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Claim severity in cashless mediclaim higher: Irda

February 15, 2011 09:45 IST
StethoscopeInsurance companies may like to deal with hospitals and third-party administrators more cautiously after going through the latest data on medical inflation.

According to data analysed by the Insurance Regulatory and Development Authority, the claim severity is 83 per cent higher in case of cashless mediclaim than reimbursement in the last two years.

Cashless mediclaim allows policyholders to get treatment without paying for it at the hospital. The insurance company settles the bill directly with the hospital.

SHEDDING LIGHT
NUMBER OF CLAIMS
  2007-08 2009-10 % Chg
Arthropathies 14,500 20,330 40.21
Blood Diseases 1,435 1,972 37.42
Circulatory 35,776 49,687 38.88
Digestive 25,881 36,420 40.72
Ear 1,466 2,371 61.73
Endocrine 5,591 6,426 14.93
Eye 6,298 12,623 100.43
Infections 9,759 12,969 32.89
  2007-08 2009-10 % Chg
Injury 24,508 33,400 36.28
Neoplasm 21,999 31,475 43.07
Nervous 4,152 6,030 45.23
Pregnancy 15,391 28,539 85.43
Respiratory 8,425 13,824 64.08
Skin 2,255 3,410 51.22
Urology 22,028 33,407 51.66
TOTAL 199,464 292,883 46.84
Source: Irda

The report said the overall claim severity had increased by 27 per cent for 2009-10 as compared to 2008-09, while circulatory disease had gone up by 56.99
per cent.

The intensity of claims varies according to the disease, reflecting the complexities of treatment. Similarly, claim severity increased in all cases, except for endocrine, eye, infections and respiratory diseases, the report said.

There were, however, no major variations in the average number of days of stay in hospitals under cashless and reimbursement heads for settlement of claims.

The report found that in case of above average hospitals, the severity of claims was 70 per cent higher than the industry average.

The report said the medicine cost to surgery charges varied in case of reimbursement and cashless systems.

Medicine cost was also higher in cashless mediclaim.

BS Reporter in Mumbai
Source: source image