The Healthy You Foundation, an NGO working in healthcare sector, has recommended the Insurance Regulatory Development Authority (IRDA) to bring out radical changes and issue guidelines for insurance companies to design affordable and consumer-firendly health insurance policies by incorporating `critical illness diseases’ and `in home-treatment’ expenses within two continuous years of policy.
The Foundation has also suggested the National Pharmaceutical Pricing Authority (NPPA) to adopt more realistic approach to improve accessibility to quality medicines and ensure affordability without compromising on quality and safety.
In a Paper on `Access of Affordable Quality Health Coverage’, the Healthy You Foundation has pointed out that in view of present scenario of expansive health insurance policies, the Regulator should advise the insurance companies to revised terms and conditions and terminology of policies keeping in view the economic profile of the consumers and designed in a manner that it becomes most affordable for the Indians.
The Foundation also stated that in the present context the consumers who have purchased healthcare policies find it difficult to sustain because currently it lacks prompt redressal and access of quality healthcare.
Currently critical diseases expenses and in-house treatment expenses are not covered and are provided in a selective manner to the consumers, depending on the amount paid as premium and duration of the policy for more than 3-4 years, pointed out Bejon Misra, Founder of Healthy You Foundation.
The Paper therefore suggests that if the Insurance Companies and the government are serious on Universal Health Coverage(UHC), then the only solution is simplifying the process to purchase insurance policies for the consumers and making them consumer friendly in terms of renewal and processing of claims.
IRDA should ensure improvement in the access of insurance products pertaining to healthcare coverage and health-related risks in an affordable manner to the consumers, added Bejon Misra.
The health profile of all the citizens in India is a must and should be made mandatory with the Aadhar Card to sustain and achieve the objective of UHC faster”, further added the Foundation Paper.
One of the major issue which needs to be resolved promptly is the differences created between hospitals, insurers and Third Party Assessors (TPAs) and the individual policyholder who are left in the lurch because of lack of transparency and accountability.
On the access of medicines; the Foundation also suggested that institutions like NPPA need to become more pragmatic in order to improve accessibility to quality medicines and ensure affordability without compromising on quality and safety.
Modern technology enables transparency and accountability to the end users of medicines, which unfortunately is lacking in the country. There is an urgent need to protect the patients from unsafe and irrational use of medicines. Healthcare sector is one of the largest and critical-to-people sectors. The information asymmetry and the human sensitivity only add to the complexity.
Under the UHC, improving access to essential medicines is perhaps the most complex challenge for all stakeholders in the public, private and NGOs involved in the field of medicines supply. They must all combine their efforts and expertise, and work jointly towards solutions.
An overall capacity strengthening of the health and supply systems is a prerequisite to respond adequately to the increased medical and pharmaceutical needs of populations.