Insurers in spot as medical advances push up treatment cost
The
challenge for insurers is in determining which procedures to admit, as
some of them cost double for the same outcome but use less invasive
methods.
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MUMBAI:
Advances in medical technology are resulting in higher health insurance
claims, with some treatments seeing a 50% jump in costs due to new
procedures.
Policy holders are opting for new procedures that are less painful and ensure faster recovery but cost substantially more. Take the case of coronary stent implants. Traditional metallic stents cost around Rs 40,000 on average. These were followed by drug-eluting stents. These are superior to metal stents as they release medicines which prevent complications, but cost Rs 1.5 lakh on average. But even they have now been overtaken by biodegradable stents, which cost above Rs 3 lakh each.
According to Sanjay Datta, head, claims and underwriting at ICICI Lombard, procedures are normally accepted if they are proven to be the safer option and are not at the trial stage. "Treatment costs have gone up by 50-60% in some cases such as arthritis and brain stroke. Several other ailments such as spinal cord disorders, heart stroke, and hip and thigh fracture have witnessed an increase of 25 to 50% in treatment costs," he said.
The challenge for insurers is in determining which procedures to admit, as some of them cost double for the same outcome but use less invasive methods. In other fields, cutting-edge technology is used by those who can afford it. However, in the case of health insurance it is available to all. The dilemma for insurers is whether to admit these claims and push up the cost of health insurance for all or to ask claimants to meet part of the cost.
Policy holders are opting for new procedures that are less painful and ensure faster recovery but cost substantially more. Take the case of coronary stent implants. Traditional metallic stents cost around Rs 40,000 on average. These were followed by drug-eluting stents. These are superior to metal stents as they release medicines which prevent complications, but cost Rs 1.5 lakh on average. But even they have now been overtaken by biodegradable stents, which cost above Rs 3 lakh each.
According to Sanjay Datta, head, claims and underwriting at ICICI Lombard, procedures are normally accepted if they are proven to be the safer option and are not at the trial stage. "Treatment costs have gone up by 50-60% in some cases such as arthritis and brain stroke. Several other ailments such as spinal cord disorders, heart stroke, and hip and thigh fracture have witnessed an increase of 25 to 50% in treatment costs," he said.
The challenge for insurers is in determining which procedures to admit, as some of them cost double for the same outcome but use less invasive methods. In other fields, cutting-edge technology is used by those who can afford it. However, in the case of health insurance it is available to all. The dilemma for insurers is whether to admit these claims and push up the cost of health insurance for all or to ask claimants to meet part of the cost.
RANJAY KUMAR
PGDM
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