Hospitalisation costs are rising at an alarming rate. The average claim size in India for 2023-24 stands at Rs 70,558, up from RS 62,548 in the previous financial year, a significant increase of 11.35%, reflecting the broader surge in healthcare expenses, said a new report.
As medical inflation continues to climb, currently at 14%, and lifestyle-related diseases tighten their grip on the population, ACKO, an insurance company, has released its ‘ACKO India Health Report 2024‘.
Further, the report draws a comparison between the claims filed by genders. Men on average claimed Rs. 77,543/- while women claimed Rs. 69,553/- (without maternity).
The report revealed critical trends across various demographics, including regions, genders, and age groups derived from ~60,000 health insurance claims filed with ACKO during 2023-24.
This report sheds light on the primary health risks leading to hospitalisations across India and examines the financial burden these conditions place on individuals and families. It further underscores the alarming financial vulnerability of many Indians, highlighting how a single hospitalisation can push a family toward financial ruin, emphasising the critical need for adequate health insurance coverage.
Other Key Findings of The Report;
Additionally, the costs of common medical procedures have escalated, with angioplasty (PTCA) costs soaring from Rs 1-1.5 lakhs in 2018 to Rs 2-3 lakhs in 2024, and projections suggest that the cost could reach Rs 6-7 lakhs by 2030. Similarly, kidney transplant costs have doubled, from Rs 5-8 lakhs in 2018 to Rs 10-15 lakhs in 2024, with expectations of surpassing Rs 20 lakhs by 2030.
Disease Trends by Age Group: Vulnerability Across Life Stages
The report dives into age-specific patterns of disease vulnerability. Children under 18 are notably more susceptible to respiratory conditions, which constitute over 11% of all claims in this age group. However, this trend reverses post the age of 18, with only 2.79% claiming between 18 to 30 and 2.98% for those between the ages of 31 to 40. After the age of 40, the rates of hospitalisation for those with respiratory conditions flatline around 3%.
Another concerning trend is the sharp rise in hospitalisations due to neoplasms (tumors, both benign and malignant) and heart conditions as people age. Notably, hospitalizations for neoplasms saw a jump by 2.8 times from ages 31-40 (3.81%) to 41-50 (10.61%). Similarly, claims related to heart, and circulatory system diseases saw a threefold increase between the ages of 31-40 (2.24%) and 41-50 (6.88%).
In a sobering statistic, ACKO’s data reveals that the largest claim related to heart disease – specifically for a cardiac procedure – filed in the past year exceeded Rs 1.1 crore, while the biggest kidney disease-related claim topped Rs 24 lakhs, underscoring the severe financial impact of serious health conditions.
Regional Health Insights: Where You Live Matters
The report also highlights significant regional disparities in health risks, revealing distinct patterns in the prevalence of various diseases across cities in the country. Kolkata and Mumbai emerged as the leading metros for circulatory system disorders, including heart attacks, strokes, and other ischemic conditions. Chennai and Pune also reported heart-related claims well above the national average.
Specifically, 7.03% of total claims in Kolkata last year were attributed to heart diseases, while Mumbai saw 7%. Chennai and Pune followed with 6.45% and 5.50% respectively, all surpassing the national average for heart-related claims.
In terms of kidney-related diseases, Delhi NCR had the highest proportion of claims. Kochi, Secunderabad, and Bengaluru also reported kidney health claims above the national average. In Delhi NCR, 35.3% of total claims were kidney-related, followed by Kochi at 18%. Secunderabad (17.4%), Bengaluru (13.1%), and Jaipur (12.8%) similarly recorded kidney-related claims exceeding the national average. The average age of kidney ailment patients across the country was 47 years.
Maternity claims trends
The report noted that a whopping 69% of maternity claims were filed for C-section deliveries while normal delivery constituted 31% of the claims in private hospitals.
A retail health policy is a must
The data further revealed the critical need for a personal retail health insurance policy, as corporate policies frequently fall short of covering hospital expenses. Over the past year, ACKO’s platinum retail health plan covered 100% of the total hospital bills claimed, while corporate policies only covered 74%. This coverage gap is largely due to the policy terms and conditions dictated by employers.
Rupinderjit Singh, Senior Vice President – Health at ACKO, said, “Shedding light on critical health issues and claim behaviours is crucial for helping our customers make informed insurance decisions. The insights from the ACKO India Health Report 2024 underscores the growing importance of personal health insurance in the face of rising medical costs. This report also highlights the necessity of comprehensive coverage that ensures 100% bill payment. We believe that understanding these trends will encourage stakeholders, including insurers, to collaborate in making healthcare more affordable for everyone.”
