Wednesday, June 3, 2009

Health insurance needs PROPER DIAGNOSIS

The author is fellow at ICRIER, New Delhi

IN ORDER TO ENSURE UNIVERSAL access to quality healthcare, the government has been making efforts for increasing health insurance penetration. The Insurance Regulatory and Development Authority (IRDA) recently relaxed norms for health insurance companies and reduced the reserve requirements. The IRDA has already licensed many third party administrators (TPAs) for faster and easier claim settlements and for providing cashless hospitalisation facility. Further, the FDI cap in the insurance sector is also set to be increased from 26% to 49% through the second insurance bill.
    Insurers are looking forward to tap the vast and fast-growing Indian healthcare market. In fact, many insurance companies have begun to offer health insurance. However, the path ahead is not so smooth for health insurers in a country like India. The health insurance industry in India at present is a loss-making one. Though the private sector health insurance is growing at 40% annually, the level of coverage is still very low and has not penetrated rural and semi-urban areas significantly.
    One of the biggest challenges — and an opportunity too — for insurance companies is to convert the huge out-of-pocket health spending (72% of the total health expenditure and 98% of the total private health expenditure) into a formal risk pooling
mechanism which people have never been exposed to before. Such a conversion process is constrained due to several factors, among them the absence of reliable morbidity and health expenditure data. Also important, from a demand-side perspective, is the low level of insurance awareness, poor trust in insurance companies over reimbursement, and absence of regular and adequate income to make regular premium payment.
    The process also involves tackling two important forms of market failures that are making insurers reluctant to sell health insurance — overutilisation of healthcare due to insurance coverage, and mostly the relatively unhealthy people buying insurance. One may wonder if these are not the common problems faced by insurers all over the world. However, the magnitude of these problems may be severe in India.
    Perhaps, both the insured clients and healthcare providers have an incentive for over-utilisation and overprovision of healthcare, adding to the bill of insurance company. Further, at present, the healthcare insurance schemes in India are mainly limited to hospitalisation, forcing the insured persons to be admitted to hospitals even for those illness requiring only out-patient care. One solution can be including the out-patient treatment as well in the insurance package, but the resulting premium will not be affordable for majority of the Indians.
    On the supply side, there are hard
ly any pricing criteria for healthcare services and no benchmark as to how much care is required by patients for each category of illness. Further, healthcare cost inflation is sure to rise further, All these will force insurance company to increase the premium, thus making health insurance a costlier proposition.
    One possible way of controlling the over-utilisation of healthcare due to insurance coverage could be the use of co-insurance and deductibles so that insured clients also have to bear a part of his total incurred health expenditure. But this will be very hard to introduce as already the present insurance schemes cover only a part of the health expenditure and, therefore, any attempt to increase the out-of-pocket healthcare burden of insured clients would make health insurance a less attractive health-financing strategy.
    In India, a majority of those buying insurance do it for investment purposes and not as an insurance product. But the health insurance schemes are without the saving component (being purely of risk pooling). This could dissuade many from getting insured. In such a situation, it is obvious that only those likely to require healthcare are interested in buying health insurance.
    It is time insurance companies applied appropriate and innovative marketing strategies to overcome all these hurdles by taking the Indian reality into account.

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Tuesday, June 2, 2009


I am a 50-year-old housewife. I am slightly overweight and have gained five kilos in the last two years due to sedentary habits. I have mild arthritis in my knees and hence, avoid exercising. My doctor suggests that I start exercising. Will it help my joints? What kind of exercises would you recommend? Please suggest ones that I can do at home.
    — Usha Bajoria
Dear Usha,
The right exercise regime can strengthen your joints, increase flexibility and improve cardiovascular fitness. Exercise is also important for weight reduction and overall well-being. Don't get into a vicious cycle of inactivity. This in time leads to more stiffness, reduced strength and cardiovascular fitness.

• Improve joint care through rest and exercise.

• Maintain an acceptable body weight.

• Achieve a healthy lifestyle.

• Begin slowly and progress gradually.

• Avoid rapid or repetitive movements of affected joints.

• Adapt activities to suit your needs.
Stretching exercises preserve range of motion and flexibility around each joint. Even inflamed joints can be put through a gentle stretch routine.
Strength training exercises using lightweights builds bone strength. Isometric strength exercises are often used to strengthen joints. Do these exercises only when pain and joint inflamma
tion are under control.
In the past, treatment of arthritis excluded aerobic exercise for fear of increasing joint pain. Aerobic exercise is however, safe and effective when the joint inflammation is not acute. Low impact cardiovascular exercises such as swimming, cycling and walking are great too. Note: Always consult your physician for exercise guidelines.
Lie on a mat or carpet. Extend the right leg up and place a bath towel around your right foot. Hold the ends of the towel and straighten your leg. Hold for 10-30 seconds and then switch legs.

Raise one leg up onto the chair, resting your heel on the edge of the chair. Slowly bring the knee closer to you chest. Repeat with the other leg.
With your feet shoulder-width apart, knees slightly bent and toes pointing straight ahead, place your right hand on your hip while you extend your left arm over your head. Slowly bend at the waist to the side and hold. Repeat on the other side.
Clasp your hands in front of you so that you feel the stretch in your upper back. Lower your head during the stretch so that your chin is close to your chest.
Clasp your hands behind your back and slowly lift your hands up until you feel a stretch.
Cross the right arm horizontally over your chest, placing your left hand or forearm just above the elbow joint, pull the right arm closer towards your chest.

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Dr Rajeev Warrier prescribes easy-to-do ayurvedic recipes for complete well-being

Diet, according to Ayurveda, defines the nature of a person, his response to circumstances, mindset and moods. Ayurveda classifies food materials into several groups such as like grains, grams (dhaanya varga), types of milk and milk products (ksheera varga), vegetables and fruits (saaka varga), types of meat (maamsa varga) etc.
    The solid diet consumed should take up half the capacity of the stomach, the liquids should take a quarter and the fourth quarter should be left free to aid digestion. The order of the intake of food is important too — sweet and heavy food first, sour and salty tastes next and the meal should end with astringent and bitter food substances. This aids digestion and absorption.
Ingredients: 1/2 cup moong dal, 1 cup broccoli florets (chopped), 4 cups water, 1 tbsp lime juice, 1/2 tsp ginger (minced), 1 tbsp fresh cilantro (chopped), 2 tbsps ghee, salt and black pepper to taste
Method: Wash moong dal and add water to it. Cook it in a pressure cooker until tender. Mix it with broccoli, lime juice, ginger, salt and
black pepper. Grease a shallow baking dish with ghee. Scoop the mixture into the dish and drizzle more ghee on top. Bake at 350-375 degrees for 10 minutes. Garnish with cilantro.
Ingredients: 2 cups asparagus stems (diced), 2 tbs water, 1 tsp lemon juice, 1 tsp cumin seed, ¼ tsp turmeric, ¼ sweet paprika, ½ cup almonds (sliced), 2 tbs ghee Method: Heat ghee until it looks clear. Add cumin seed and stir briefly and add turmeric and paprika. Now add the asparagus stems and sauté for 2-3 minutes more. Now cover the pan and stir occasionally. Add water to prevent sticking. Add in the almonds and cook for two more minutes. Serve hot.
Ingredients: 1 small white radish (peeled), 1 medium zucchini, 1
medium carrot (peeled), 1 fennel bulb, 6-8 almonds (soaked and slivered), 2 tbs ghee, 1-2 tbs water, salt and pepper to taste
Method: Wash and slice all the vegetables finely. Heat ghee in a large flat pan. Sauté the almonds and add all the vegetables. Stir for a couple of minutes and cover the pan. Cook the vegetables on medium flame until tender. Season with salt and pepper and serve hot.
Ingredients: 1 cup carrot (sliced), 1 tbsp raisins, rock salt and black pepper to taste, 1/2 tsp minced ginger root, 1 tsp fresh parsley, 1/2 tsp fresh lemon juice, 1/8 tsp fresh lemon peel, 1/8 tsp crushed cardamom, 1 tbsp ghee
Method: Steam the carrot for 5-6 minutes until tender. Heat ghee in a pan and sauté the raisins. Now add carrots, ginger cardamom, salt and pepper. Stir for three to four minutes. Drizzle lemon juice, the peel and parsley. Serve hot.
(Dr Rajeev Warrier is xyz of Arogya Ayurvedic Spa & Clinic)

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