unit 5 -1.pdf

Unit V Mobile Health Services
Definitions
mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies
as they are integrated within increasingly mobile and wireless health care delivery systems. The
field broadly encompasses the use of mobile telecommunication and multimedia technologies in
health care delivery. The term mHealth was coined by Robert Istepanian as use of "emerging
mobile communications and network technologies for healthcare".[8][page needed]
A definition used at
the 2010 mHealth Summit of the Foundation for the National Institutes of Health (FNIH) was "the
delivery of healthcare services via mobile communication devices".[9]
The GSM Association
representing the worldwide mobile communications industry published a report on mHealth in
2010 describing a new vision for healthcare and identified ways in which mobile technology might
play a role in innovating healthcare delivery systems and healthcare system cost management.[10]
While there are some projects that are considered solely within the field of mHealth, the linkage
between mHealth and eHealth is unquestionable. For example, an mHealth project that uses mobile
phones to access data on HIV/AIDS rates would require an eHealth system in order to manage,
store, and assess the data. Thus, eHealth projects many times operate as the backbone of mHealth
projects.[3]
In a similar vein, while not clearly bifurcated by such a definition, eHealth can largely be viewed
as technology that supports the functions and delivery of healthcare, while mHealth rests largely
on providing healthcare access.[9]
Because mHealth is by definition based on mobile technology
such as smartphones, healthcare, through information and delivery, can better reach areas, people,
and/or healthcare practitioners with previously limited exposure to certain aspects of healthcare.
The National Institute for Health and Care Research (NIHR) has published a review of research
on how mHealth and digital health technologies can help manage health conditions.[11]
Medical uses[edit]
mHealth apps are designed to support diagnostic procedures, to aid physician decision-making for
treatments, and to advance disease-related education for physicians and people under
treatment.[12]
Mobile health has much potential in medicine and, if used in conjunction with human
factors may improve access to care, the scope, and quality of health care services that can be
provided. Some applications of mobile health may also improve the ability to improve

accountability in healthcare and improve continuum of care by connecting interdisciplinary team
members.[13]
mHealth is one aspect of eHealth that is pushing the limits of how to acquire, transport, store,
process, and secure the raw and processed data to deliver meaningful results. mHealth offers the
ability of remote individuals to participate in the health care value matrix, which may not have
been possible in the past. Participation does not imply just consumption of health care services. In
many cases remote users are valuable contributors to gather data regarding disease and public
health concerns such as outdoor pollution, drugs and violence.
While others exist, the 2009 UN Foundation and Vodafone Foundation[3]
report presents seven
application categories within the mHealth field:[6]
• Education and awareness
• Helpline
• Diagnostic and treatment support
• Communication and training for healthcare workers
• Disease and epidemic outbreak tracking
• Remote monitoring
• Remote data collection
Education and awareness[edit]
Education and awareness programs within the mHealth field are largely about the spreading of
mass information from source to recipient through short message services (SMS). In education
and awareness applications, SMS messages are sent directly to users' phones to offer information
about various subjects, including testing and treatment methods, availability of health services,
and disease management. SMSs provide an advantage of being relatively unobtrusive, offering
patients confidentiality in environments where disease (especially HIV/AIDS) is often taboo.
Additionally, SMSs provide an avenue to reach far-reaching areas—such as rural areas—which
may have limited access to public health information and education, health clinics, and a deficit of
healthcare workers.[3][7]
Helpline[edit]
Helpline typically consists of a specific phone number that any individual is able to call to gain
access to a range of medical services. These include phone consultations, counseling, service
complaints, and information on facilities, drugs, equipment, and/or available mobile health
clinics.[3]
Diagnostic support, treatment support, communication and training for healthcare
workers[edit]
Diagnostic and treatment support systems are typically designed to provide healthcare workers in
remote areas advice about diagnosis and treatment of patients. While some projects may provide
mobile phone applications—such as a step-by-step medical decision tree systems—to help
healthcare workers diagnose, other projects provide direct diagnosis to patients themselves. In such
cases, known as telemedicine, patients might take a photograph of a wound or illness and allow a
remote physician to diagnose to help treat the medical problem. Both diagnosis and treatment
support projects attempt to mitigate the cost and time of travel for patients located in remote
areas.[3]

mHealth projects within the communication and training for healthcare workers subset involve
connecting healthcare workers to sources of information through their mobile phone. This involves
connecting healthcare workers to other healthcare workers, medical institutions, ministries of
health, or other houses of medical information. Such projects additionally involve using mobile
phones to better organize and target in-person training. Improved communication projects attempt
to increase knowledge transfer amongst healthcare workers and improve patient outcomes through
such programs as patient referral processes.[3]
For example, the systematic use of mobile instant
messaging for the training and empowerment of health professionals has resulted in higher levels
of clinical knowledge and fewer feelings of professional isolation.[14]
Disease surveillance, remote data collection, and epidemic outbreak tracking[edit]
Projects within this area operate to utilize mobile phones' ability to collect and transmit data
quickly, cheaply, and relatively efficiently. Data concerning the location and levels of specific
diseases (such as malaria, HIV/AIDS, TB, Avian Flu) can help medical systems or ministries of
health or other organizations identify outbreaks and better target medical resources to areas of
greatest need. Such projects can be particularly useful during emergencies, in order to identify
where the greatest medical needs are within a country[3]
Policymakers and health providers at the national, district, and community level need accurate data
in order to gauge the effectiveness of existing policies and programs and shape new ones. In the
developing world, collecting field information is particularly difficult since many segments of the
population are rarely able to visit a hospital, even in the case of severe illness. A lack of patient
data creates an arduous environment in which policy makers can decide where and how to spend
their (sometimes limited) resources. While some software within this area is specific to a particular
content or area, other software can be adapted to any data collection purpose.
Treatment support and medication compliance for patients[edit]
Remote monitoring and treatment support allows for greater involvement in the continued care of
patients. Recent studies seem to show also the efficacy of inducing positive and negative affective
states, using smart phones.[2]
Within environments of limited resources and beds—and
subsequently a 'outpatient' culture—remote monitoring allows healthcare workers to better track
patient conditions, medication regimen adherence, and follow-up scheduling. Such projects can
operate through either one- or two-way communications systems. Remote monitoring has been
used particularly in the area of medication adherence for AIDS,[15][16]
cardiovascular
disease,[17][18]
chronic lung disease,[18]
diabetes,[19][3][20]
antenatal mental health,[21]
mild
anxiety,[22]
and tuberculosis.[15]
Technical process evaluations have confirmed the feasibility of
deploying dynamically tailored, SMS-based interventions designed to provide ongoing behavioral
reinforcement for persons living with HIV.[23]
among others. Specific mobile applications might
also support adherence to taking medications.[24][25]
In conclusion, the use of mobile phone technology (in combination with a web-based interface) in
health care results in an increase in convenience and efficiency of data collection, transfer, storage
and analysis management of data as compared with paper-based systems. Formal studies and
preliminary project assessments demonstrate this improvement of efficiency of healthcare delivery
by mobile technology.[26]
Nevertheless, mHealth should not be considered as a panacea for
healthcare.[27]
Possible organizational issues include the ensuring of appropriate use and proper
care of the handset, lost or stolen phones, and the important consideration of costs related to the

purchase of equipment. There is therefore a difficulty in comparison in weighing up mHealth
interventions against other priority and evidence-based interventions.[28]
Criticism and concerns[edit]
The extensive practice of mhealth research has sparked criticism, for example on the proliferation
of fragmented pilot studies in low- and middle-income countries, which is also referred to as
"pilotitis."[29]
The extent of un-coordinated pilot studies prompted for instance
the Ugandan Director General Health Services Dr Jane Ruth Aceng in 2012 to issue a notice that,
"in order to jointly ensure that all eHealth efforts are harmonized and coordinated, I am directing
that ALL eHealth projects/Initiatives be put to halt."[30]
The assumptions that justify mhealth
initiatives have also been challenged in recent sociological research. For example, mobile phones
have been argued to be less widely accessible and usable than is often portrayed in mhealth-related
publications;[31]
people integrate mobile phones into their health behavior without external
intervention;[32]
and the spread of mobile phones in low- and middle-income countries itself can
create new forms of digital and healthcare exclusion, which mhealth interventions (using mobile
phones as a platform) cannot overcome and potentially accentuate.[33]
Mhealth has also been
argued to alter the practice of healthcare and patient-physician relationships as well as how bodies
and health are being represented.[34][35]
Another widespread concern relates to privacy and data
protection, for example in the context of electronic health records.[35][36]
Studies looking into the perceptions and experiences of primary healthcare professionals using
mheath have found that most health care professionals appreciated being connected to their
colleagues, however some prefer face to face communication.[13]
Some healthcare workers also
felt that while reporting was improved and team members who require help or training could be
more easily identified, some healthcare professionals did not feel comfortable being monitored
continuously.[13]
A proportion of healthcare professionals prefer paper reporting.[13]
The use of
mobile apps may sometimes lead to healthcare professionals spending more time performing
additional tasks such as filling out electronic forms and may generate more workload in some
cases.[13]
Some healthcare professionals also do not feel comfortable with work-related contact
from patients/clients outside of business hours (however some professionals did find this useful
for emergencies).[13]
Communicating with clients/patients while using a mobile device may need to be considered.[13]
A
decrease in eye contact and the potential to miss non-verbal cues due to concentrating on a screen
while speaking with patients is a potential consideration.[13]
Society and Culture[edit]
Healthcare in developed countries[edit]
In developed countries, healthcare systems have different policies and goals in relation to the
personal and population health care goals.
In the US and EU many patients and consumers use their cell phones and tablets to access health
information and look for healthcare services. In parallel the number of mHealth applications grew
significantly in the last years.
Doctors, nurses and clinicians use mobile devices to access patient information and other databases
and resources.

Technology and market[edit]
Basic SMS functions and real-time voice communication serve as the backbone and the current
most common use of mobile phone technology. The broad range of potential benefits to the health
sector that the simple functions of mobile phones can provide should not be understated.[50]
The appeal of mobile communication technologies is that they enable communication in motion,
allowing individuals to contact each other irrespective of time and place.[51][52]
This is particularly
beneficial for work in remote areas where the mobile phone, and now increasingly wireless
infrastructure, is able to reach more people, faster. As a result of such technological advances, the
capacity for improved access to information and two-way communication becomes more available
at the point of need.
Mobile phones[edit]
Mobile phone subscribers per 100 inhabitants 1997–2007
With the global mobile phone penetration rate drastically increasing over the last decade, mobile
phones have made a recent and rapid entrance into many parts of the low- and middle-income
world. Improvements in telecommunications technology infrastructure, reduced costs of mobile
handsets, and a general increase in non-food expenditure have influenced this trend. Low- and
middle-income countries are utilizing mobile phones as "leapfrog technology" (see leapfrogging).
That is, mobile phones have allowed many developing countries, even those with relatively poor
infrastructure, to bypass 20th century fixed-line technology and jump to modern mobile
technology.[53]
The number of global mobile phone subscribers in 2007 was estimated at 3.1 billion of an
estimated global population of 6.6 billion (47%).[54]
These figures are expected to grow to 4.5
billion by 2012, or a 64.7% mobile penetration rate. The greatest growth is expected in Asia,
the Middle East, and Africa. In many countries, the number of mobile phone subscribers has
bypassed the number of fixed-line telephones; this is particularly true in developing
countries.[55]
Globally, there were 4.1 billion mobile phones in use in December 2008. See List of
countries by number of mobile phones in use.
While mobile phone penetration rates are on the rise, globally, the growth within countries is not
generally evenly distributed. In India, for example, while mobile penetration rates have increased
markedly, by far the greatest growth rates are found in urban areas. Mobile penetration, in
September 2008, was 66% in urban areas, while only 9.4% in rural areas. The all India average

was 28.2% at the same time.[56]
So, while mobile phones may have the potential to provide greater
healthcare access to a larger portion of a population, there are certainly within-country equity
issues to consider.
Mobile phones are spreading because the cost of mobile technology deployment is dropping and
people are, on average, getting wealthier in low- and middle-income nations.[57]
Vendors, such
as Nokia, are developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub
$50–100, such as Sun's Java phone). Non-food consumption expenditure is increasing in many
parts of the developing world, as disposable income rises, causing a rapid increase in spending on
new technology, such as mobile phones. In India, for example, consumers have become and
continue to become wealthier. Consumers are shifting their expenditure from necessity to
discretionary. For example, on average, 56% of Indian consumers' consumption went towards food
in 1995, compared to 42% in 2005. The number is expected to drop to 34% by 2015. That being
said, although total share of consumption has declined, total consumption of food and beverages
increased 82% from 1985 to 2005, while per-capita consumption of food and beverages increased
24%. Indian consumers are getting wealthier and they are spending more and more, with a greater
ability to spend on new technologies.[58]
Smartphones[edit]
More advanced mobile phone technologies are enabling the potential for further healthcare
delivery. Smartphone technologies are now in the hands of a large number of physicians and other
healthcare workers in low- and middle-income countries. Although far from ubiquitous, the spread
of smartphone technologies opens up doors for mHealth projects such as technology-based
diagnosis support, remote diagnostics and telemedicine, preprogrammed daily self-assessment
prompts, video or audio clips,[59]
web browsing, GPS navigation, access to web-based patient
information, post-visit patient surveillance, and decentralized health management information
systems (HMIS).
While uptake of smartphone technology by the medical field has grown in low- and middle-income
countries, it is worth noting that the capabilities of mobile phones in low- and middle-income
countries has not reached the sophistication of those in high-income countries. The infrastructure
that enables web browsing, GPS navigation, and email through smartphones is not as well
developed in much of the low- and middle-income countries.[50]
Increased availability and
efficiency in both voice and data-transfer systems in addition to rapid deployment of wireless
infrastructure will likely accelerate the deployment of mobile-enabled health systems and services
throughout the world.[60]
Other technologies[edit]
Beyond mobile phones, wireless-enabled laptops and specialized health-related software
applications are currently being developed, tested, and marketed for use in the mHealth field.
Many of these technologies, while having some application to low- and middle-income nations,
are developing primarily in high-income countries. However, with broad advocacy campaigns
for free and open source software (FOSS), applications are beginning to be tailored for and make
inroads in low- and middle-income countries.[6]
Some other mHealth technologies include:[1]
• Patient monitoring devices

• Mobile telemedicine/telecare devices
• Microcomputers
• Data collection software
• Mobile Operating System Technology
• Mobile applications (e.g., gamified/social wellness solutions)
• Chatterbots
Mobile device operating system technology[edit]
Technologies relate to the operating systems that orchestrate mobile device hardware while
maintaining confidentiality, integrity and availability are required to build trust. This may foster
greater adoption of mHealth technologies and services, by exploiting lower cost multi purpose
mobile devices such as tablets, PCs, and smartphones. Operating systems that control these
emerging classes of devices include Google's Android, Apple's iPhone OS, Microsoft's Windows
Mobile, and RIM's BlackBerry OS.
Operating systems must be agile and evolve to effectively balance and deliver the desired level of
service to an application and end user, while managing display real estate, power consumption and
security posture. With advances in capabilities such as integrating voice, video and Web 2.0
collaboration tools into mobile devices, significant benefits can be achieved in the delivery of
health care services. New sensor technologies[61]
such as HD video and audio capabilities,
accelerometers, GPS, ambient light detectors, barometers and gyroscopes[62]
can enhance the
methods of describing and studying cases, close to the patient or consumer of the health care
service. This could include diagnosis, education, treatment and monitoring.
Air quality sensing technologies[edit]
Environmental conditions have a significant impact on public health. Per the World Health
Organization, outdoor air pollution accounts for about 1.4% of total mortality.[63]
Utilizing
Participatory sensing technologies in mobile telephone, public health research can exploit the wide
penetration of mobile devices to collect air measurements,[62]
which can be utilized to assess the
impact of pollution. Projects such as the Urban Atmospheres are utilizing embedded technologies
in mobile phones to acquire real time conditions from millions of users mobile phones. By
aggregating this data, public health policy shall be able to craft initiatives to mitigate the risk
associated with outdoor air pollution.
Data[edit]
Data has become an especially important aspect of mHealth. Data collection requires both the
collection device (mobile phones, computer, or portable device) and the software that houses the
information. Data is primarily focused on visualizing static text but can also extend to interactive
decision support algorithms, other visual image information, and also communication capabilities
through the integration of e-mail and SMS features. Integrating use of GIS and GPS with mobile
technologies adds a geographical mapping component that is able to "tag" voice and data
communication to a particular location or series of locations.[64]
These combined capabilities have
been used for emergency health services as well as for disease surveillance, health facilities and
services mapping, and other health-related data collection.[65][66][67][68]

List of open-source health software
Public health and biosurveillance
Health system management
Disease management
Imaging/visualization
Medical information systems
Research
Mobile devices
HEALTH INSURANCE
Health insurance is one of the most important in our life, everyone should know about how it
works and what it is, Is it good or bad making a purchase. Health insurance policies are no longer
just a convenience they will cover you from financial losses. Check the pros and cons of health
insurance in India below.
While you might be working hard to achieve the financial goals that you've set for yourself and
your family, an unexpected health problem could impact your journey downwards. If you are the
sole worker in the family, the financial stress could be immense even if someone in your family
suffers from a medical emergency.
The rising cost of private medical care in the country is so high, that hospitalization can give you
a heart attack too it will impact your financial health too. Purchasing a health insurance policy is
a smart way to keep your finances protected. When you buy health insurance policy, you get into
an agreement with the insurance provider wherein the insurer agrees to compensate the medical
expenses.
Why Health Insurance is Important?
Health Insurance is important because
• Lifestyle-related ailments are common these days
• Healthcare is becoming increasingly expensive
• It is difficult for a family to quickly arrange for huge amounts of money required for
treatment
• Most of the savings of a family are in the form of fixed assets, which cannot be liquidated
quickly

• For instance, most insurers now offer individual policy and family floater plans. You get
to protect yourself with an individual plan, but with a family floater plan, you can ensure
the health of your entire family.
Advantages of Health Insurance Policy
Rising costs of healthcare as well as the evident need for adequate healthcare today make health
insurance policy a definite must. When it comes to critical illnesses, the strain that it can put on a
family's wellbeing is undeniable, leaving people to turn to their life savings for aid.
This, however, does not ascertain a concrete solution due to inflation, meaning savings are rarely
sufficient to meet such healthcare expenses.
In a typical average Indian household, the male head of the family is usually the only earning
member with about 3-4 dependants. Oftentimes, if the primary breadwinner’s ability to work is
compromised due to a major illness, the rest of the family remains in dire straits. It would not be
possible for them to sustain their lifestyle, repay debts or even afford the high costs of treatment.
• Cashless hospitalization: In case if you are suffering from a health problem and get
admitted to one of the network hospitals, you’ll mostly be able to take advantage of
cashless hospitalization. The general insurance company will pay your medical bills to
the hospital. Thus, you will not be required to bear the high treatment costs from your
pockets. In case if you are admitted to a non-network hospital, you will be able to use the
reimbursement claim facility here.
• Network Hospitals: Network or tie-up hospitals are the hospitals with which the
insurance companies enter into an agreement to provide cashless treatment service to
their customers. In cashless hospitalization, the customer need not pay medical bills to
the hospital. They provide free and cashless services. The insurance company tie-up with
those hospitals and they take care of the medical expenses charged by the hospital.
• No Claim Bonus:
No claim bonus or the renewal bonus is the increase in sum insured at the time of renewal
provided by the insurance company for no claims made in the previous policy year. The
maximum renewal bonus or No claim bonus provided by the insurance companies would
not exceed 100% of the basic sum insured.
There are a few health cover plans which provide a 10% to 50% renewal bonus for each
claim-free year. The higher the renewal bonus percentage each year, the higher would be
the sum insured at the time of renewal. The best health insurance policy is the one that
provides up to 100% renewal bonus or no claim bonus for each claim-free year.
• Add-ons or Riders: You can purchase a critical illness or accident cover add-on to make
sure that your policy covers such exclusions as well.
• Financial Protection: If you unexpectedly die/ permanent disability happens due to an
accident having a health insurance policy will cover you and your family with financial
protection.

• Peace of Mind: Having a health plan eliminates the need for you to worry about
healthcare expenses and allows you to choose the best medical care for yourself and your
family. Best care can also give good recovery, allowing you to get back to your healthy
life.
• Affordable healthcare:
Coverage and Premium are the most frequently compared things while deciding on the
best health insurance policy. But comparing the coverage with the premium charged by
the insurance companies is the big mistake people made. A health insurance policy has
many things such as inpatient hospitalization, Ayush treatment, and other terms and
conditions which should be thoroughly checked before buying it.
So, before buying the policy consider all the factors because a simple analysis of
comparing different health insurance policies against the premium from different
insurance companies can only result in disappointment at the time of claim settlement.
Buy health insurance policy with PolicyBachat compare with different companies and get
low premiums.
Disadvantages of Health Insurance Policy
One of the main disadvantages of having health insurance is the cost. Health insurance policy
can be very costly even for those that have a health insurance plan through their employers.
Costs may be so high that many end up struggling to make payments. This can be quite
challenging for those who have low incomes or are self-employed. Health care coverage for
families may cause an added financial burden.
• Pre-Existing Exclusion: Another disadvantage would involve people who have pre-
existing diseases. They have to undergo a waiting period which is typically four years.
Insurers typically require you need to wait for four years for any pre-existing illness to be
covered.
This becomes a major obstacle for older individuals with pre-existing medical conditions.
This is particularly so because pre-existing illnesses don't only include illnesses you may
have received treatment for in the recent past. It includes illnesses for which there were
signs or symptoms in the 48 months prior to the payment of the first premium.
• Waiting Period: In the Waiting period you must wait for a specified amount of time
before you make a claim. But you cannot claim some or all benefits of the health
insurance from your company. The initial waiting period or 30 day waiting period is the
time where the customer has to wait before making a claim under the health insurance
policy. Any accident-related claims are exempt from this waiting period rule. This is also
added to prevent people from taking health insurance only at the time of illness.
• Increase in Premiums: The premiums of your Health insurance policy mostly depend
upon your age. There can be a significant difference in the premium amount when you
purchase a health policy when you are 30 years old and when you buy one after crossing
50 years. The insurers get increased risk by charging a higher premium. This is the reason
why it is said that you should purchase health insurance when you are young.

• Co-Pay: Co-pay is the way of making customers liable and participating in the claim
settlement process. Co-pay is the amount of claim which is to be borne by the insured
customer at the time of claim settlement. Most of the health insurance policies have a co-
pay condition if there are senior citizens included in the policy. Higher the co-pay amount
selected by the customer lower would be the health insurance premium.
Health Insurance Benefits
Health insurance is a major necessity for the healthy life of an individual. Below are the benefits
of having a health insurance policy
• Comprehensive Coverage: Buying a policy online will help you tackle health-related
issues and avail the best possible medical treatment without worrying about expenses.
Most of the health insurance plans cover healthcare expenses such as In-Patient
Hospitalisation Expenses, Pre-Hospitalisation and Post-Hospitalisation Expenses,
Ambulance Expenses, Daycare Expenses, Domiciliary Hospitalisation Expenses, etc.
• Cashless Treatment: Generally insurance companies have tie-ups with hospitals, known
as network hospitals that offer cashless treatment to the insured in case of hospitalization.
These hospitals reimburse the expenses related to treatment availed by the insured. This
means, you can avail of treatment at these hospitals without paying anything for the
medical expenses incurred, and the insurance company will reimburse you for the same
later when you make a claim. Note that the claim will be approved if it is made in
accordance with the terms and conditions mentioned under the policy.
• Portability Benefits: Health insurance portability allows the policyholders to transfer
their existing health insurance policy to a new health insurance provider. It safeguards
customers from being taken for granted by the insurance companies, thereby giving them
flexibility and offering them better options in case they are not satisfied with their
existing health insurance plans.
• Financial Security Against Rising Medical Costs: Considering the rising medical
expenses in India, it becomes imperative to get a reliable health insurance policy on time.
The policy not only offers you wide coverage but also protects you from hospitalization
expenses in case of emergency even during inflation. It not only keeps you stress-free but
also takes care of your health.
• Tax Benefits: The government promotes health insurance by offering tax deductions on
the premium paid for them, under Section 80D of the Income Tax Act, 1961.
• Lifetime Renewability Benefit: Lifetime renewability benefit allows the policyholder to
renew their health insurance policy without any age limit or upper restriction. Especially
for senior citizens and parents, the lifetime renewability benefit takes off the financial
pressure in case of a medical emergency. The Insurance Regulatory and Development
Authority of India (IRDAI) has given guidelines to the insurance providers to offer this
benefit under the health insurance plans that they offer.
Before purchasing a health insurance policy know about the advantages and disadvantages
of health insurance in India. Compare health insurance quotes to get the best health
insurance plan online at PolicyBachat easily.

Health Care Insurance-Pros and Cons
Healthcare insurance, in general, has its advantages and disadvantages which are to be weighed
before purchasing the right health insurance policy. The rising cost of health care in the country
has pushed many people towards purchasing health insurance as per their requirements. The
COVID-19 pandemic has also brought much awareness among the general public in terms of the
importance of health insurance due to the heavy costs involved with the treatment for
coronavirus.
Health insurance is the only way of protecting yourself from spending heavily on medical bills
and ensures that you walk out of the hospital with a healthy pocket. Can you name a few people
who can help you with Lakhs of rupees at any point in time? What if you are admitted to a
hospital at midnight? Where will you run for the money at the odd times? All these problems can
be addressed with a single health insurance policy which can be taken based on your
requirements.
There are many general insurance companies as well as Standalone health insurance
companies offering health insurance products in the market. Even IRDA has suggested and asked
the insurance companies to roll out a standard health insurance product to benefit the
policyholders at the time of Porting the policy from one insurance company to the other.
What are the Pros and Cons of availing a Healthcare Plan
Pros of health insurance are Cashless hospitalization, Network Hospitals, No Claim bonuses,
Add-ons, or Riders, Financial Protection, Peace of Mind, Affordable healthcare. One of the main
cons of having health insurance is the cost, Pre-Existing Exclusion, Waiting Period, Increase in
Premiums, Co-Pay.
Let us understand the advantages and disadvantages of Healthcare insurance before purchasing
one:-
Advantages of Healthcare insurance:
Cashless Treatment & Reimbursement:
One of the biggest advantages of the health care insurance is its ability to provide the cashless
facility in the network hospitals. Customers can directly go to the hospital and get admitted after
showing the health insurance card provided by the insurance company. The insurance companies
have a tie-up with the hospitals to provide cashless treatment to their customers and later claim
from the insurance companies. This cashless system has proved to be beneficial to many people
who cannot afford to spend Lakhs of rupees for treatment.
Another option provided by the insurance companies is to go for reimbursement. That is the
customer has to pay the medical bills and later claim from the insurance company by submitting
all the required documents. This is the least preferred method opted by the customers and another
point to be noted is that Cashless hospitalization is available only in those hospitals where the
insurance company is having a tie-up.
Ease of admission in Hospitals:
Hospitals normally admit a patient after paying a token amount and starting the treatment. The
rest of the amount is to be paid before discharge without which the treatment would be halted

and the discharge process would be affected. This kind of situation is not faced in case of
admission in the hospital with a valid health insurance policy.
You can get admitted to the hospital by showing the health insurance card given to you by the
insurance company. This card acts as the token amount for admission to the hospital. This ease
of admission in the hospital at any point of time is possible only with the health insurance policy.
Income tax exemption:
Indian government has been encouraging people to purchase health insurance and is also
providing tax benefits for purchasing health insurance. Below are the income tax exemption
amounts under Section 80D of the Income-tax act.
• Family age below 60 years: The deduction for the medical insurance premium paid for
family ( Self, Spouse and Dependent Children) is up to Rs.25, 000/- and the Health care
insurance premium paid for Dependent Parents below the age of 60 years is Rs.25, 000/-.
The total deductions that can be claimed for the family with the age band below 60 years
are Rs.50, 000/-.
• Parents aged above 60 years: In case either of the parents is aged above 60 years, the
deductions for the health insurance premium is up to Rs.50, 000/- for the premiums paid
towards Parent’s Health insurance. The deduction for the medical insurance premium
paid for the Family (Self, Spouse, and Dependent Children) is up to Rs.25, 000/-. Hence,
the total deduction, in this case, is Rs.75, 000/-.
• Self/Spouse & Parents aged above 60 years: When one family member is above 60
years of age, one can claim up to Rs.50, 000/- under the Income-tax. Additionally, for
parents over 60 years of age, medical insurance paid is exempted up to Rs.50, 000/- under
the Income-tax act. The total deduction for family members aged above 60 years and
parents aged above 60 years is Rs,1, 00, 000/-.
Financial Protection:
The biggest benefit of Health insurance is that it prevents the sudden erosion of your savings and
assets. You might be investing an amount for your child's study or marriage and the same
amount might be eaten in case of your hospitalization if you don’t have proper health insurance
coverage. Health insurance with Cashless or Reimbursement option protects your financial
health and prevents you from liquidating your assets to pay the hospital bills in case of
hospitalization.
Having a health insurance policy can provide a good sleep to you thinking that the
hospitalization expenses will be taken by the insurance company and all your savings and assets
will be safe. The premium paid for a health insurance policy depends on the sum insured
required and the age of the family members. The premium paid per year would not be more than
5% of your annual income but prevents you from spending your annual income in case of
hospitalization.
Disadvantages of Healthcare insurance:
Waiting periods:
Health insurance policy is like any other insurance policy when it comes to terms and conditions.
A normal health insurance policy contains three types of waiting periods:-

• Initial/30-day Waiting Period: This waiting period is applicable to all the new
policyholders who have to wait for at least 30 days before claiming for any
hospitalization. Hospitalization due to an accident is exempted from this waiting period.
• Specific disease waiting period: There are certain diseases mentioned in the policy copy
such as Knee cap replacement, Hernia, Cataract treatments where the waiting period is at
least one 1year. You have to wait for one or two years before claiming for the diseases or
illnesses mentioned in the policy copy.
• Pre-existing disease waiting period: Pre-existing illness or disease is a condition or
ailment that already exists 48 months prior to the time of purchasing the health insurance
policy.
Health insurance policy has these three types of waiting periods which are applicable to all the
customers after taking the policy. The main disadvantage of health insurance is the waiting
period mentioned in the policy copy. There might be instances where the customer has taken the
health insurance policy but might not be able to use it owing to the waiting periods mentioned in
the policy copy.
Premium increases with Age:
Health insurance premiums are based on the age of the customers and the sum insured selected.
The premium increases with an increase in age and would be on the higher side for people aged
above 60 years of age. This is due to the increased risk of hospitalization at old age. The higher
the risk of hospitalization, the higher would be the health insurance premium.
There are separate health insurance products designed specifically for senior citizens. Insurance
companies have also launched health insurance products covering the specified diseases and
charging premiums for the same. Although there are health insurance products specifically for
senior citizens most of them have a Co-pay clause.
The co-pay clause specifies that a certain percentage of the claim amount has to be borne by the
customer. The co-pay can range up to 50% of the claim amount. Having co-pay in the health
insurance policy is also a burden to the customer who may not afford the co-pay claim amount.

unit 5 -1.pdf

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unit 5 -1.pdf