An Audit of Indian Health Insurance Claims for Mental Illness from Pooled Insurance Information Bureau's Macroindicator Data

INTRODUCTION: Information on the social and voluntary insurance coverage of mental illness in India is scarce. We attempted to address this lacuna, utilizing a secondary macrodata approach for 3 years. Mental illness per se is not covered by most of existing Indian health insurance policies. MATERIALS AND METHODS: Publicly available de-identified claim macrodata for all health (nonlife) insurance for Indian financial year from 2011–2012 to 2013–2014 were collected. The age group, gender, amount of claims, proportion of claims, and details of number of days of hospitalization were collected and analyzed. Descriptive statistics, Chi-square test, and Wilcoxon tests were used appropriately. P ≤ 0.05 was considered statistically significant. RESULTS: In 2011–2012, there were 2864 claims from the registered 2,591,781 members citing mental illness (0.11%) which decreased to 0.03% in 2012–2013 and marginally rose to 0.07% of all claims. The total amount of claims paid for mental illness was Rs. 51.7 millions in 2011–2012, Rs. 97.2 million in 2012–2013, and Rs. 150 million in 2013–2014. Statistically significant difference emerged in terms of age group, gender, amount and proportion of claim, and number of days of hospitalization. CONCLUSION: The penetration of health insurance is low and claim for mental illness remains low. The difference in patterns of age, gender, amount of claims, and number of days for mental illness provides detailed relevant information to formulate future policies.