Health Insurance Is a Necessary Evil: People Buy It Only Because They Have No Other Option
Prof Bejon Kumar Misra International Consumer Policy Expert and Consumer Rights Advocate Health insurance in India is marketed as vital protection against unexpected medical expenses, promising "cashless" hospitalization and "peace of mind." However, when emergencies occur, consumers find themselves battling insurance companies and hospitals, both deploying tactics that prioritize profit over patient welfare. Q. Is health insurance a necessary evil? In many ways, yes. Most people purchase health insurance not from trust but from necessity. An NSSO study revealed that 55 million Indians were pushed into poverty due to healthcare costs in a single year. The trust deficit is genuine because insurance companies aggressively market promises but deliver disputes during claims. Policies contain hidden clauses, exclusions, and fine print designed to benefit the insurer. Hospitals exploit insured patients through inflated costs, cashless claims are denied, and families scramble during crises. Q. How do insurance companies behave differently before and after selling a policy? Not all companies behave this way, but differentiation is difficult for consumers. At the point of sale, companies promise the world – easy claims, cashless coverage, and total peace of mind. But once the premium is paid, the reality is very different. Patients face questioning about insurance limits before treatment begins, shifting focus from recovery to fighting for basic rights. Q. Why do hospitals ask about insurance coverage before admission? Once hospitals know coverage limits, they inflate treatment costs to match those amounts. Instead of charging as per standards based on actual medical need, investigation costs are raised arbitrarily. Patients don't object, believing expenses are insurer-covered, enabling hospitals and doctors to charge more while patients pay indirectly. Q. Does health insurance protect corporate profits over patient care? Absolutely. Insurance companies are raking in record profits, while patients are left battling paperwork, hidden clauses, unjustified delays. Policies contain co-payments, sub-limits, and exclusions ensuring insurers can deny claims legally. Patients are no longer treated as individuals in distress – they are "revenue streams" to be billed heavily. Q. Are premium increases justified? Healthcare costs are rising, but insurers use "medical inflation" as blanket excuses without transparent sharing of actual hospital payments. If hospitals are overcharging, insurers should negotiate better, not simply pass the burden onto helpless consumers. Q. Why is there no effective grievance redressal despite regulatory discussions? Regulatory reform remains largely on paper, designed to pacify public anger without truly shaking up the system. Grievance redressal is slow and frustrating; patients fight giant corporations alone. Insurance companies know there are no serious consequences for harassing or denying claims. Regulators rarely come down hard. Without an independent, patient-first ombudsman with power to impose massive penalties, the system remains broken by design. Q. What reforms would you recommend? No advance payments at admission for insured patients. Regulate hospital billing transparently via State Hospital Regulator under Clinical Establishment Act 2010. Mandate simple one-page policy disclosures. Hold insurers and TPAs jointly accountable with IRDAI penalties. Create time-bound, independent grievance systems with punitive consequences.