The ACKO India Health Insurance Index 2024 has presented a detailed examination of health trends across India, based on data collected from roughly 60,000 claims.
This comprehensive report sheds light on various medical conditions, healthcare patterns, and financial challenges within the healthcare system, offering insights to guide policy decisions and insurance strategies.
As a key player in the Indian health insurance market, ACKO’s aim is to leverage this data to refine its services and better address the shifting needs of its customer base.
The report identified several significant trends related to medical conditions, with a focus on geographic, gender, and age-related disparities. For example, kidney-related claims were highest in Delhi NCR, while cities like Kolkata and Mumbai topped the charts for heart disease claims.
The analysis also noted a high prevalence of heart-related conditions in cities such as Chennai and Pune.
Meanwhile, 69% of maternity claims were linked to C-sections, with a notable distinction between public and private healthcare facilities.
A major issue highlighted in the report is the increasing cost of healthcare.
ACKO reported an average rise of 11.35% in claim sizes, a reflection of medical inflation, which reached 14% in India during 2023.
The financial burden of healthcare remains significant for many households, with 62% of healthcare costs being paid out-of-pocket. Additionally, only 23% of urban households have health insurance coverage, leaving a large portion of the population financially exposed in the event of medical emergencies.
ACKO emphasised that comprehensive health insurance is essential to protect against these rising costs and provide financial security.
The report also analysed health trends across different age groups. It found that respiratory conditions were more common among those under 18, accounting for over 11% of claims for this age group.
Conversely, the frequency of tumour-related hospitalisations saw a marked increase after the age of 40.
Heart disease risks also surged significantly between the ages of 31 and 50, with the risk of hospitalisation for heart-related conditions tripling over this period.
The report noted that Indians face higher risks of heart disease compared to other populations due to a combination of genetic factors, lifestyle choices, and dietary habits.
In addition to health trends, the ACKO report examined the financial aspects of insurance policies. It found that corporate health insurance plans often fail to cover the full cost of hospital bills, primarily due to policy limitations set by employers.
ACKO recommends that individuals consider supplementing their corporate plans with personal health insurance to ensure adequate coverage, especially in light of rising medical costs.
The report also underscored the importance of understanding critical insurance terms such as waiting periods, room rent limits, and deductibles, which can significantly impact the extent of coverage available under a policy.
Meanwhile, ongoing discussions in India’s Goods and Services Tax (GST) Council may soon affect the insurance landscape.
The council is currently reviewing the possibility of reducing GST rates on health insurance premiums.
A group of ministers has been appointed to study this issue and is expected to submit their findings by the end of October 2024.
Industry experts believe that a reduction in GST could make health insurance more affordable and accessible, ultimately boosting insurance penetration across India.
Insurance industry leaders have expressed optimism about the potential GST reduction. They argue that lowering the tax rate on health and life insurance could help close the gap in social security coverage, particularly for white-collar workers who are not covered under government programs like the Employees’ State Insurance Corporation (ESIC).
Lowering the GST could also encourage more individuals and businesses to invest in health insurance, which would help increase financial protection for a broader section of the population.
