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Purpose: This paper aims to explore ten years of data on net premiums received and incurred claims of select health insurance companies and compare it with public sector total health insurance.
Design/methodology/approach: It is an exploratory paper comparing year-on-year premiums received and incurred claims of health during the period 2011-12 to 2020-21. ( Indian financial year start from April to March). Data has been shown in charts with trend lines without constants. Further, the Compounded Annual Growth Rate ( CAGR) has been calculated using log-linear regression.
Findings: The private sector is in business to earn profits, while the public sector is liberal in remitting the claims. Private-sector businesses earn more premiums than the public sector. However, the private sector's incurred claims are comparatively much less than the public sector's. The private sector is increasing business, but public sector growth is falling. The difference between year-on-year net premiums and incurred claims of the public sector is decreasing at 6.95%, but the same is increasing in the private sector at 19.63%. However, it cannot be generalised that the private sector is taking over the public sector business. The public is playing its social responsibility with accountability. However, the private sector aims to earn more earnings.

BACKGROUND: Chronic diseases contribute to a significant proportion (71%) of all deaths each year worldwide. Governments and other stakeholders worldwide have taken various actions to tackle the key risk factors contributing to the prevalence and impact of chronic diseases. Private health insurers (PHI) are one key stakeholders, particularly in Australian health system, and their engagement in chronic disease prevention is growing. Therefore, we investigated the impacts of chronic disease prevention interventions implemented by PHI both in Australia and internationally. METHOD: We searched multiple databases (Business Source Complete, CINAHL, Global Health, Health Business Elite, Medline, PsycINFO, and Scopus) and grey literature for studies/reports published in English until September 2020 using search terms on the impacts of chronic disease prevention interventions delivered by PHIs. Two reviewers assessed the risk of bias using a quality assessment tool developed by Effective Public Healthcare Panacea Project. After data extraction, the literature was synthesised thematically based on the types of the interventions reported across studies. The study protocol was registered in PROSPERO, CRD42020145644. RESULTS: Of 7789 records, 29 studies were eligible for inclusion. There were predominantly four types of interventions implemented by PHIs: Financial incentives, health coaching, wellness programs, and group medical appointments. Outcome measures across studies were varied, making it challenging to compare the difference between the effectiveness of different intervention types. Most studies reported that the impacts of interventions, such as increase in healthy eating, physical activity, and lower hospital admissions, last for a shorter term if the length of the intervention is shorter. INTERPRETATION: Although it is challenging to conclude which intervention type was the most effective, it appeared that, regardless of the intervention types, PHI interventions of longer duration (at least 2 years) were more ...

Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed the various schemes used to defraud the Medicare and Medicaid programs and private insurance companies and how the proposed legislation contained in H.R. 3461 and S.1231 could strenghten federal and state health care programs."

11.6.2015 On 22nd December 2014, the Department of Health commenced a public consultation on the scope for private health insurance to incorporate additional primary care services. The aim of the consultation was to examine the scope for private health insurers to cover a fuller range of services provided in primary care settings, with a view to creating incentives for a transfer of appropriate services from acute to primary care settings and to encourage the most effective use of resources. The original consultation discussion document set out the general background and some structured questions to help interested parties focus their submissions and is available here. A total of 31 submissions were received as part of the consultation, including from private health insurers, General Practitioner representative and training organisations, pharmacy and private hospital representatives, employers and other interested parties. A copy of all of the submissions received is now available below. Follow-up meetings with interested parties took place during March this year and the Department has considered all of the views submitted as part of the consultation process, with a view to identifying the capacity that exists for an appropriate expansion of services. An analysis document, which summarises the key themes arising from the consultation is now available here, together with a conclusion of the consultation process available here.

For almost a century, the Netherlands was marked by a large market for voluntary private health insurance alongside state-regulated social health insurance. Throughout this period, private health insurers tried to safeguard their position within an expanding welfare state. From an institutional logics perspective, we analyze how private health insurers tried to reconcile the tension between a competitive insurance market pressuring for selective underwriting and actuarially fair premiums (the insurance logic), and an upcoming welfare state pressuring for universal access and socially fair premiums (the welfare state logic). Based on primary sources and the extant historiography, we distinguish six periods in which the balance between both logics changed significantly. We identify various strategies employed by private insurers to reconcile the competing logics. Some of these were temporarily successful, but required measures that were incompatible with the idea of free entrepreneurship and consumer choice. We conclude that universal access can only be achieved in a competitive individual private health insurance market if this market is effectively regulated and mandatory cross-subsidies are effectively enforced. The Dutch case demonstrates that achieving universal access in a competitive private health insurance market is institutionally complex and requires broad political and societal support.

Chapter 1: Introduction: The European Union, the Insurance Industry and the Public-Private Mix in Healthcare -- Part 1: The Political Roots of EU Insurance Legislation -- Chapter 2: Insurance Directives and the Single Market: towards a trivialization of Private Health Insurance? -- Chapter 3: Solvency II, the European Government of Insurance Industry and Private Health Insurance -- Part 2: The Impact of the European Union Private Health Insurance -- Chapter 4: The Uncertain and Differentiated Impact of EU Law on National (private) Health Insurance Regulations -- Chapter 5: An increasing homogenisation of Private Health Insurers under Solvency II? -- Part 3: Shifting the public-private mix in healthcare? Multifaceted paths towards Europeanization -- Chapter 6: Private Health Insurance in Belgium: Marketization Crowded Out? -- Chapter 7: Europeanised, marketised but still governed by the State? Private Health Insurance in France -- Chapter 8: Ireland: The Ambiguous Role of the Health Insurance Market -- Chapter 9: The Dutch Way: Experimenting with Competition in the Healthcare system -- Chapter 10: In between the market and public health insurance: a place for occupational welfare in Europe? .

Hospital Casemix Protocol data provide a brief summary outlining morbidity data and costs associated with an episode of care. Federal government legislation requires that hospitals report this information to private health insurers who, in turn, merge these data with benefit outlays and report their findings to the Department of Health and Ageing (DoHA). This article gives a brief outline of the collection, cleansing and processing of these data and subsequent reporting to DoHA by Medibank Private, which accounts for approximately 30% of collected data.