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Health insurance data repository by April 06’
Falaknaaz Syed - Mumbai
The long felt need for a data repository to enable pricing
of health insurance products is now being addressed under the aegis of the Tariff
Advisory Committee (TAC). Work towards building a data repository for health
insurance started six months ago and so far all the 25 TPAs across the country
have submitted data on policy details, claims settlement and related hospital
information. Data from the insurers will be added to the repository at a later
stage. The Insurance Regulatory Development Authority of India (IRDA) is currently
analysing the data, making it uniform since maintenance of records of each TPA
differs.
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Currently, every TPA is undergoing
training on coding International classification of diseases established
by World Health Organisation at
Bangalore and Mohali
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International classification of diseases established by World
Health Organisation (WHO) has been chosen for coding the diseases. International
Classification of Diseases 10 (ICD10) coding has been chosen for diagnosis,
ICDPCS 10 coding for procedures, LOINC for outpatient care, while internal service
codes will be developed by IRDA. Currently, every TPA is undergoing the WHO
training on these codings at Bangalore and at Mohali after which all health
insurers will use the same codes to help in easy analysis. The TPAs are expected
to code the data in ICD 9 and ICD 10 and submit it to TAC by April 2006. TAC
will thus have a uniform database by April 2006.
IRDA has funded the process with technical collaboration from Bearing Point
(USAID).
A credible database helps insurers to price their products.
Lack of database has been considered as a major deterrent in popularising health
insurance in the country. To address this issue, last year the main Health Insurance
Working Group constituted a Sub-Committee on Health Insurance Data. The Sub-Committee
submitted its report and inter alia proposed setting up a health insurance data
repository under the aegis of the TAC located in Mumbai. IRDA suggested that
TAC collect data from TPAs initially followed by collection of data from the
public and private insurance companies.
Speaking about the advantages of the data repository, Dr
D V S Sastry, director general, IRDA said, “The health insurance data repository
will assist in better monitoring and supervision of health insurance. IRDA can
conduct studies on pricing, claims settlement, disease wise analysis etc.”
He informed that a data repository is being developed for the entire insurance
industry. “We have begun with health and motor portfolios and later the
process will be replicated with other segments. So far, there is no data available
at one place for any of the insurance portfolios. We are working towards compiling
the scattered data available with the insurance companies, make it uniform and
store at TAC. We have already started collecting data from public sector general
insurance companies and will be followed by private sector companies.”
A bigger project is on the anvil with the Standing Committee on Information
Technology set up by IRDA which is advising IRDA on setting up and maintaining
the data warehouse. So far, two meetings have taken place.
Nimesh Parekh, CEO, United Healthcare Company said, “Building of the data
repository for health insurance is foundation to a long term sustainable health
insurance industry for this market. I applaud IRDA for recognising the importance
of such a step. We have done this for the health insurance industry with the
hope that other medical systems like ESIS, CGHS also adopt the same standards
so that the country can collect usable data that can be warehoused.”
falak@expresshealthcaremgmt.com
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