Health-Insurance and Third Party Administrators in India: Awareness and Perception of Policy-Holders

Health-insurance is indispensable these days due to scourging infectious and non-infectious diseases, increased uncertainty of life, proliferating health-care technologies and associated costs. Therefore health-insurance is an important mechanism in pooling risks and finances catering health-care needs of population. Third Party Administrators (TPAs), novel concept, introduced by Insurance Regulatory and Development Authority in 2001, as an interface between patients, hospitals and insurance-company, infused a new management-system of streamlining costs and quality health-care service issues. Designed with a prologue to ensure rights of both insurer and insured, it establishes a code of conduct for both. However, till-today, effective institutionalization of TPA services is a concern. There is a chunk-of-people unaware of the difference between TPAs and health-insurance agents. Towards this, a survey-study was carried out to ascertain awareness and perceptions of health-insurance policy-holders towards effectiveness of their services. The study concluded that TPAs were still at a nascent stage of development, with substantial delay in issuance of identity cards and unsatisfactory tele-service. Though the system claimed to be cashless, still certain amount was charged from patients at the time of hospitalization. Also negligence of patients towards booklet containing terms-and-conditions, list of included and excluded diseases and empanelled-hospitals were seen.