Why the AYUSH thrust is a boon for consumers and insurers alike!
Jul 29, 2016, 07.47 AM IST
The alarming increase in lifestyle and stress related chronic ailments followed by the severe side effects that allopathic drugs cause have forced people to turn to alternative forms of medicine such as Ayurveda and Homeopathy, considered largely to be a preventive medical science. While globally, alternative medicines have been gaining popularity as a part of a general health and wellness regime, the rise of a major homegrown domestic fast moving consumer goods brand has created waves and unsettled major multinationals in the category and has put the spotlight on Ayurveda and Homeopathy products in India in recent times.
Interestingly, the government too has recognized the importance of alternative treatments such as Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH) and has stepped up its efforts in promoting them by working with the apex ministry to streamline treatments and come out with a national policy governing these treatments.
Furthermore, AYUSH is also likely to receive a major boost as the government has announced plans to set up an All India Institute of Medical Sciences-like hospital, exclusively offering AYUSH treatments in every state to give a fillip to its usage.
The earlier National policy on Indian systems of medicine and homeopathy was framed in 2002 and since then a number of advancements have taken place in this field. In this span of fourteen years, National AYUSH mission was launched and various acts and laws concerning this field were amended too. Minimum Standard Regulation (MSR) on Ayurveda, setting up of infrastructural facilities to ensure safety and efficacy of AYUSH drugs, organization of world Ayurveda congress, celebration of first international day of Yoga, common Yoga protocol 2016 and similar steps have increased the awareness of the common public worldwide for acceptance and usage of this bunch of medical treatments as an alternative to conventional chemical based drugs.
For insurers, this is good news as companies would now be able to increase the usage of these treatments not just as a curative measure but also as a preventive shield to eventually bring down claim costs. Meanwhile for consumers, access to Ayush will considerably go up in their regular health insurance policies, which plays a critical element in financing healthcare expenses incurred. In 2013, while the insurance regulator- Insurance Regulatory and Development Authority of India (IRDAI) asked insurers to include AYUSH in health insurance products, it did not make it mandatory for general insurers to cover it in all health plans. Therefore, Ayush currently is being covered by many general insurers in their flagship comprehensive health plans albeit selectively.
However, after the national policy on AYUSH is formulated, it will help facilitate its integration in the existing healthcare delivery system in India. The improved regulation, quality control, enhancement in research and development and availability of extensive infrastructure will help in growth of these systems. A combination of these factors will create an ecosystem that will enable insurers to offer innovative products covering various aspects of healthcare through these systems and help insurers devise mechanism to improve health risk of its customer base. For some of the health conditions, average treatment cost may be lesser in AYUSH system, thereby helping insurers to reduce overall claims size and costs. Also, the standardization of AYUSH hospitals and treatments will ensure that AYUSH may become a standard feature across all health insurance products.
The biggest stumbling block for AYUSH treatments covered under insurance is that most insurers provide cover only for hospitalisation and largely AYUSH treatments do not require hospitalisation as in the case of modern medicine. It only covers in-patient expenses in a government hospital. The number of government-run Ayush hospitals is limited and those providing in-patient facilities are fewer. The coverage of alternative medicines is dependent on the particular insurer. There is also a capping on the amount covered which usually ranges from 7.5 per cent to 25 per cent of Sum Insured. Hence, currently the utilization of the Ayush cover is limited.
However to encourage the utilisation of AYUSH, outpatient department (OPD) services for AYUSH related treatments are important and can be offered to the customers of a health insurance policy. Many insurers have already started experimenting with OPD products which currently constitute a majority of the overall medical expenses incurred in the country.
These products are designed covering consultation and medicines purchase for Ayurveda, Homeopathy and similar treatments up to specified sub limits, for less serious and general diseases not requiring twenty four hours stay in a hospital. Such measures will ensure that health insurance customers are able to avail timely treatment to prevent the illness from worsening and may actually help in nipping the ailment in its inception stage.
Wellness programs leveraging the benefits of AYUSH also can be designed and can prove to be very good and popular for preventive maintenance. Home based therapies among others can also be a part of such wellness programs.
Additionally, with standardisation and availability of specialised Ayush hospitals, insurers will also be able to make them a part of their preferred provider network enabling availability of cashless access for easier claim settlement. The inclusion of AYUSH hospitals under network provider list will help insurers in standardizing billing formats and enable negotiated pricing for various treatments and procedures.
Insurers can also have AYUSH practitioners as consultants to establish that the care rendered to their customer is medically necessary and customary as per AYUSH treatment protocol. Further, government regulations regarding acts concerning AYUSH, safety testing and efficacy of AYUSH drugs, quality research in this sector will help insurers mitigate frauds. Ayush can also play a vital role in mass affordable health insurance schemes.
Overall, AYUSH is likely to play a key role in the Indian healthcare eco-system in the next few years as insurers and consumers alike are increasingly becoming concerned about the adverse effects of chemical based drugs and the rapidly escalating costs of conventional health care. Additionally, longer life expectancy and life style related problems have brought with them an increased risk of developing diseases such as obesity, cancer, diabetes, heart problems and mental disorders which are often chronic and fatal in nature.
For insurers, data generated over future years and experience will further help insurers to establish claim authentication and providing a seamless experience for Ayush across all health insurance products. The government thrust can help the Indian insurance industry take the lead in covering alternative treatments as even in developed markets like the US, alternative treatments in health insurance are covered in a limited manner restricted to treatments related to acupuncture, biofeedback, chiropractic treatment, massage and clinical hypnosis when found to be only medically necessary by the insurer.
A series of consultations and feedback from the insurance industry and insurance regulator with several lakh Ayush practitioners, healthcare experts and the health ministry will ensure that Ayush can be cohesively streamlined in the regular health insurance system and play an integral role in the healthcare delivery system in India.
Executive Chairman, Universal Sompo General Insurance Company Ltd