ROLE OF INSURANCE COMPANIES IN HEALTHCARE
SHABBIR H. KAZMI
Apr 19 - 25, 2010
Globalization of the economy, employee mobility, high cost of employee replacement, and the need to retain valuable employees pose new challenges for companies. At the same time cost of medical treatment is escalating at an alarming rate. Healthcare requirements range from high frequency low-cost conditions to major surgical events requiring intensive care.
Today, employees demand and choose to work for companies that offer better healthcare facilities.
Some companies have offered medical benefits to their employees by maintaining an account ledger of medical expenses and reimbursing claims.
They have not only experienced steadily rising costs but also sudden peaks in expenses caused by major medical events. Managing health care requires a combination of clinical knowledge, contractual administration, tracking systems and healthcare management expertise. As their primary focus is to make a profit in their core business they neither have the time nor the resources to undertake healthcare management at their own and then there is the risk associated with major medical events. Therefore, now they tend to pass on the risk to an insurance company by getting cover for the stated needs and undertaking to pay a predictable amount.
Private insurance companies also offer health insurance. Despite the high cost, private insurance companies have filled a market segment purchasing and providing quality health care.
Allianz EFU Health is a joint venture between the leading insurer in the world Allianz Group and the local insurer EFU Group. Together, they have brought a rare blend of international expertise with a local perspective.
Allianz EFU Health focuses on making quality healthcare accessible and affordable for a wide spectrum of the local population. It is the first company in Pakistan to offer health insurance to individuals and families and companies with as few as just five employees. To ensure quality, it has put in place an Integrated HealthCare delivery system. Allianz EFU claims to be the only company in Pakistan with the resources to deliver an effective integrated health care program that is sufficiently flexible to develop and grow as needs change.
Allianz EFU uses a state-of-the-art computerized system that enables it to track medical events, benchmark practice and analyze clinical practice in detail. The activity is aimed at ensuring that patients receive the most appropriate care. If the patients need extensive treatment Allianz EFU staff doctors will work closely with the hospital to ensure that the best approach to treatment is being arranged.
Allianz EFU played a leading role in consulting an honorary medical advisory board comprising of eminent physicians and surgeons of the country. One of the key roles of this Board is to localize International Best Practice Guidelines. These guidelines are endorsed by the World Health Organization and practiced by leading physicians and surgeons worldwide. Implementation of these guidelines ensures consistency of treatment and helps reduce complication rate.
An integrated HealthCare system consists of various components that include 1) selection of only those hospitals that meet stringent quality criteria; 2) credentialing of network hospital's physician and surgeons; 3) gathering, analyzing and sharing clinical data with doctors to both increase access to treatment that works, and reduce unnecessary services proven to be of no benefit to patients; 4) coordinating care from hospital admission to "discharge planning"; and 5) case Management for prolonged and chronic illness.
New Jubilee Insurance is the third largest insurance company of Pakistan. It was established in 1953 with its Head Office in Karachi and branches throughout Pakistan. NJI enjoys the distinction of being assigned an Insurer Financial Strength (IFS) rating of "AA" by both PACRA and JCR-VIS.
The fact that both independent rating companies have rated us "AA" affirms NJI's financial strength which has been steadily built over the past five decades.
NJI is the pioneer of health insurance business in Pakistan. It's backed by well trained professionals, including full time doctors, experienced underwriters and servicing personnel to provide efficient and personalized service to its valued customers. New Jubilee health care policy is a unique group health insurance designed by professional for employers who wish to provide comprehensive protection to their employees and their dependents family members against medical expenses arising due to sickness and accidents.
New Jubilee health Care policy provides peace of mind to your employees and employers both when the cost of medical treatment is escalating at an alarming rate. The medical policy can be designed to suit needs of an individual to provide health insurance against expenses arising from hospitalization due to sickness and accident, maternity cases and outpatient treatment.
IGI Insurance is a flagship organization of Packages Group, one of the leading business houses of Pakistan. IGI Insurance underwrites all types of property and casualty insurance: fire, marine, motor, travel, health and miscellaneous. Since 1953, IGI Insurance has been providing comprehensive risk management facilities to a number of distinguished local and multinational business concerns through a network of branches in Pakistan. IGI offers a managed care solution to suit healthcare needs backed by professional staff, financial strength and insurance experience accumulated over five decades. IGI managed care system claims to provide quality healthcare at an affordable cost.
Its managed care system comprises of: 1) a network of over fifty carefully selected hospitals throughout the country; 2) a network of diagnostic centers and pharmacies; 3) qualified staff doctors and 4) an expert claims handling team. Through this system, the insurer ensures that the customers get the best available treatment at reputed hospitals under the administrative supervision of its staff doctors. The claims team guarantees that NJI charges are charging competitive rates by the healthcare providers (hospitals, labs) thereby ensuring a tight control on treatment expenses.
This is not the exhaustive list of plans offered by local and foreign insurance companies operating in Pakistan. However, there is an urgent need that the players and regulators undertake awareness programs. Pakistanis certainly deserve comprehensive plans but cost often becomes prohibitively high.