Welcome to Medimanage Health India. Get Information on Health, Health Insurance, Weight, Diet, Skincare, Baby Health, Parents Health, Sex Life etc.
 
 

Rujuta Diwekar’s Lose your weight, Don’t lose your mind!

During one of my monthly book buying binges at Crossword around 4 months ago, I came across this book called “Don’t lose your mind, LOSE YOUR WEIGHT” by author Rujuta Diwekar who is well known for being Dietician & Nutritionist for “the-size-zero­-Kareena-Kapoor”. Due to some books remaining unread, it took a little while for this book’s turn to come for a read. Around 2 months back, I took it for reading. I was totally blown over by the simplicity & easy manner in which this book is written. The best part is that the book does not bore you (diet is a boring subject & holding reader’s attention consistently is tough task, I feel) & keeps flowing like an interesting storybook.

First chapter talks about the various diet fads, the myths about so-called weight-loss programs and fattening foods. Author rather makes a bold statement that “There is really nothing like ‘safe food’ or ‘fattening food’. Everything that you eat judiciously, at the right time and in the right quantity is good for you”. She then gets you to the basics of How to eat. Now, that’s something we don’t think we need to learn. But then the simple rules that Rujuta tells you change your perspective towards eating. (How do you know you are eating fast… While you are chewing food in mouth, if you keep food ready in your hands or on your spoon means you are eating fast & then that will result in overeating.) Here she rightly says that when it comes to food, think nutrients & not calories.

She then takes you to rethinking about what to eat. Carbohydrates, Proteins, Fats, Vitamins, Minerals, supplements & water…… She explains all these important aspects of food in language that’s not technical at all. This helps reader understand them better and use the information in his/her day-to-day food intake. (This is one big important feature of this book, as it’s not technical at all, you can take the advice there & then and start implementing it immediately). Here too she helps you understand things like whether you are drinking enough water or not…If your urine is always crystal clear (& not light yellow, dark yellow or reddish), you are drinking right quantity of water. Simple tests & rules like that help you start using the book’s advice right away.

Then she unveils the soul of her diet regime. The four principles of eating right….

Principle #1: "Eat some real food within 10-15 minutes of waking up."

Not tea or coffee but some real food…When we sleep, our blood sugar levels are dropped & we must bring them up to optimum levels. A real food (I have started eating an apple) leads to slow & steady rise of blood sugar levels. Tea & coffee actually work against this requirement as they contain caffeine (or cigarette) which increases the blood pressure, heart rate & breathing rate and make body feel “kicked”. In reality, body feels stressed but we take this as feeling awake. Stress is the biggest enemy of an efficient digestive system, the fat burning process of the body and hence, keeping body stress-free help you burn the fats at better rate. She also talks about the right potty style, the Indian Pot way. (In fact, this book has many boxes of relevant information which are spread within the chapters and they help you understand a particular point, concept or food item in detail. Some of them are Honey Lime Water / How to drink alcohol if you must / Coffee post dinner / What about sex post dinner / Tea & antioxidants / Italians & Olive Oil to name a few)

Don’t lose your mind, Lose your weight!

Principle # 2 - "Eat every 2 hours."

She says that you can follow this principle 2 only if you follow principle 1 because eating first thing in the morning lays down the foundation for day long hunger. This principle is derived from psychological perspective of body. Our body, when we eat at longer intervals (no breakfast, lunch at 2.00 pm & dinner at 10.30 pm), feels that it’s a starvation mode & hence, stores food (in form of fat) as it doesn’t know when the next lot of food will come its way. Also, when we eat at prolonged gaps, we tend to overeat. Eating every two hours makes body feel cared & reassured. It doesn’t feel like storing fat as it’s getting its food intake regularly. Also, when we eat at short intervals, we tend to eat less which means calorie intake is small. This simple mantra cuts down your fat stores and reduces your dependence on stimulants like tea, coffee & cigarettes.

Principle #3: "Eat more when you are active & less when you are less active"

Again the author tells you that one cannot follow the principle no. 3 unless you follow principle no. 2. Only when you actually eat all the time can you actually decrease meal size when less active and increase when more active. High activity could be both physical and mental. Activities like intense thinking, gymnasium, attending important meets are the ones where you are actively involved & are demanding a lot of energy from you. Low activity is when you are passive & do not use much of mental energies too. Activities like watching movie or TV, small chat over phone, being driven in car are considered as low activities. Eating more food when you are more active will make your body an efficient calorie burner which will increase the metabolic rate of your body. This will help you stay energetic all day long & will help you lose your fats more effectively.

Principle #4: "Finish your last meal of the day at least 2 hours prior to sleeping."

Digesting food is a calorie burner and a type of work for the body. The digestive system gets relaxed post sunset & if you overload your stomach with food in the night, most of it will get wasted or will get converted in fat. When we sleep, it’s time for body to repair the wear & tear and rejuvenate. If the stomach is full of food then, the body either starts working for digestion & ignores the rejuvenation OR ignores the digestion and works of repairing wear & tear. Both these things harm body. Keeping 2 hours gap between last meal & sleeping will help most of your food get digested and that leads to making you feel hungry in the morning. The principle 4 again ties down to principle 1.

Real Life Examples: In last two chapters, author has provided various real life examples on actual diet habits of people & analysed what’s wrong with them. Then she goes ahead & shows with minimal changes in lifestyle, how these people can shift to healthy eating habits and experience better results. The idea is to make one aware about one’s eating habits and then bring in a conscious change for better. This is typically like time & motion studies that manufacturing or process oriented industries adopt where log of activities is observed for a week or two weeks and then modifications are suggested.

This book is MUST for any adult who wants to remain fit & healthy and does not want to get cheated by the extreme diet fads & weight loss programs. When you want to cut down on your fat, the food (at least some food) is looked upon as poison. But Rujuta Diwekar brings back the old wisdom of “Anna He Purna Brahma” (The food is God). Go guys & gals, buy this book, read & implement to make you feel happy & healthy from within.

P.S.: Feel, Crossword should also keep some copies of this book in philosophy section where I frequent more. Like I believe that Godfather is not a Fiction but a Management book, I think that this book is about the eating as ‘way of life’ & hence should find a space in philosophy section too. At least, I would have come across this book earlier & reaped the benefits long back Wink

analyzing future of cashless mediclaim in India

Preamble

Last 3-4 days, we have been seeing a lot of news in various media about cashless network hospital list being brought down to fewer in numbers & this list does not have big hospitals where the treatment cost is high & hence, have a greater need for their presence in list. We fear that these news items have created confusion in our members’ mind & hence, here is small explanatory note from our team.

Genesis of the thought process

Insurance companies have been witnessing inflated, fraudulent & unwarranted hospitalisations claims when the patient had declared that he/she has insurance cover & wishes to go for cashless treatment. Also, an analysis of cashless claims brought out pointer that 80% hospitalisations (by amount) happen in only 25-30% hospitals. The advantages of curtailed list are envisaged as follows:

1). Limited hospital list (around 450 all over India) would offer better administrative control.

2). TPAs can drive more business to small number of hospitals & hence, can demand volume discounts.

3). With better administrative control, all bad claims (fraudulent, inflated & unwarranted) can be reduced to a greater extent.

Methodology adopted

New India Assurance Company (it’s the largest, has major Health Insurance exposure and their current CMD has good rapport with other PSU Insurers’ CMDs) had taken the lead & appointed four of its empanelled TPAs as nodal TPAs (one for each region i.e. East, West, South & North) & asked them to draw a list of around 100-125 hospitals in each region. Only these PPN (Preferred Provider Network) hospitals would qualify for cashless treatment. PPN is a very common concept in west & helps insurer have better control over claims without compromising the quality of care.

 How it impacts you?

1). Currently, this does not impact corporate members as this arrangement is meant for only retail / individual policy holders.

2). However, looking at the success of this arrangement, soon, this may get extended to corporate policy-holders too.  

3). Currently, only New India, Oriental Insurance & United India have agreed for following this network. National Insurance has their own ideas about how to implement this & hence, declined to be part of this network as of now (see news mentioned above).

What are the shortcomings of this system?

1). Cashless treatment becomes very useful when the treatment is costly. With no tertiary care hospitals in major cities being part of this Preferred Provider Network, members would be forced to raise the funds for cost of treatment before the treatment starts.

2). Cashless treatment has been one of the major attractions which has helped increased Mediclaim penetration in Urban & Semi-Urban India. With these kind of restrictions, the new policy sales may suffer an impact which is detrimental to overall claims experience. (New policies sale brings in premium without any claims in its initial years which help insurance companies improve their claims ratio.)

3). There is no proper methodology adopted for selection of these hospitals & many network hospitals are in dark about this change. Without any bench-marking, the quality of care may deteriorate & just for want of cashless, members may have to face inefficient service levels.

What should be done to implement this better manner?

  1. 1). A right mix of Tertiary, Secondary & Primary care hospitals should be ensured while finalising the city-wise Preferred Provider Network.

  2. 2). A stringent & transparent criterion should be adopted for selection of hospitals which should broadly look at following features:

    a). No. of Beds
    b). Infrastructure & Manpower quality
    c). Certifications & Statutory Compliances like minimum wages, PF etc.
    d). Published rates for various treatment & acceptance of Insurance Tariffs
     
  3. 3). A formal Third party annual audit & review methodology should be decided by the insurance company for these PPN hospitals.
  4. 4). In case of occurrence of fraudulent practices, the hospital should be banned for a period of three years and even reimbursement at such hospitals should not be allowed.

 

Summary

Though the initiative taken up by insurers has shaken up the hospital industry & made the consumers anxious, we have reasons to believe that this is a start of much needed changes in the Health Insurance industry. What we expect is well thought-out strategy derived out of data available with the insurers & then an efficient implementation of the same in phased manner to ensure that the consumer is not hassled unnecessarily. 

In case you have any queries, please feel free to connect with me at sudhir [at] medimanage.com


About Medimanage:

Medimanage is India’s first boutique health insurance broker, with an integrated service model which provides Unbiased Health Insurance Advisory, Technology based delivery and Professional Claims Assistance. To know more contact purandar [at] medimanage.com

 

More interesting news just today

Public sector insurers to push for a common claims settling agency (http://economictimes.indiatimes.com/personal-finance/insurance/insurance-news/Public-sector-insurers-to-push-for-a-common-claims-settling-agency/articleshow/6154912.cms)

  •  New Items for reference

Insurance Cos slash list of hospitals in Mumbai for making fraudulent claims(http://timesofindia.indiatimes.com/City/Mumbai/Insurance-cos-slash-list-of-hospitals-in-Mumbai-for-making-fraudulent-claims/articleshow/6145243.cms)

One PSU insurer stays with cashless Mediclaim

(http://timesofindia.indiatimes.com/India/One-PSU-insurer-stays-with-cashless-mediclaim/articleshow/6153259.cms)

 

 

Intermediary is often-used-management-jargon for simple word “Agent” or “Broker”. In India, we are aware of insurance/estate agents and share/estate brokers. Generally, these are those tie-wearing, persistent people who sell you insurance (Please note, you never BUY insurance, it’s always SOLD to you) or those mobile chattering, cigarette-smoking ones who help you find buyer for your house or find you a house for renting. That’s the image you have about them. So it’s quite natural that you look at a Broker or Agent as Seller’s representative. But there is huge difference between an Agent & a Broker when the context is Insurance industry.

An Agent is a representative of a single insurance company who is authorised to sell only one insurance company’s products while a Broker is buyer’s sole representative who can help you buy insurance from multiple insurance companies. An agent’s paramount concern is to safeguard Insurance Company’s interest while a Broker must ensure that his Client’s welfare is taken care of first. That’s why you often find an agent pushing certain products to you even when you are not convinced that they are the right fit for your needs. Generally, the drivers of push in such cases are the targets of insurance company or higher percentage of commission for agent. But a broker’s primary responsibility is to understand your needs, use his market knowledge to identify correct product, negotiate the rates (generally, for group insurances), obtain the cover for you & help you in case of a claim. An appropriate way to summarise his role is to say that “a broker helps you buy an insurance product & service it during its lifespan”.

The fundamental principle on which the “intermediation” started in the world was “Information Asymmetry”. In simple words, the buyer didn’t know what’s available in the market & the seller didn’t know who wants to buy a product. The “Intermediary” or “Agent” or “Broker” brought these two together and made a sale, albeit by earning some commission. If you look around all the agents or brokers till the internet exploded, they were focused only on bringing you information about what is available. But when internet came in common man’s life, searching for products & services became easy on web & the “Information Asymmetry” collapsed. Now, simply by typing some search terms, one could find out what he needed, also get some detailed information about the product & then make his decision. Thus internet has simply changed the rules of the game for Brokers. Now, the Broker cannot simply rely on information that he holds to win a client. It’s possible that a smart client knows more than him thru internet.

So what’s that broker should do now to remain relevant in the changed business scenario? Now the broker needs to “add value” to services offered by him than just get product information & quotes to a client. There are three areas where we can see value offering happening.

  1. Underwriting Expertise where the broker can help client buy right product by explaining him the policy conditions, its impact on claims, providing alternatives which will reduce premium but not affect the benefits much etc. This is very important support needed by clients for all types of Insurances but matters most for Liability & Health Insurance.
  2. Service Expertise where client’s all insurance related processes are managed by the broker thus client having minimal interaction with Insurance company or its outsourced agencies. Health or Motor insurance, due to high claims, are service intensive & hence, this aspect is very important for these two lines of insurance business.  
  3. Complementary Domain Expertise & value add is what separates a good broker from an excellent broker. A Motor insurance broker adding value to client about how to minimise accidents, more help on Automobile care and assistance to get best service (both preventive or breakdown) would be always preferred than one who helps you in just first two aspects. A Health Insurance Broker, who educates you about better Lifestyle, not only helps you live healthy but also supports you completely when you get hospitalised, will be always preferred by clients.

Unfortunately in India, the brokers came on the insurance scene pretty late i.e. in 2003 (time when insurance industry was opened to private players too). Till then, as clients were aware about only insurance agents, it took lot of time for brokers to position their services in correct manner. Most of the brokers did not have patience to educate their clients & hence, started operating like an agent by just getting quotes from the insurer & placing the business. Also many retired (compulsory or voluntary) insurance officials got into broking business on strength of the captive business that they were handling as insurance officials & continued managing those clients now as brokers. On top of this, by end of 2009, there are around 300 licensed brokers, operating mainly in major cities & vying for the business that other brokers are currently managing. This has brought intense competition in the market where for a single client, there are multiple brokers appointed to get better premium rates. Here, the competition is not between multiple insurers but truly between different brokers.

Worldwide, it’s standard practice that a Broker evaluation is done first where client evaluates various service aspects & capabilities of 2-3 short-listed brokers & selects one of them as Authorised Broker who then helps the client buy the most appropriate product. This broker then also services those products for the period of insurance. Generally, these broker appointments are for 3-5 years tenure where a broker can design a medium to long term insurance program & execute the same in the best interests of client. But in India, due to clients’ perception of brokers as “agents of insurer” as well as brokers’ focus to root out current broker & win the business solely on basis of obtaining “lowest quote”, client are being misguided in appointing multiple brokers for single insurance contract. This logically has led to unethical practices as well as falling service levels for the insurance contracts. Following are the logical fall-outs of this faulty practice.

  • When the competition is between the brokers & not insurers, the broker tends to fudge the claims & other related data while presenting to insurer to enable him obtain a lower quote. This is simply “misrepresentation of client’s information” which most of the clients may not be aware of. Many clients are strict about their corporate code of conduct, ethics & values but ignore such wrongful conduct by their authorised representatives. Ethical conduct is the first casualty of multiple broker arrangement.
  • Misrepresentation of data may help a broker get lower quote but when insurers come to know about this, they either ask for more premium OR are ready to cancel the policy as the claims ratio is high (this is bound to be high when the premium underwriting is faulty). The ultimate sufferer in such case is always the client.
  • Faulty underwriting, over a period of time, results into continuing losses for insurers & hence, insurers tend to behave extra-conservative. Insurance is about calculated risk-taking to arrive at moderate premium rates but with continuing losses, the premium rates harden which ultimately results in higher costs for clients.
  • When insurers make losses, they look at various options to cut down the costs. The brokerage gets cut first which results into lower incomes for brokers. Brokers then look at providing minimal service & tend to make same revenues by increasing volume. This further deteriorates the service levels of the broker.
  • As the broker who now has understood his client’s philosophy of using multiple brokers every year, has no interest in looking at the client’s insurance program for more than 1 year horizon which results in short-term approach. This tends to make the insurance program undergo changes every year which results in inconsistent user experience.

As the broker is supposed to be Client’s representative, the change must be initiated at clients’ end. The clients are not under the purview of Insurance Regulatory & Development Authority (IRDA) & hence, IRDA really can’t do much about this except for occasionally fining an errant broker. I have high hopes that over a period of time, clients would realise the fault in “Multi-Broker” theory and would change for better. It would need lot of education & counselling of clients by the Insurers & Brokers. To put it appropriately, Monogamy is the law of marriage & that applies to Insurance Industry too.

 
Medimanage Health India Corporate Blog | Health India Blog | Health Insurance India Blog