The challenges of supplementary medical insurance in Iran were investigated
According to the financial news report, citing the public relations of the Iran Insurers Syndicate, Hamid Jahandideh, the secretary of the health insurance working group of the Iran Insurers Syndicate, also stated about the health insurance situation: the statistics published on the performance of the insurance industry in the first 6 months of 1402 indicate It is because of the total premium generated in the country’s insurance industry, which is 135 thousand billion tomans, an amount equivalent to 51 thousand billion tomans belongs to the treatment sector. In other words, 38% of production insurance premiums in the first 6 months of 1402 belonged to the medical sector.
He added: the medical insurance premium in the same period of 1401 amounted to 28 thousand billion tomans; That is, in the 6 months of this year, compared to the same period last year, we have faced 80% growth in insurance premiums in this field.
The secretary of the medical insurance working group of the Iranian Insurers’ Syndicate also stated: out of the total amount of damages paid in the insurance industry, which is about 64 thousand billion tomans, about 27 thousand billion tomans are related to the damage of the medical sector; In other words, 42% of the total amount of damage belongs to the treatment sector.
Jahandideh stated: In the number of paid damages, about 93% of the total damage cases have been assigned to the field of medical damages, which indicates the existence of a large number of medical cases and, as a result, the large number of users of this field. In this way, the total number of damage cases in all insurance fields is around 35 million, of which 32.5 million belong to the medical damage sector.
He added: Medical insurances are inherently among the insurance policies with losses, and if professional principles are followed in the competitive market, actuarial and appropriate and technical premium rates are announced, and finally, treatment losses are closely monitored and the ratio of losses can be reduced. Control or minimize treatment insurance policies.
Jahandideh emphasized: Of course, due to the huge increase in medical expenses, the minimal contribution of basic insurers, the increase in the average age of the country (over 40 years old), the increase in medical tariffs, the spread of corona disease in the past few years, and the activation of underlying diseases caused by That, the growth of inflation (several times in a year) as well as currency fluctuations and the increase in the huge costs of medicine and consumables and dental costs (affected by the removal of the preferred currency) have so far imposed exorbitant costs on insurance companies.
In response to the question of whether medical insurance is economically profitable for insurance companies, the secretary of the medical insurance working group of the Iranian Insurers Syndicate said: Medical insurance alone cannot be profitable. But in case of attracting portfolios of other disciplines, medical insurances are considered a good option for the profitability of insurance companies in the overall portfolio portfolio. In other words, medical insurances are considered as a showcase of insurance companies, a possibility for the entry of other portfolios of insurers.
He added: Of course, in the meantime, it is necessary to pay special attention to the provision of optimal services in medical insurance so that this issue can maintain the portfolio with the insurance company and be effective in attracting property portfolios.
Jahandideh said: Therefore, in general, it can be said that medical insurance policies are not very profitable from an economic point of view. However, issuing small and large insurance policies and receiving insurance premiums on time and appropriately can be a solution for making a profit in these insurance policies.
The secretary of the medical insurance working group of the Iranian Insurers’ Syndicate further stated: about 25% to 30% of the amounts of medical damages paid by insurance companies are related to fraudulent, fake, induced damages, etc., which has unjustly increased the ratio of medical damages .
In response to the question that if medical insurance is not profitable, why do insurance companies provide these services, he stated: In order to attract profitable property portfolios, insurance companies are forced to provide supplementary medical insurance policies according to the conditions desired by policyholders. In order to receive the maximum discount in treatment premium rates and also to receive appropriate coverage and optimal services in the treatment sector, the insurance policyholders tend to combine their portfolios and hand over their portfolios to the insurance company subject to receiving the aforementioned benefits.
Jahandideh added: Also, due to the increase in medical expenses, most companies are looking for medical insurance policies for the well-being of their personnel. Therefore, insurance companies attract their property portfolios with a significant profit through competition in providing services, especially for certain policyholders. Based on this, the policy of some insurance companies is that by attracting large insurers, they will be presented as a large share of the insurance market and in other words, they will be instilled in the mind of the audience as a “brand”.
The secretary of the medical insurance working group of the Iranian Insurers’ Syndicate continued: According to the statistics of the Central Insurance, the ratio of medical losses in the previous year was about 78%, and it seems that this ratio will increase to about 85% now (the first 6 months of 2014).
He added: In general, due to the upward trend of tariffs and the huge increase in medical expenses and the maximum use of supplementary treatment insurance policies by the insured and the issuance of insurance policies with unlimited coverage and without Applying tariffs and increasing fake and unrealistic costs, this ratio is increasing. In the meantime, it is necessary to point out that the “damage coefficient” which shows the profit or loss of insurance fields, is very different from the “damage ratio” (the result of dividing the amount of damage by the premium).
In response to the question, how will the future of medical insurance be assessed with the continuation of the current situation, Jahandideh stated: Considering the issues raised, including the high rate of tariffs and medical expenses, the failure to provide a suitable rate in the insurance industry to attract portfolios due to In the fiercely competitive market and sometimes price-cutting by some insurance companies and the increase in fake and unrealistic costs, the ratio of medical damages has an upward trend, so that not only the insurance premiums received are not enough to pay the damages, but the amount of damages The payment is usually much higher than the insurance premium received in the treatment department.
He continued: In the meantime, the non-payment of medical insurance premiums by the policyholders has deprived the insurance companies of the opportunity to invest. Of course, it is possible to somehow control the ratio of damage by providing optimal services for the well-being of the insured (creating special applications and providing ancillary services in the centers of the contracting party to the insured) as well as selling other insurance policies.
The secretary of the medical insurance working group of the Iranian Insurers’ Syndicate added: Also, the satisfaction of the insured can have a very good effect on the growth of medical insurance sales and, accordingly, the consolidation of other insurance policies, in other words, a satisfied customer of Through advertising (person-to-person) can have a much higher impact than providing advertisements through the media.
He said about the measures that the Insurers’ Syndicate can use to improve the current situation of medical insurance: Considering the presence of all commercial insurance companies in the Insurers’ Syndicate, the Syndicate can hold regular meetings to raise issues. , by making decisions and presenting suggestions and sharing the experiences of insurance companies, to have an optimal effect on improving the current state of medical insurance. Here, it is necessary to mention the continuous presence of members of the treatment working group in the meetings, as well as the avoidance of insurance companies from frequently moving the treatment managers.
Jahandideh also pointed to the measures taken by the insurers’ union and stated: the formation of a specialized dental committee to set tariffs for all types of dental services, the formation of a committee for contracts of medical centers to negotiate with hospital and laboratory associations, etc., in order to obtain discounts due to the volume The relations of insurance companies with medical centers and unification of the tariff procedure among insurance companies, the formation of a specialized committee for treatment damages, which among the duties of the mentioned committee is to develop guidelines for the payment of treatment damages in order to unify the procedure between insurance companies and assessors. There has been a damage that has been finalized.
The secretary of the medical insurance working group of the Iranian Insurers’ Syndicate continued: The formation of a committee to determine the minimum treatment rate is necessary at this time, but unfortunately, due to the competitive market, insurance companies are reluctant to They do not cooperate with the said committee.
He stated: The investigation and proposal to amend the regulations of 99 treatments by Syndicate’s treatment working group is one of the significant measures in the field of treatment. Also, in the near future, we will see effective compensation and control of the treatment loss ratio of the insurance policyholders with more than 20,000 insured people.