From Cure to Care: How Health Insurance Is Shifting Towards Preventive Health

Health insurance is meant to cover your expenses in case of a medical emergency. And that is the main reason why you need it. But increasingly, the focus of health insurance is not just on reimbursing your medical insurance but on trying to make sure that incidents when you need medical assistance are prevented or delayed. Today's health insurance plans are proactive and include annual preventive health checkups within built-in benefits.

“You likely have access to a preventive health checkup at least once a year, and many insurance plans these days allow policyholders to schedule the tests online or, in most cases, through partner labs. Typically, at very little cost. Some plans include a preventive health checkup from the first year, as opposed to waiting periods that were in place before,” says Kunal Varma, CEO and Founder, Freo.

Prevention Is Better Than Cure 

Most comprehensive plans now cover preventive tests now covered by gender. For women, the tests will be screenings and can include pap smears, mammograms, breast ultrasounds, and so forth. For men, the routine tests will be prostate exams and testicular screenings! There are screening components (that are general) for both, such as screenings that cover full-body health checks, blood sugar, cholesterol, blood function tests, and liver/kidney tests. They may also include cancer-specific markers and physical examinations by specialists.

Prevention is effective at identifying health risks that may otherwise go undiagnosed until full-blown illness occurs. Medical doctors can intervene promptly with lifestyle or potentially less invasive treatments, rather than incurring large costs at a hospital with larger claims down the line. For insurers, this translates into better claims ratios and pricing models that are more sustainable. For individuals, this means lower out-of-pocket expenses and enhanced health in the long run.

A robust preventive health care program is a win-win proposition for everyone. For the patient, it mitigates the risk of a high-impact morbidity or mortality. “For the insurer, it reduces the cost burden and outgo. For the population at large, it reduces the disease burden. Many programs are now being developed that offer monetary benefits to customers who show positive outcomes and adherence to preventive health plans,” says Varsha Gujarathi, Chief Customer Officer, Universal Sompo General Insurance.

The Way Forward 

As we continue to gather data at an industry level, many insurers are beginning to report that a growing share of critical illnesses (especially lifestyle-related diseases such as diabetes, hypertension, and early-stage cancers) are being identified during routine preventive testing. Early identification means better treatment that allows the health system to mitigate long-term medical costs.

Indeed, there are trends that show increased detection rates of critical illness. “One of the most successful areas has been the identification and early detection of breast cancer and cervical cancer in females. Along with these, detection of cardiac ailments, atherosclerosis, and liver damage has also been among the successful outcomes of preventive health checks. Various Studies show a 15-20 per cent early detection rate increase,” says Gujarathi.

Insurers can be more effective in raising awareness around nudges, reminders through their mobile app, and simpler booking options. “A few are even rewarding policyholders with wellness points, lower premiums, or cash back for attendance at preventive check-ups. The challenge is to transform the view of insurance from solely a reactive safety net to an active partner for health,” says Varma.