Customer’s Expectations to Stakeholder’s Abuse: Combating Fraud in Health Insurance

Round # 3:
Customer’s Expectations to Stakeholder’s Abuse: Combating Fraud in Health Insurance

Post liberalization in 2000, Health Insurance sector has had its ups and down. At the moment Third Party Administrators (TPA’s) are playing a cardinal role in pushing the reach of health insurance in India. The concept of cashless hospitalization which has been a major factor in instilling confidence among customers of Health Insurance has been viable because of TPAs. Of late, this sector is in murky waters. With a potential 1.23 billion customers, need for addressing the issue of frauds is imminent. There is a need to reduce the gap between decision making and decision implementation, this effect should be visible in both external and internal factors influencing a company. Profiting and not Profiteering should push growth forward.

There is a lack of confidence between TPAs and other stakeholders’ viz., insurers, insured and hospitals. On one hand, it has led insurers to believe that TPAs are the cause of high claims outgo and increased grievances, while on the other hand it has also caused hardships for the insured.

Few companies have braced the storm of frauds well, while others are struggling to get a grip. Where are we going wrong? Is the system at blame? Do we need to reconsider our ethical stance? With momentum shifting towards the need for Social Health Insurance, in longer run, it will be the exchequer that is to bear the brunt. This will have serious economic consequences.

How to resolve this stalemate? What are the confidence building measures to break this impasse? These are some of the pertinent questions which need to be answered to keep the growth of this efficient portfolio of Health Insurance consistent