Insurer have to examine whether the healthcare system has improved for the better since the mandatory health insurance has come into effect. If not, why not? Also, they need to question whether there is any yardstick or indicator that would help them evaluate the system per se run by independent authorities. Are the insurers better of today in all respects: in terms of number of insured policy holders, profitability of the business and last, but not the least, the claim scenario. Most importantly, the feedback of reinsurers.
Policy Holder will have an equal of questions to ask: Does the compulsory insurance benefiting the companies or is it an added cost to them? Has the mandatory health insurance led to better employee performance at the workplace? Certainly, the impact on their respective balance sheets – after all, everything involves money.
Health Care Provider will not be lagging behind other stakeholders. They do have their own set of questions such as: is the country equipped to handle the sudden influx of more healthcare seekers in terms of hospitals, clinics, physicians, specialist, paramedics etc. What should be the relationship between the cost of service and the volume of business in terms of handling more patients? Put it differently, does it mean more patients should lead to lowering of costs? Tough questions indeed. Of course, the capacity to handle the processing of patients’ paper work and the correlation with insurance companies and the third party administrators.
Regulator will have to examine the efficiency of the system in place in regulating all stakeholders. Is the monitoring mechanism in place adequate? If not, how to beef out. How to weed out elements that dilute the basic philosophy of providing adequate healthcare to all and sundry on a compulsory basis? Cost of treatment will definitely top the agenda because it is all about business and money. How good is the fraud detection mechanism: does the existing mechanism able to proactively function or is it in a reactionary mode?
The Gulf Health Insurance Forum 2010 will turn the spotlight on these critical issues. |