The health situation and the provision of services vary considerably from one State to

another. Although public health services in principle provide free basic health care to all, the
care provided by most state health systems suffers from inadequate resources and poor
management. As a result, the majority of the population turns to private health services that
offer more expensive care and of very unequal quality.

In India, the health system mixes public and private providers. Public health facilities - local
clinics providing basic care, regional hospitals, national hospitals - are funded by the federal
states and the federal state and managed by the state authorities.

India's public health expenditures are lower than those of other middle-income countries. In
2012, they accounted for 4% of GDP, which is half as much as in China with 5.1%. In terms
of public health spending per capita, India ranks 184th out of 191 countries in 2012. Patients'
remaining costs represent about 58% of the total. The remaining costs borne by the patient
represent an increasing share of the household budget, from 5% of this budget in 2000 to over
11% in 2004-2005. On average, the remaining costs of poor households as a result of
hospitalization accounted for 140% of their annual income in rural areas and 90% in urban
[Link] financial burden has been one of the main reasons for the introduction of health
insurance covering the hospital costs of the poorest.

The aim of the study was to analyze healthcare projects from the viewpoint of the planning,
implementation and evaluation of the projects. The purpose was to generate knowledge about
the work done in projects that can be utilized in healthcare management
.
The study was a non-experimental survey. Descriptive statistics were collected using a
convenience sampling method. The data were collected from all hospital-funded development
projects in all acute care setting in one Finnish university hospital. 397 project participants were
recruited for participation in the web survey which formed the basis for the research data. The e-
questionnaire was comprised of five domains: Project planning and providing information about
the project; Experiences of project implementation (16 questions); Evaluation (7 questions);
Human resources affecting the project outcomes (26 questions). The questionnaire included
background information as well as open-ended questions enquiring about the participants' views
on the development of project related activities. After two survey rounds the response rate was
29.5% (n=117). Quantitative data were analyzed using descriptive statistics. Qualitative data
were analyzed using content analysis.
Results: 71% of the project participants took part in the project in addition to their usual
responsibilities. The participants were mainly physicians and nurses (77%). Half of the
participants were in managerial positions and had previous project experience. 50% of the
participants thought that the information communicated about the project was sufficient. The
project groups were multi-professional; cooperation was seen as having been successful and
that aims were perceived as having been achieved successfully(92.5%). Although the
participants noticed a conflict between their own work and the project work, their eagerness for
future-oriented development and smooth integration of project results as part of their daily
routines were the main reasons they took part in the projects.
Conclusions: Setting up clear guidelines and adhering to them would encourage experts to take
part in projects. Dissemination of information during the project internally and externally would
strengthen the degree of commitment of the project participants. Integration of projects into the
hospital strategy would be of primary importance to guarantee the success of long-term
systematic development work.
Keywords: Project, project management, project work, health care, human resources
The percentage of India's national budget allocated to the health sector remains one of the
lowest in the world. Currently, efforts are being made to expand health insurance coverage as
compulsory in India, because in India only there is no minimum health insurance percentage.
When we compare to other countries the rank of the India in health insurance is very low. We
note that most of the insurance companies to focus on patients in hospital. We briefly
highlight some of the more popular forms that government, private, and community-based
insurance schemes have taken and the results of quantitative research conducted to assess
their reach and cost-effectiveness.

As a result, 71% of the project participants took part in the project in addition to their usual
responsibilities. The participants were mainly physicians and nurses (77%). Half of the
participants were in managerial positions and had previous project experience. 50% of the
participants thought that the information communicated about the project was sufficient. The
project groups were multi-professional; cooperation was seen as having been successful and
that aims were perceived as having been achieved successfully (92.5%). Although the
participants noticed a conflict between their own work and the project work, their eagerness
for future-oriented development and smooth integration of project results as part of their daily
routines were the main reasons they took part in the projects.

KEYWORDS: Health insurance, ethnography, Health Policy and Systems Research

(HPSR), India
Introduction:

The concept of health insurance was proposed in 1694 by “Hugh the Elder Chamberlen” from
the “Peter Chamberlen family”. In the late 19th century, "accident insurance" began to be
available, which operated much like modern 10 disability insurance. This payment model
continued until the start of the 20th century in some jurisdictions (like California), where all
laws regulating health insurance actually referred to disability insurance. Patients were
expected to pay all other health care costs out of their own pockets, under what is known as
the fee-for-service business model. During the middle to late 20th century, traditional
disability insurance evolved into modern health insurance programs. Today, most
comprehensive private health insurance programs cover the cost of routine, preventive, and
emergency health care procedures, and also most prescription drugs, but this was not always
the case. Insurance may be described as a social device to reduce or eliminate risk of life and
property. Under the plan of insurance, a large number of people associate themselves by
sharing risk, attached to individual insurance plan that exclusively covers healthcare costs
and is called Health Insurance. Since the past two decades, there has been a phenomenal
surge in acceleration of healthcare costs. This has compelled individuals to have a re-look on
their actual monthly expenditures, spending patterns and simultaneously allocate a proportion
of their income towards personal healthcare. This has resulted in individuals availing
healthcare insurance coverage not only for themselves but also for their family members
including their dependants. In short, healthcare insurance provides a cushion against medical
emergencies. The concept of insurance is closely concerned with security. Insurance acts as a
shield against risks and unforeseen circumstances. In general, by and large, Indians are
traditionally “risk - averse rather than risk lovers by nature”.

How many accident you need to realise that you need Health Cover? It takes just one visit to
a hospital to make us realize how vulnerable we are, every passing second. For the rich as
well as poor, male as well as female and young as well as old, being diagnosed with an illness
and having the need to be hospitalized can be a tough ordeal. Heart problems, diabetes,
stroke, renal failure, cancer – the list of lifestyle diseases just seem to get longer and more
common these days. Thankfully there are more speciality hospitals and specialist doctors –
but all that comes at a cost. The super-rich can afford such costs, but what about an average
middle class person. For an illness that requires hospitalization/ surgery, costs can easily run
into five digit bills. A Health insurance policy can cover such expenses to a large extent.
Read why Health Insurance is more important these days compared to Old days Health is a
human right, which has also been accepted in the constitution. Its accessibility and
affordability has to be insured.

Some major health insurance companies in India include:

 National Insurance Company.

 New India Assurance.
 United India Insurance.
 ICICI Lombard.
 Tata 11 AIG.
 Royal Sundaram.
 Star Allied Health Insurance.
 HDFC standard life.
 Bajaj Allianz Apollo.
 AG Health Insurance Company.

India‘s fast growing demand for affordable health cover is attracting greater business
attention, with both life and non-life insurance companies now entering the market with
innovative new protection and savings medical insurance products. This intense competition
for health insurance customers has only intensified in recent months, with the introduction of
new savings linked and investment-oriented health insurance schemes by some of the
country‘s largest insurance groups. India‘s insurance sector first opened up to private and
international investors in 2001. Over the past ten years coverage rates across the populous
South Asian country have doubled and the domestic insurance industry has overtaken several
more developed financial markets in the process. The overall number of insurance policies
sold has increased several times over, and combined premium income is now projected to
reach between US$350 to US$400 billion by 2020. Health insurance, in particular, has
become as one of the country‘s fastest growing insurance lines, accounting for almost a third
of new written premiums last year. Sales of medical insurance products have been driven by
three key factors:

 A low penetration rate of about 5 percent at present.

 Surging treatment costs.
 Lack of other social safety options across most of India.
With total expenditure on healthcare, through both Indian government schemes and private
sector activity, expected to exceed US$200 billion by 2015, even more significant
opportunities for the country‘s health insurance sector will likely emerge. Over the next three
years, health insurance has the potential to 12 become an INR300 billion market (US$6
billion), according to industry observers. The introduction and increased proliferation of
private sector players in India‘s health insurance sector has worked to both develop
innovative new coverage products and increase service standards for clients in the domestic
market. Of particular note has been how the entrance of several major life insurance brands,
including:

 Life Insurance Corporation of India.

 Aviva Life Insurance.
 Max Life Insurance.

Has affected the market recently. These life insurers offer largely savings-based health plans
that provide lump sum compensation to clients in case of a critical illness or other malady
specifically defined by a specific policy. These long-term products have tenures that can last
up to 20 years. When the policy expires, customers are entitled to receive the fund value.
Normally this is not a cashless process as payment is reimbursed on submission of medical
bills. Most of these health insurance plans sold by life insurance companies are unit-linked
insurance products, whereby returns are determined by the performance of the stock market.
Industry Profile
HEALTH INSURANCE SCENARIO IN INDIA

Health is a human right. It’s accessibility and affordability has to be ensured. The escalating
cost of medical treatment is beyond the reach of common man. While well to do segment of
the population both in Rural and Urban areas have accessibility and affordability towards
medical care, the same cannot be said about the people who belong to the poor segment of the
society. Health care has always been a problem area for India, a nation with a large
population and larger percentage of this population living in urban slums and in rural area,
below the poverty line. The government and people have started exploring various health
financing options to manage problem arising out of increasing cost of care and changing
epidemiological pattern of diseases. The control of government expenditure to manage fiscal
deficits in early 1990s has let to severe resource constraints in the health sector. Under this
situation, one of the ways for the government to reduce under funding and augment the
resources in the health sector was to encourage the development of health insurance. In the
light of escalating health care costs, coupled with demand for health care services, lack of
easy access of people from low income group to quality health care, health insurance is
emerging as an alternative mechanism for financing health care. Indian health financing
scene raises number of challenges, which are:

 Increase in health care costs

 High financial burden on poor eroding their incomes
 Need for long term and nursing care for senior citizens because of increasing nuclear
family system
 Increasing burden of new diseases and health risks
 Due to underfunding of government health care, preventive and primary care and
public health functions have been neglected.

In the above scenario, exploring health financing options became critical. Naturally, health
insurance has emerged as one of the financing options to overcome some of the problems of
our system. In simple terms, health insurance can be defined as a contract where an
individual or group purchases in advance health coverage by paying a fee called “premium”.
Health insurance refers to a wide variety of policies. These range from policies that cover the
cost of doctors and hospitals to those that meet a specific need, such as paying for long term
care. Even disability insurance, which replaces lost income if you cannot work because of
illness or accident, is considered health insurance, even though it is not specifically for
medical expenses. Health insurance is very well established in many countries, but in India it
still remains an untapped market. Less than 15% of India’s 1.1 billion people are covered
through health insurance. And most of it covers only government employees. At any given
point of time, 40 to 50 million people are on medication for major sickness and share of
public financing in total health care is just about 1% of GDP. Over 80% of health financing is
private financing, much of which is out of pocket payments and not by any pre-payment
schemes. Given the health financing and demand scenario, health insurance has a wider scope
in present day situation in India. However, it requires careful and significant efforts to tap
Indian health insurance market with proper understanding and training.

VARIOUS HEALTH INSURANCE PRODUCTS AVAILABLE IN

INDIA:-

The existing health insurance schemes available in India can be broadly categorized as:

1. Voluntary health insurance schemes or private-for-profit schemes

In private insurance, buyers are willing to pay premium to an insurance company that pools
similar risks and insures them for health related expenses. The main distinction is that the
premiums are set at a level, which are based on assessment of risk status of the consumer (or
of the group of employees) and the level of benefits provided, rather than as a proportion of
consumer’s income. In the public sector, the General Insurance Corporation (GIC) and its
four subsidiary companies (National Insurance Corporation, New India Assurance Company,
Oriental Insurance Company and United Insurance Company) provide voluntary insurance
schemes. The most popular health insurance cover offered by GIC is Mediclaim policy

• Mediclaim policy: - It was introduced in 1986. It reimburses the hospitalization expenses

owing to illness or injury suffered by the insured, whether the hospitalization is domiciliary
or otherwise. It does not cover outpatient treatments. Government has exempted the premium
paid by individuals from their taxable income. 9 Because of high premiums it has remained
limited to middle class, urban tax payer segment of population.

 Some of the various other voluntary health insurance schemes available in the market
are :- Asha deep plan II , Jeevan Asha plan II, Jan Arogya policy, Raja Rajeswari
 policy, Overseas Mediclaim policy, Cancer Insurance policy, Bhavishya Arogya
policy, Dreaded disease policy, Health Guard, Critical illness policy, Group Health
insurance policy, Shakti Shield etc.
 At present Health insurance is provided mainly in the form of riders. There are very
few pure health insurance policies under voluntary health insurance schemes.

2. Mandatory health insurance schemes or government run schemes:

 Employer State Insurance Scheme (ESI):-

Enacted in 1948, the employers’ state insurance (ESI) Act was the first major legislation on
social security in India. The scheme applies to power using factories employing 10 persons or
more and non-power & other specified establishments employing 20 persons or more. It
covers employees and the dependents against loss of wages due to sickness, maternity,
disability and death due to employment injury. It also covers funeral expenses and
rehabilitation allowance. Medical care comprises outpatient care, hospitalization, medicines
and specialist care. These services are provided through network of ESIS facilities, public
care centres, non-governmental organizations (NGOs) and empanelled private practitioners.
The ESIS is financed by three way contributions from employers, employees and the state
government.

 Even though the scheme is formulated well there are problem areas in managing this
scheme. Some of the problems are :-
 Large numbers of posts of medical staff remain vacant due to high turnover and low
remuneration compared to corporate hospitals.
 Rising costs and technological advancement in super specialty treatment. ƒ
Management information is not satisfactory.
 The patients are not satisfied with the services they get
 Low utilization of the hospitals
 In rural areas, the access to services is also a problem All these problems indicate an
urgent need for reforms in the ESIS Scheme.

• Central Government Health Insurance Scheme (CGHS):-

Established in 1954, the CGHS covers employees and retirees of the central government and
certain autonomous and semi-autonomous and semi-government organizations. It also covers
Members of Parliament, Governors, accredited journalists and members of general public in
some specified areas. Benefits under the scheme include medical care, home visits/care, free
medicines and diagnostic services. These services are provided through public facilities with
some specialized treatment (with reimbursement ceilings) being permissible at private
facilities. Most of the expenditure is met by the central government as only 12% is the share
of contribution.

The CGHS has been criticized from the point of view of quality and accessibility. Subscribers
have complained of high out of pocket expenses due to slow reimbursement and incomplete
coverage for private health care (as only 80% of the cost is reimbursed if referral is made to
private facility, when such facilities are not available with the CGHS).

• Universal Health Insurance Scheme (UHIS):-

For providing financial risk protection to the poor, the government announced UHIS in 2003.
Under this scheme, for a premium of Rs. 165 per year per person, Rs.248 for a family of five
and Rs.330 for a family of seven , health care for sum assured of Rs. 30000/- was provided.
This scheme has been made eligible for below poverty line families only. To make the
scheme more saleable, the insurance companies provided for a floater clause that made any
member of family eligible as against mediclaim policy which is for an individual member. In
spite of all these, the scheme was not successful.

The reasons for failing to attract rural poor are many:-

 The public sector companies who were required to implement this scheme find it to be
potentially loss making and do not invest in propagating it. To meet the target, it is
learnt that several field officers pay the premium under fictions names.
 Identification of eligible families is a difficult task
 Poor find it difficult to pay the entire premium at one time for future benefit,
foregoing current consumption needs.
 Paper work required to settle the claims is cumbersome
 Deficit in availability of service providers
 Set back due to health insurance companies refusing to renew the previous year’s
policies.
 In 2004, the government also provided an insurance product to the Self Help Group
(SHG) for a premium of Rs.120 and sum assured of Rs.10000/-. However, the intake
is negligible. The reasons for poor intake are similar to those cited above.
3. Insurance offered by NGOs/Community based health insurance:

Community based schemes are typically targeted at poorer population living in communities.
Such schemes are generally run by charitable trusts or non-governmental organizations
(NGOs). In these schemes the members prepay a set amount each year for specified services.
The premia are usually flat rate (not income related) and therefore not progressive. The
benefits offered are mainly in terms of preventive care, though ambulatory and inpatient care
is also covered. Such schemes tend to be financed through patient collection, government
grants and donations. Increasingly in India, CBHI schemes are negotiating with for profit
insurers for the purchase of custom designed group insurance policies. 9 CBHI schemes
suffer from poor design and management. Often there is a problem of adverse selection as
premiums are not based on assessment of individual risk status. These schemes fail to include
the poorest of the poor. They have low membership and require extensive financial support.
Other issues relate to sustainability and replication of such schemes. ¾ Some of the popular
Community Based Health Insurance schemes are: - Self-Employed Women’s Association
(SEWA), Tribuvandas Foundation (TF), The Mullur Milk Co-operative, Sewagram, Action
for Community Organization, Rehabilitation and Development (ACCORD), Voluntary
Health Services (VHS) etc.

4. Employer based schemes

Employers in both public and private sector offers employer based insurance schemes
through their own employer. These facilities are by way of lump sum payments,
reimbursement of employees’ health expenditure for out patient care and hospitalization,
fixed medical allowance or covering them under the group health insurance schemes. The
Railways, Defense and Security forces, Plantation sector and Mining sector run their own
health services for employees and their families.

Market Share:-

Government's policy of insuring the uninsured has gradually pushed insurance penetration in
the country and proliferation of insurance schemes.
Gross premiums written in India reached Rs 5.53 trillion (US$ 94.48 billion) in FY18, with
Rs 4.58 trillion (US$ 71.1 billion) from life insurance and Rs 1.51 trillion (US$ 23.38 billion)
from non-life insurance. Overall insurance penetration (premiums as % of GDP) in India
reached 3.69 per cent in 2017 from 2.71 per cent in 2001.
In FY19 (up to Jan 2019), premium from new life insurance business increased 3.91 per cent
year-on-year to Rs 1.59 trillion (US$ 22.04 billion). In FY19 (up to Jan 2019), gross direct
premiums of non-life insurers reached Rs 1.39 trillion (US$ 19.28 billion), showing a year-
on-year growth rate of 12.65 per cent.

Literature Review
When a person experiences a bad shock to health, their medical expenses typically rise and
their contribution to household income and home production declines According to the
WHO, Each year, approximately 150 million people experience financial catastrophe,
meaning they are obliged to spend on health care more than 40% of the income available to
them after meeting their basic needs. Low income and high medical expenses can also lead to
debt, sale of assets, and removal of children from school, especially in poor nations. A short-
term health shock can thus contribute to long-term poverty. At the same time, because
households often cannot borrow easily, they may instead forego high-value care. When they
do access care it will often be of low quality, which can lead to poor health outcomes. Theory
suggests that health insurance can address some of these problems. By covering the cost of
care after a health shock, insurance can help to smooth consumption, reduce asset sales and
new debt, increase the quantity and quality of care sought, and can improve health outcomes.
Unfortunately, rigorous evidence on the impact of insurance is scarce, and there are even
fewer studies on the effects of insurance in developing countries. One reason for the lack of
evidence is that it is difficult to find a valid control group for the insured. We cannot simply
compare the outcomes of 19 insured and uninsured households, since health insurance status
is typically strongly correlated with other household characteristics. For example, rich and
well educated households typically have both better health and better health insurance
coverage, but the positive correlation between health and insurance status tells us nothing
about the impact of insurance. On the other hand, those in poor health may be more likely to
pay for health insurance, but finding that the insured tend to be sicker would not imply that
insurance causes illness. Below we review past evidence on the impacts of health insurance,
focusing on studies where health insurance status is plausibly exogenous, or where studies
have attempted to eliminate bias due to self-selection.

Scope of the study

The study covered the use of insurance as a risk management tool by individuals,
family, or any organization or SMEs. Two categories remained the focal points of
reference, Guntur is one of the most Fastest developing districts in Andhra Pradesh.
It is the capital of Andhra Pradesh. The study will cover risk arising out of external
or internal events and how to minimize them in uncertainty.

In this research, I came know that by taking health insurance there are so many uses. Mainly the
Individuals, families, groups, etc. are claiming the insurance claims. It is using as risk minimising tool
for middle class and poor people. This study mainly concentrated in Guntur, Andhra Pradesh. Guntur
is the one of the fastest growing city in Andhra Pradesh. Because, Amaravati a new capital of Andhra
Pradesh, it is situated in Guntur district.

Purpose of the study

The purpose of this study is to find out the Awareness, Preferences and Buying patter of
Health Insurance, in Health Insurance companies.
Health Insurance is viable solution to ensure access to basic Health care services to the
masses, the number of people with Health Insurance coverage is low in India. There are some
structural issues with system. The present study is an attempt to find the cause for low Health
Insurance coverage. The study address the awareness and buying pattern of Health Insurance
and scope of the private Health Insurance companies schemes. Given the growing interest on
the importance of Health Insurance, the outcome of the present study is considered useful in
guiding policy making and to help to knowing the complete process of Health Insurance.
Findings of the Study
 In the area which I have taken survey, in that majority of females have taken health
insurance policies, here I observed much number of females are having awareness
than males. They are much concentrating on their future risk than males.
 Above 40 age group people are taking much interest on their health and also escaping
from the risk.
 According to my survey, I found illiterates are having much health insurance policies,
when compares to literates. The awareness of the health insurance is high in illiterates
than the literates. Illiterates are having much knowledge about health insurances and
their uses, when they are in risk.
 In my survey, all respondents are already having health insurance even though again
they are willing to take another health insurance policy. These kind of respondents are
very rare.
 People are not trusting the private insurance companies as much, because in my
survey I came to know that, majority of my respondents are having their health
insurances in the government insurance companies.
 Private health insurance companies are charging more charges, and different kinds of
additional fee on their policy holders. So that, people are not interesting to take health
insurance policies in private health insurance companies.
 In my survey, my majority respondents are illiterates, they are not having any trust
upon private insurance companies.
 People are taking the policies, not only in individually. Many are taking the policies
for whole family, which means if anyone are injured/lost health conscious in a family
that policy will help for each and every person in the family.
 If any workers are there, they are taking in a group wise policy. To protect whole
group. These kind of policies mainly we can observe in companies or any business
organisations.
 Now a days many of the organisations are offering the health insurances for their
employees, as a part their salaries.
 Many of the people are assuming that, the services which the health insurance
companies will give are more effective and they are able to claim easily, when they
are in need.
 Even though majority of them are did not claimed the policies. They are continuously
paying the policies, because the persons who claimed the policies are satisfied with
the service. By observing them rest of the people are also paying their policies, for
their future uses.
 I found many of the people are taking their policies in the age of 26 – 35. Because
they start doing work from that age, to escape from the risk in their work place.
 Even though people are not interested to take health insurance policies, the
companies/organisations are forcing to take health insurance policies.
 Because the owners of the companies are thinking that, if the employees are having
health insurance policies, the risk of owners will decrease in case of any injury or any
loss of health conscious in work place. So that the owners can decrease their money
burden in case of injury of their employees.
Suggestions
 The main suggestion for the private health insurance companies is to create more trust
among people, by giving more suggestions to the people. Mainly the people who are
illiterates they are not trusting the private health insurance companies.
 By decreasing additional charges and hidden charges in the insurance policies the
private health insurance companies will gain more customers than the public
companies.
 Providing more information to the customers, like giving sufficient information to the
customers and explaining different schemes and plans.
 Reducing the fake news from the agents to customers. Some of the agents will
mislead the customers. Like, customers will get more benefits if they take policy from
their company.
 Health insurance companies should explain the advantages of health insurance very
clearly to the customers and benefits in future.
Conclusion
The result of this study shows that the annual premium is the most important factor that
influences the decision or choice of health Insurance plan. This means that households having
higher income have higher probability of buying healthcare plan. Thus, less income groups
may not opt for health insurance plan. Thus there is a need to develop more products that
cater to need of larger and all levels of income groups. Apart from annual premium, hospital
network and disease coverage or coverage of services hold importance in making choice of
healthcare plan. Thus, insurance company should provide larger network of hospitals and
services in their plans in order to satisfy their customer fully. Accessibility of service
provider and company reputation also moderately influence the decisions. The decision made
for choosing the plan is mainly influenced by self-perceptions. Family and relatives and past
experience hold second position for assisting in the choice of plan. Most people would prefer
to buy healthcare plan from private insurance companies for they provide better services and
innovative products. Thus, there is large scope for private insurance companies to grow.
The legal and regulatory framework of private health insurance, particularly because it
operates in the voluntary market, should continually balance competing goals of access,
affordability and quality of healthcare and provide health coverage to a larger fraction of the
population with varying risk characteristics and ability to pay. Regulations, aside from their
aim of providing protection of health insurance policyholders and beneficiaries, can be potent
tools to promote access to healthcare, control pricing of health coverage vis-à-vis healthcare
providers and enhance quality of healthcare. Allowing the participation of other entities that
provide health coverage, such as Hospital and/or Professional entities, and self-insured health
insurance schemes of Mutual Benefit Associations and Cooperatives would further increase
the reach and depth of private health insurance. Licensing standards for compliance which are
enforced on health care provider facilities as well as self-regulation in the medical profession
and within provider groups are necessary for continuing improvement of healthcare quality.
Private health insurance cannot grow if reasonable consumer expectations relating to access,
cost and quality of healthcare remain promises rather than realities.
The analysis clearly shows that there is demand for cash less health insurance scheme but the
customers want reduction in number of exclusions and inclusion of pre-existing diseases.

Health insurance in India: What do we know and why is ethnographic research needed. (n.d.).
Retrieved from [Link]

Talk: Health insurance. (2019, June 06). Retrieved from

[Link]
ipation

Alam, A. Y. (1970, January 01). Steps in the Process of Risk Management in Healthcare. Retrieved
from [Link]
healthcare

Global Health Observatory. (n.d.). Retrieved from [Link]

Brand India. (n.d.). Retrieved from [Link]

Emerging Health Insurance in India – An overview By J Anita
[Link]
0in%20India-An%20overview_J%[Link]

HEALTH-INSURANCE-“IDENTIFYING-AWARENESS-PREFERANCES-AND-
BUYING-PATTERN-IN-MUMBAI-Swati-Kedare

 Strengths:

 Premium rates are increasing and so are commissions.

 The variety of products is increasing.
 Prospects expect more services from their brokers.

 Major Weaknesses:

 Insurance companies are often slow to respond to changing needs.

 There is an increasing trend of financial weakness among the companies.
 There are more competitors for agencies to compete with banks and Internet
players.

 Opportunities:

 The ability to cross sell financial services is barely being tapped.

 Technology is improving to the point that paperless transactions are available.
 The client’s increasing need for an “insurance consultant” can open new ways to
service the client and generate income.

 Threats:
 The increasing cost and need for insurance might hit a point where a backlash
will occur.
 Government regulations on issues like health care, mold and terrorism can
quickly change the direction of insurance. Increasing expenses and lower profit
margins will hit hard on the smaller agencies and insurance companies.
 Increasing expenses and lower profit margins will hit hard on the smaller
agencies and insurance companies.
Literature Review

J Anita – 2001

Health insurance is like a knife. In the surgeon’s hand it can save the patient, while in the
hands of the quack, it can kill. Health insurance is going to develop rapidly in future. The
main challenge is to see that it benefits the poor and the weak in terms of better coverage and
health services at lower costs without negative aspects of cost increase and overuse of
procedures and technology in provision of health care.

Ali Yawar Alam - 2016

Risk is a probability/threat of damage, injury, liability loss that is caused by vulnerabilities

and that may be avoided through pre-emptive action/s. Interaction of humans with health
systems pose a threat to them mainly because of the; complex technology, intensely complex
procedures, high demand on services, time pressure, high expectations from the service users,
hierarchical by nature of training and responsibilities. W.H.O estimates show that in
developed countries as many as 1 in 10 patients is harmed while receiving hospital care.
According to AHRQ national health disparities report 2013, rate of harm associated with
hospital stays in U.S hospitals is 25.1 per 100 admissions. Major contributors to
these hospital-acquired conditions (HACs) were; adverse drug events, catheter associated
urinary tract infections, patient falls, pressure ulcers, surgical site infection, central line
associated infections, venous thrombo - embolism and ventilator associated pneumonia.
According to Institute for Healthcare improvement (IHI), medical errors have become the
third leading cause of death in the United States each year, behind cancer and heart disease. A
13.5 percent rate of harm was identified within the US Medicare population by the Office of
Inspector General using the Institute for Healthcare Improvement’s Global Trigger Tool.

Barro and Sala-I-Martin - 2004

One of the key determinants apart from the growth in labour and the stock of physical capital
is the human capital. Two key elements of human capital are the extent to which the labour
force is educated, and the level of its health. There is a large body of theoretical and empirical
research on the determinants of economic growth, suggesting health as one of the major
determinants. Recent empirical work has sought to assess the association between human
capital and aggregate economic performance and found that, given labour and capital,
improvement in health status and education of the population lead to a higher output.

Ashok Vikhe Patil, ([Link]) (2002):

In their paper on “Current Health Scenario in Rural India”. They attempt to analysis
critically the current health status of India, with a special reference to vast rural
population of the beginning of the 21 century. The author concentrated to improve the
prevailing situation, the problem of rural health both in macro and micro level in a holistic
way, to bring ensure good health for poorest of population. He applied the model that, a
paradigm shift from current „biomedical model‟ to a „socio-cultural model‟ is required to
meet the needs of the rural population.

Shashidhar [Link] (2002)

Made a study on “Environment and Health in Belgaum Division of Karnataka State- a Spatial
Analysis”. He attempts to explain the Environment conditions of the study area to know the
prevalence of various diseases and causes of the diseases are linked to the geographical
surrounding and to the socio-cultural factors. He also concentrates on Utilization pattern of
healthcare facilities to minimize the health problems. The study is confined only to the
government health centres and major diseases their causative factors. Author concluded that,
the present research has done in improving the health literacy and provide better facilities for
improvement of public health by proper planning, organizing and establishing of the
healthcare system both in rural and urban areas.

K.N and Sathish Selvakumar (2003),

Have worked on “Spatio-info Health map- A Health GIS application”, in this article the
author analyzed to implement a custom GIS application which would be an interactive spatial
analysis tool enabling the health officer to perform re-distributing, re-locating health
jurisdictions for effective utilization of health infrastructure. Methodology was done in two
phases, phase-1 activity was to create the health jurisdiction for the entire Karnataka state,
created a template and sent to each District Health Office to collect PHC and Sub-Centre
data. This list was mapped to the village boundary and entire PHC & SC jurisdiction was
compiled. Phase-2 activity develops a custom GIS software specific to the needs of the
Health Department. Based on the uses requirements specification document was prepared and
circulated with the department for feedback and approval. Outcome of this robust GIS
software with specific tools catering to Health Department.

Gary Higgs (2004):

“A Literature Review of the Use of GIS-Based Measures of Access to Health Care
between geographic access, utilization, quality and health outcomes. The varieties of
approaches taken by him concerned with testing out the relative importance of
geographical factors that may influence access are examined. He also concentrated on
critically evaluates the situation with regard to the use of such measures in a broad range of
accessibility studies using GIS and GPS. However, this review of the literature has also
drawn attention to the different definitions attached to the term accessibility in health
concept it highlighted some conceptual issues with the application of GIS.

Luis Rosero-Bixby (2004):

Wrote an article entitled-“Spatial access to healthcare in Costa Rica and its equity: a GIS-
based study” this article reports a GIS based analysis of access to healthcare by the Costa
Rican population according to 2000 census. He discuss that, it is important to know the
supply and demand of health services and to understand how these two factors converge in
accessibility of health services for the population, in order to monitor and evaluate the impact
of current reforms in the health sector in the study area. The author has concluded by
studying the map of access to health services allowed to identify geographic inequities and to
pinpoint specific communities in need. He has shown the study region need to centrally
organize a complete healthcare by feasibility of using GIS technology for monitoring and
evaluating the reform process and to optimize decisions on location allocation to make access
more equitable.
Mark F Guagliard (2004)
Has studied the “Spatial accessibility of primary care: concepts, methods and challenges”,
He analyze the basic concepts and measurements of access, provides some historical
background, outlines the major questions concerning geographic accessibility of primary
care, describes recent developments in GIS and spatial analysis, and presents examples of
promising work.

Wei Luo ([Link]) (2004):

They contributed a joint paper on paper the authors have examined temporal changes of
access to primary health care in Illinois “between” 1990-2000, by using GIS. Census data
were used to define the population distribution and related socio economic data were used to
measure the non-spatial access. Both the spatial and no spatial data were used to access the
primary shortage areas. By this study the author identify that spatial accessibility to primary
care are majority of the state was improved from 1990-2000. Areas with worsened spatial
accessibility were primarily concentrated in rural areas and limited in urban areas, mainly
because of population with high scores of socio economic disadvantages and socio cultural
barriers, and healthcare needs. He suggest to improving those disadvantaged population
groups for the success of future policies.