Medi Assist’s 2024 Findings Shed Light on Rising Costs, Incidence and Demography Wise Hospitalisation Patterns

• Delhi, Andhra Pradesh, and Uttar Pradesh saw a higher rise in average treatment costs
• Respiratory disorders, cardiac and Cancer emerge as top contributors to rising healthcare costs

Bengaluru – January 10, 2025: Medi Assist, India’s leading Health Benefits Administrator, has today released an in-depth analysis of healthcare trends -“Indian Healthscape 2024”. With an eye on rising hospitalisation costs, evolving patient demographics, and the increasing burden of critical ailments, the report highlights key health patterns and challenges shaping the future of healthcare in India. The findings emphasise the regional healthcare trends along with the growing need for targeted approaches to tackle medical inflation, and improve patient outcomes, all while ensuring accessibility and affordability in the healthcare system.

Key Trends:

1. Cancer Concerns
   • Cancer emerged as the fastest-growing ailment, taking the top spot in incidence rate increasing 10-12% YoY
   • Incidence (% age of claims w.r,t overall insured) has been observed to rise after the age of 40 with a steeper increase among women. Women are observed to have a 1.2-1.5X higher incidence rate w.r.t Men
2. Cardiac Disorders
   • Cardiac conditions ranked second in terms of both increase in cost and incidence rates, with men over 40 most affected
   • Data suggests that men have approximately 1.3 -1.5X higher rate in cardiac ailments w.r.t women
   • Group policies reported higher incidence rate of cardiac claims w.r.t Retail policies
3. Respiratory Ailments
   • Respiratory ailments topped the list in increase in average cost of treatment of nearly 10-13% YoY with the higher increase in Karnataka, Maharashtra and NCR.
   • Moreover, respiratory ailments are the biggest reason for hospitalisation amongst children.
4. Cataract Treatments
   • Cataract treatments are seeing a consistent yearly increase post COVID and is the most performed surgery amongst senior citizens
   • Group policies reported higher incidence rate of Cataract claims w.r.t Retail policies

• Regional Trends:
  • Top 5 states to see higher rise in average hospitalisation costs: Delhi, Maharashtra, AP, UP, West Bengal and Haryana
  • In Maharashtra, cities like Mumbai, Raigad, and Nashik witnessed a surge in cardiac-related treatment costs. Respiratory issues and maternity cases also showed significant growth in costs.
  • In Andhra Pradesh, top contributing cities were Guntur and Visakhapatnam.
  • Similarly, in UP, Ghaziabad and Noida led to the largest contribution in increase of cost of treatment
• Fraud, Waste and Abuse
  • Fraud, Waste and Abuse is a serious concern in the Health Insurance Industry causing financial stress for insurers, escalating premiums and increasing settlement times for beneficiaries. Document forgery, Medically Unnecessary Treatments and Non-Disclosure are the top tactics used by bad actors. These contribute 30-40%, 18-28% and 20-25% respectively of the overall detected frauds
  • Medi Assist’s award-winning AI powered MAven Fraud Detection Engine has more than doubled the detection of malicious claims, setting superior benchmarks in safeguarding the interests of all the stakeholders

Dhruv Rastogi, Senior Vice President and Head of Data Science, Medi Assist, said, “Our 2024 findings provide a vital understanding of the evolving health landscape, from the rising incidence of critical ailments to the growing financial burden on patients. Such information is essential for identifying areas which help insurance products to be constantly innovated to ensure better outcomes and manage costs effectively. Medi Assist’s industry leading AI powered technology platform enables innovative flexible benefits like OPD, Top Up Covers, Wellness programmes and routine health checks to be administered efficiently.”

Commenting on the increasing costs of treatment across the country, Dr Vijay Sankaran, Chief Claims Officer, Medi Assist, said, “We are cognizant of the steep medical inflation in the country and have focussed efforts in this direction. Medi Assist’s large network of hospitals plays an integral part in offering better discounts and packages to insurers thereby enabling them to have access to competitive rates and also enable members to experience cashless convenience.  The yearly increase in average claim amount in Medi Assist Portfolio has been 5-7% vs the typical medical inflation in the country which is around 10-13%”