Health insurance: Bringing mental illness under health insurance cover will help customers

Published: October 31, 2018 12:46 AM

The Mental Healthcare Bill 2017 was a progressive reform in the midst of growing awareness. The Insurance Regulatory and Development Authority of India’s (Irdai) directive that followed, now includes mental illnesses in the ambit of health insurance coverage for customers.

The National Mental Health Survey 2016 estimates that about 150 million adult Indians, or 15% of India’s population suffer from mental health problems.

By Ashish Mehrotra

The Mental Healthcare Bill 2017 was a progressive reform in the midst of growing awareness. The Insurance Regulatory and Development Authority of India’s (Irdai) directive that followed, now includes mental illnesses in the ambit of health insurance coverage for customers.

Viewed against the evolving narrative on mental health, this has the potential to significantly expand access to treatment —a critical need given India’s worsening mental health crisis.

The National Mental Health Survey 2016 estimates that about 150 million adult Indians, or 15% of India’s population suffer from mental health problems. Those between 30-49—a productive age group in the workforce—are among the most affected. Without the availability of insurance, patients have had to cover the entire cost of treatment out of pocket. This has proved a major deterrent, due to which an estimated 80% of patients do not seek or receive any treatment.

Cover for mental illness
Provisions to cover mental illness in policies will have to be framed within certain inherent challenges. Insurers will have to chart out the implementation and scope of coverage against different parameters.  As treatment becomes accessible and more affordable with insurance, many more Indians will come forward to seek treatment. Including coverage for mental illnesses will also increase the penetration of health insurance coverage, as a new section of people find insurance products that comprehensively answer their needs.
A 2018 Health & Wellness survey conducted across six Indian cities, with 2,100 respondents, to understand the shifting health and wellness trends across the country spotlighted the changing preferences of customers. The study revealed that the definition and awareness of wellness is fast expanding beyond just physical health, to achieving a stress-free lifestyle.

Tailor-made solutions

Customers are increasingly looking for greater value in their insurance plans. They want tailor-made solutions that work for them, with more personalisation, whether it’s in health, well-being or mental health care. Going forward, insurers will have to take a customer-centric view, re-evaluating conventional plans.  Mental health treatment, for example, does not always require hospitalisation—traditionally covered by insurance. Holistic treatment here might include psychiatric consultation along with ongoing support through medication and periodic reviews to avoid reccurrence of the condition.

Insurers would have to look through the prism of what customers need, to design products that are relevant and fit their specific needs.
In an outcome-based shift, insurers are rewarding customers for healthy behaviour, which is what the new-age customer is asking for. Around 43% of the respondents in the wellness survey said they expected an increase in coverage with no increase or a marginal increase in premium for achieving fitness targets. Catching the problem early is critical in the context of mental health.

Insurers could respond with health plans that cover preventive services, such as depression screening for adults. There are still several challenges hampering efforts in mental health care – a serious paucity of mental health facilities, professionals and financing facilities in the country. The insurance regulator’s directive will pave the way for change on multiple levels and focus on the needs of patients.

The writer is MD & CEO, Max Bupa Health Insurance

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