One major change was implementing the Indian Insurance Act, first proposed by the previous government.
The Act enables global reinsurers to enter as 100 per cent owned branches and increases overall foreign direct investment (FDI) in the insurance industry from the current limit of 26 per cent to 49 per cent. While there are many aspects of insurance, the most significant opportunity not only for insurers but also for Indian society, is the health insurance sector.
India is one of the fastest growing health insurance markets in the world. It has grown rapidly since the industry opened to private and foreign players in 1999 with the establishment of the Insurance Regulatory Developments Authority. In 2014, the health insurance market grew to $2.7bn from just $150m in 2004. It is on track to hit $8bn by 2020.
There are a number of factors driving this growth.
From a workforce perspective, just 10 per cent of India’s 300m working population work within formal sectors such as government, the public sector or in large private companies, which often offer health insurance perks. The rest work in the informal sectors, meaning they are self-employed or working in family businesses and, therefore, without corporate health insurance cover.
It is this end of the market that is most dependent on financial security during ill health. Yet, in the absence of health insurance plans, many are liable for medical bills and loss of potential income during treatment.
Demographically, the population boom, rising life expectancy and increased incidences of lifestyle-related diseases means that total healthcare expenditure is growing rapidly. It is expected to rise from $70bn to $280bn by 2020.
Despite this, there is a low spend per capita compared with countries where healthcare is largely funded by the government, meaning that some 62 per cent of total expenditure on health is paid for out of pocket.
India has one of the lowest penetration rates of pre-paid health coverage and medical insurance in the world. This is due to its geographical size, the capital required to invest in developing the distribution network and the current lack of focus from insurers in the individual health insurance sector.
The limitation on foreign investment rules in insurance did not give much incentive for a lot of foreign experienced players to participate in this market. There are just five standalone health insurance companies and 17 private sector insurance companies offering health insurance. So there is low consumer choice, coverage and competition. Compare this with the UK, which has 911 general insurers. India itself had over 100 players in general insurance before the market was nationalised in 1972.
Active foreign participation is critical for the sector, bringing better standards and driving competition, with better quality products, customer coverage and choice. The increase in the FDI limit will create significant opportunities for foreign players to enter the market through joint ventures, mergers or acquisitions.
Yet there are some significant challenges that remain, such as finding the right acquisition target or a partner with the right balance of local knowledge and cultural compatibility in the boardroom between the two organisations. Successful firms will be those that are comfortable with local regulatory requirements and have working knowledge of India’s business environment.
Modi’s government has promised to revamp India’s healthcare sector and make services more affordable and accessible for all walks of society. With the doors opening to India’s insurance industry, the health insurance sector will play an increasingly important role in delivering this commitment to its citizens from all walks of life.