Simplifying Health Care is a social entrepreneurship, creating awareness on Individual and Corporate Social Responsibility to make quality Healthcare Affordable and Available to every Indian by Risk Pooling and Risk Sharing method. We have developed a sustainable, scalable model that is efficient, cost effective, creates a marginal surplus to the Insurer, the provider network and the managers by making people participate to eliminate moral Hazards.
We encourage people to discuss their medical problems and avail the health care solution from the doctors or hospitals that suits them the best. We request the Doctors and the hospitals to reduce their costs where ever possible in the interest of the patient and the insurers.
The high Claim Ratio in Mediclaim portfolio is the result of not addressing the issues of the components of health care industry and their role in cost escalation.
o Health care financier – i.e. insurer
o Health care Provider – i.e. hospitals / doctors / paramedics
o Patients – i.e. Policyholder
In this value chain, the Insurer is the weak link, vulnerable to moral hazards. He has no role in the medical management, but simply pays the bills or face the Consumer Forum action. He really needs a medical group that is ethical to advice, develop a system with inbuilt checks and balances to scrutinize the medical management, documentation, and billing and prevent the moral hazards.
Is, simply the winner? Patients come to him for treatment and do not question the costs, especially when the insurer is the paymaster.
By way of right, want the insurer to pay for all his health care costs, not worried about the costs and wants the treatment cashless. Often threatens legal action for non-compliance.
• Insurance Company,
• Insurance product,
• Value of cover But
• Have not empowered him to choose his TPA.
Empowering the people to select his choice of TPA is the vital link in bringing the Claim Ratio down.
It may be prudent for the insurer to refrain from appointing the TPAs known to have
• Links with Private Sector Insurance Companies
• Links with the Hospital chain
This will prevent the Public Sector Insurance Companies losing their data base and the customers to the Private Sector Insurance Companies on one side stop them from becoming the catchments area and cash cow for the private hospital chain.
• Insurance Companies empanelling all the IRDA Licensed TPAs and allowing the policyholders to choose their TPA.
• Bringing in competition amongst the TPAs by allotting work to all of them.
• Allowing the TPAs associate between each other and cover the country.
By appointing Anyuta TPA, as the consultant in Healthcare for their company, the Insurer will put an end to Moral Hazard in Health Care industry. Anyuta is a neutral TPA, focused and structured to bring down the healthcare costs and the claim ratio to create a win – win situation to all the stakeholders. We are proud to mention that our research and development (R&D) in the health care industry as the Care Provider, managers, claim processor and settler helped us to come out with a fool proof system of containing Moral Hazard.
Our field trial of this system as TPA in Health care, for UHIS, by New India Assurance Company Limited, in Karnataka, Mediclaim Policy for the entire State government employees and their families of Rajasthan State, provided by Rajasthan State Insurance and Provident run and the RSBY policies for 5 districts of Odisha State, provided by Ifco – Tokio, , is a success in containing revenue out flow, generating revenue for the insurer and hospitals while providing the best of care to the policyholders.
The key to success is in helping the Policyholder to take an informed medical decision, preventive care, minimizing the hospitalized care, cutting on unnecessary medication, encouraging domiciliary care, follow up care, utilizing the existing healthcare infrastructure and helping them to upgrade. Preventing specialists care when it could be delivered by competent Family Physician is a huge revenue saver.
Anyuta builds a healthy relationship between the Patients, Doctors and the Healthcare Financiers. As doctors ourselves we know that there is no alternative to the much revered DOCTOR – PATIENT relationship. By taking this relationship to a new height on an ethical platform, Moral hazard disappears. We also energize a new generation of Indians who would put the concept of service back in "public service."