.
Imagine you go to your doctor with chronic pain in your left flank. Your doctor sends you for a scan to see if you have kidney stones. Actually, you have two large stones in your left kidney – and one that has come down and is stuck in the ureter.
Your doctor says she wants to keep you under observation and see if the stones can be passed without surgery. You get admitted to the hospital. A series of tests are run in the first two days. You were given lots of fluids, but to no avail. Finally, on the third day, the stone is removed in the operation theatre.
Normally, you will be discharged after 24 hours of treatment, but you are suffering from mild diabetes and high blood pressure. So, your doctor says she would like you to stay in the hospital one more day.
Your surgery and the next 24 hours will be covered, but nothing else, as the remaining tests and days in hospital were neither necessary, nor were you being ‘actively’ treated.
So, despite paying heavily health insurance premiumStill, you may have to pay 30-40 percent of your hospital bill from your pocket.
