Managed-Care story: Resolving conflict of interest - 07/24

Two years ago, my uncle on my in-law’s side was admitted to a hospital for UTI-related surgery. From the outset, it was evident that the hospital aimed to maximize revenue. They requested various pre-surgery tests, including a CT scan. Clearly, hospitals pray for more patients and diseases to increase their top line.

In contrast, insurance companies strive to minimize hospital bills. Year after year, they raise premiums to cover claims. Ultimately, hospitals profit while insurance companies and the general population suffer.

How can we strike a balance? Managed care holds the solution. Health Maintenance Organizations (HMOs or hospitals) closely manage patient care, resulting in lower costs. HMOs limit patients to a local network of providers, which helps control expenses as HMOs as the insurance providers.

From an Indian perspective, Narayana Health recently introduced health insurance covering ₹1 crore in surgeries for just ₹10,000 per year (compared to traditional insurance charges ranging from ₹20,000 to ₹48,000). Unlike conventional plans, this managed care approach prioritizes a seamless and efficient experience, focusing on Narayana Health’s trusted network of experienced doctors and advanced facilities. This minimizes administrative obstacles. In other countries, this concept is known as managed care rather than insurance.

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