India is grappling with one of the highest rates of medical inflation in Asia, standing at 14%, coupled with a burden on individuals who pay for their own healthcare. A staggering 71% of Indian workers cover their healthcare costs out of pocket, a figure that is alarmingly high compared to global standards. According to 2021 data, India ranks 28th globally for out-of-pocket health expenditure, surpassing even many low-GDP African nations.
Nithin Kamath, co-founder of Zerodha, has underscored the critical need for Indians to secure comprehensive health insurance. In a post on X, Kamath warned that the majority of Indians are "one hospitalization away from bankruptcy," highlighting the financial vulnerability of those without adequate health coverage.
Kamath advised that to avoid financial distress during medical emergencies, Indians should opt for insurers with a proven track record of at least five to ten years, and a favorable claim settlement ratio of around 80-90%. "A good health insurance plan is mandatory," Kamath emphasized.
Reflecting on his personal experience, Kamath, who suffered a stroke in February of this year due to factors such as lack of sleep, overwork, fatigue, and the loss of his father, stressed the importance of selecting an insurer with an incurred claim ratio between 55-75% and a network of 5,000–8,000 hospitals.
Kamath also recommended avoiding health insurance policies with room-rent restrictions and disease-specific sub-limits, as these can lead to substantial out-of-pocket expenses. He advised choosing plans with minimal waiting periods for pre-existing conditions, restoration benefits, and coverage for daycare treatments, along with pre- and post-hospitalization care. Additional features to consider include domiciliary care (at-home care), free annual health checkups, loyalty bonuses, wellness discounts, and coverage for alternative medicine.
The challenges of healthcare costs in India were further highlighted in a report by Insurtech company Plum titled "Health Report of Corporate India 2023." The report revealed that only 15% of workers received health insurance support from their employers, leaving the majority to shoulder the burden of their healthcare expenses.
Compounding the issue are difficulties in getting insurance claims approved. A survey by Local Circles, which included 39,000 participants across 302 districts, found that 43% of respondents faced challenges in having their claims authorized. The reasons cited included inadequate disclosure of policy limitations, confusion caused by technical jargon, and denials due to pre-existing conditions.
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