Role of health insurance in allergic disease management

According to a report, a total of 288 million Indians were covered under health insurance during 2015 from government and private entities. It was also reported that Government health insurance schemes amounted to about 335 million Indian rupees covering about 214 million rural population in FY2015. However, the national health report of India in 2018 indicated 34% of the total population of India have health insurance coverage, 79% of them were covered by public insurance companies and government schemes. This indicates the lack of awareness and lack of healthcare coverage to the population of India.

The share of coverage and premium across insurance type and provider 2017 (Insurance Regulatory and Development Authority India, 2017)

The share of coverage and premium across insurance type and provider 2017 (Insurance Regulatory and Development Authority India, 2017)

Asthma and allergic rhinitis are the most prevalent allergic conditions in India. The expenditure caused by the treatment and management of allergic diseases poses a huge economic burden on the country. India is one of the
least insured countries globally, with a health insurance penetration rate of about 20%. The World Health Organization (WHO) indicated that the public sector in India spent just 1.46% of gross domestic product (GDP) on health care, ranking 187th among 194 countries in 2017 (Ernst & Young, 2018). Researches indicate a lack of government funds, lack of proper treatment and management facilities (allergic diseases) and lack of healthcare insurances and services. Improvement of these aspects has helped developed countries like France, USA, and the UK in public healthcare.

How do health insurance companies gather data?

The insurance companies determine the prevalent types of diseases in India that requires a large amount of out of pocket expenses for the treatment and management of the disease. They first collect the data of incidence cases, mortality cases and cost of expenses made for the treatment for all allergic diseases prevailing in India (PwC, 2017). Electronic medical records or electronic health records collected by health insurance companies is the biggest source of data collection. In addition, health insurance companies also make tie-ups and joint ventures with hospitals to improve health insurance marketing and data collection.

Data collection by health insurance companies

Data collection by health insurance companies

The private firms also gather data from research registries, clinical data, and social and digital media (McKinsey & Company, 2018). The major type of data that is obtained by the insurance companies are the patient demographics of the allergic diseases, frequency of respiratory disease among each category of the allergic disease, healthcare resource utilization on the particular allergic disease, annual direct and indirect cost of treatment of allergic disease and activity impairment with the age of patients suffering from the allergic disease (Ghoshal et al., 2016).

How do health insurance companies target audience?

The majority of the medical insurance companies are targeted toward the adult section of the society i.e. 25- 50 years of age (PwC, 2017). They provide a variety of medical insurance that protects them against any mishappening caused by allergic diseases. However, the medical insurance companies have now started including the pre-existing medical conditions in the clause, such as cancer, infections, and birth-related issues; in case of any emergencies caused by those medical conditions in case of travel or other things. This age group is highly targeted because they are the working section of the society that can easily afford the expenses of medical insurance for protecting themselves from allergic disease and its time management.

Target audience factors for health insurance provision

Target audience factors for health insurance provision

The dependent children and old age parents are also supported by the parents that belong to this age group. Another section as a target audience is the old age people i.e. 50-80 years of age. This is due to the fact that the allergic reactions become more severe from the old age. The insurance companies have devised specific insurance policies for the old age group of people (PwC, 2017). They also have included several pre-existing conditions because at this age people develop several medical conditions that need special care.

How health insurance help in the management of allergic diseases?

Allergic diseases are generally exempted from medical insurance, in accordance with the pre-existing disease clause, especially in India. However, nowadays there are some medical insurance companies that are providing medical insurance for pre-existing diseases like asthma, cancer, and childhood conditions, under set circumstances. Furthermore, the premium for such medical insurance is higher than the normal medical insurance according to a report published in 10th Global Conference of Actuaries, India. This can, however, help to control the disease with the help of financial health provided by medical insurance including pre-existing conditions (Mohanty, 2016). There is a very less population that is covered with the medical insurance for the allergic diseases, that too by a private medical insurance company that does not cover the out of pocket cost for the medication. However, these insurances cover only the expenses of the hospitalization charges (Koul and Dhar, 2018).

However, considering the case of USA, they have the provision of health insurance to people suffering from any allergic conditions that need medical treatment and intervention. The Asthma and Allergy Foundation of America (AAFA) provides health insurance to those affected with asthma and other allergic conditions (AAFA, 2018). There are programmes like; The Children’s Health Insurance Program (CHIP), Medicaid, Medicare, and The Consolidated Omnibus Budget Reconciliation Act (COBRA). In addition, people insured by AAFA ensure proper insurance coverage for hospitalization and treatment procedures. They also provide insurance to children suffering from allergies for early management and interventions, like the Kids With Food Allergies (KFA) community. According to a report by AAFA in 2016, health insurance to people and children has helped in reducing the burden of expenditure and management of allergic conditions in the USA.

Health insurance in the USA helped in reducing the economic burden

Over the years, health insurance for allergic conditions in the USA has reduced the economic burden of cost to $18 billion in 2016 from over $30 billion in 2011 (AAFA, 2018). Similarly, the economic burden from food allergies too reduced to about $25 billion from over $50 billion in 2011. Even though, the prevalence of allergic cases especially allergic rhinitis makes a steady rise of 6.1 million children and 20 million adults as in 2017, a decrease in overall economic burden helps patients in better allergic management and healthcare. Thus, it is a classic case example of how health insurance companies helped in the management of allergic diseases in the USA.

In India, a majority of the population do not possess health insurance and high premium costs even for the insured may preclude purchasing asthma medications. However, a wider penetration of the health insurance schemes with lower premiums may improve access to routine care and adherence to medications for persons with allergic. Better healthcare expenditures by the public and private sector may also help in reducing the economic burden of allergies in India.

Reference

Avishek Majumder

Research Analyst at Project Guru
Avishek is a Master in Biotechnology and has previously worked with Lifecell International Private Limited. Apart from data analysis and biological research, he loves photography and reading. He loves to play football and basketball in his spare time with an avid interest in adventure and nature. He was also a member of the Scouts in his school and has attended Military training.
Avishek Majumder

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