Wellness – A Strong Driver for Health Insurance Market in 2042

87.58 meters! 23 years old Neeraj Chopra threw Javelin 87.58 M on 9^th August 2021 to secure an Olympic gold for India. Track & Field event which was hitherto monopoly of Caucasian race was won by an Indian! This is not the first time that an athlete from subcontinent have bemused the Olympians, but this was made glaringly noticeable in today’s social media era. For past few years Indians are achieving greater deeds in athletic events and this medal may be the pinnacle of efforts so far. A deluge of Neeraj Chopra workout videos on social media points to the increasing interest in fitness by the current generation. Many work-out methodology and celebrity videos are being floated suggesting heightened level of interest in good health and fitness overall. A country with almost 78.4% population below age 45 has taken up fitness as a talking point at least on social media. Population over 45 has swelled from 18.3% to 21% over a decade indicating longer longevity and increased duration for NCD management. The Pandemic which forced most of the global population indoors also opened lot of debates on staying fit with indoor exercises. Major focus on sedentary lifestyle was brought in during the multiple extended lockdowns. Healthy lifestyle and fitness regime was ever so badly needed by most of the urban populace. Are we more aware of our fitness level and well-being now? Are we more than ever concern about that growing weight or declining stamina? The pandemic exposed one basic truth, the healthier people had better chance of survival through infections. Those with underlying conditions had prolonged hospital stay or some unfortunates could not make it. This has further increased focus on healthy living and fitness. One more aspect which came to the fore is of preventive care. For a common Indian citizen all vaccination almost stop after age of 5 and very few take flu shot or other preventive vaccination post their schooling age. A highly successful government campaign on fight against polio brought importance of vaccination for general improvement of quality of life for population. Major Corporates are organizing annual seasonal vaccination camps for their employees which result in improvement of their productivity by reducing the medical absenteeism. The importance of preventive care towards increasing of economic growth is recognized by all major stakeholders. The pandemic further emphasized on importance of preventive care. The Covid-19 vaccination data given below:  

Covid-19 Deaths per Million in vaccinated population
Age Group	Not Vaccinated	Single Dose	Fully Vaccinated
60+	65.4	1.3	0.8
45-59	20.6	0.4	0.2
18-44	2.8	0.2	0.09

  The data suggests for senior population the chances of survival increased almost by 500 times by single dose of vaccination. Even for the younger population the data suggests fully vaccinated individuals are very unlikely to suffer fatality compared to unvaccinated individuals. This clearly shows efficacy of vaccination and the difference it can make in life-and-death situation. The pandemic and related figures are easily accessible in social media due to heightened awareness. The effectiveness of various vaccination programs is well documented in medical literature. Both these events have brought issues related to fitness and wellness right at the center of peoples focus. The need and urgency for Wellness India has seen a frantic growth in GDP over last two decades averaging more than 6.6% per decade. This has pushed the larger part of population to higher income strata. The erstwhile agrarian economy is becoming predominantly manufacturing and servicing industry-based economy. The rural hard-working Indians are turning towards urban jobs seeking prosperity and making lifestyle sedentary. The non-communicable diseases (NCD) as a result of sedentary lifestyle are on rise. India has estimated 70 million diabetics as of 2019 and the figure will grow to 100 million by 2030 with another 200 million pre-diabetics struggling to stay fit. As estimated by World Economic Forum India will incur $4.6 trillion loss due to NCDs and mental health issues between 2012-30. For a country progressing fast towards overall prosperity and being counted amongst one of the major economy this may become a major roadblock. One worrying trend observed amongst Indian is that the NCDs set in quite early at around the age of 45 as against developed countries age limit of 55. Indians are more prone to Diabetes and Hypertension related ailments due to food habits and improved standard of living. The country is well-poised on all other counts to become a major superpower in coming decades provided we prevent our productive population from major onslaughts of NCDs at younger age and inculcate healthy lifestyle.

Difference in Fitness, Wellness and Preventive Care

Although most of us discuss Fitness and Wellness in same breath, these two are technically different concepts. Fitness specifically refers to physical ability to perform a task whereas Wellness is all encompassing well-being. Fitness is more about toning muscles and improving stamina which may be first step towards wellness which is about a healthy lifestyle. Fitness is about exerting your body to achieve specific levels tasks and wellness is about complete harmony on Physical, Emotional, Spiritual and Environmental aspect for an individual. Preventive care is more associated with physical well-being to pre-warn or avoid any health incidence. For a populace in general wellness is much accepted as an idea.

Wellness in Indian Context

In the United States of America wellness moment began in 1950s. In 1948 World health Organization (WHO) defined Health as “a state of complete physical, mental, and social well- being and not merely the absence of disease or infirmity”. National Wellness Institute (NWI) which initially started as Institute of Lifestyle Improvement under the auspices of the university of Wisconsin changed its name in 1985 to NWI and is working as a non-profit organization. According to the National Wellness Institute, “Wellness is an active process through which people become aware of, and make choices toward, a more successful existence.” In India, wellness is a concept which has been in vogue since ancient times. Traditional medicinal and health practices like Ayurveda and Yoga have propounded the concept of mental and physical wellness. Yoga as a core philosophy prescribes Yam (abstinences), Niyam (observances), Aasan (postures) and Pranayam (breathing) as four pillars of lifestyle. Most of the ancient wellness concepts have largely focused on the basic needs of an individual within the necessity hierarchy, namely health, nutrition and relaxation. In recent times, wellness as a concept has taken up a multi-dimensional definition, encompassing the individual’s desire for social acceptance, exclusivity and collective welfare. Mainly influenced by changes in society and in the lifestyles of individuals, this change has also been accelerated by extraneous factors like globalization and a greater awareness of the need for wellness among individuals. The NABH (National Accreditation Board for Hospitals & Healthcare Providers) defines Wellness as “a state of a healthy balance of the mind and body that results in overall well-being.”   The wellness industry in India has evolved rapidly from its nascent unstructured beginning in the early 1990s to a comprehensive ecosystem today. The advance in technology has further opened the field for health app and wearables tracking physical activities, dietary habits and overall body vitals. Wellness players, thus have responded to this change, shifting their focus from traditional offerings like curative healthcare and value-oriented mass products to new generational offerings like preventive healthcare, luxury products and personalized services. The wellness ecosystem comprises consumers, providers, adjacent industries, facilitators and the Government- Consumers - The Consumers mainly comprise a young population with rising income levels and the increasing need to look good and feel good, which has led these young consumers to seek wellness solutions to meet lifestyle challenges. Sedentary lifestyle has further accentuated the need to engage in some or other physical activity. Changing social paradigms have posed newer challenges on psychological well-being increasing mental stress. Providers - The Providers offer wellness services and products to meet the hygiene, curative and enhancement needs of the consumer. Multiple models have evolved with some working as aggregators for suite of services. The pharma industry, hospitals, gym and spas everyone is pitching in with their products and services to capture share of market. The wellness provider has to be connected with all the players to provide appropriate solution. Allied industries - The Allied industries, such as healthcare, media, retail, gaming, hospitality and education capitalize on the growth of the wellness sector to generate additional revenue streams, leverage existing competencies and offer a wider array of services/products to customers. Facilitators - The Facilitators, include employers, insurance companies and schools, who are likely to play a key role in encouraging and inculcating pro-wellness habits among consumers going forward. Government - The Government has multiple roles as a provider, facilitator, enabler, and regulator of the industry. The major focus is on have-nots currently as private players are providing products and services to higher income strata.

Wellness and Insurance

1980 onwards the insurers in US shifted their focus towards preventive-care and wellness of Corporate employees. Direct data to support the correlation between such initiatives and reductions in claims cost is not available. However significant improvement in insurance claims was observed and thus began the field of wellness. The insurer are realizing and promoting the wellness accelerated the growth of wellness offerings in the service sector. In India the insurance sector opened in 2001 and from 2008-09 on wards the retail health insurance market started expanding. Stand Alone Health Insurance (SAHI) companies brought more focus on retail health segment and past decade has seen lot of innovation in health insurance segment. On Group front their have been some wellness initiatives supported by the Group Managers/Corporates. Seasonal vaccination camp, Yoga training sessions, guidance on diets have been few initiatives run by Corporate HR departments. The Insurance Regulatory and Development Authority of India (IRDAI) has ensured that health insurance plans adapt to the changing trends of the modern society by providing conducive environment. Today’s health plans have become multi-dimensional in their scope. Insurers have initiated offered incentives to policyholders for adopting a healthy lifestyle. Wellness benefits, which were previously offered by few health insurers, have been given a fillip by the recent IRDAI guidelines. These guidelines have allowed insurance companies to include wellness benefits in health insurance plans to promote healthy living by rewarding through premium discounts. The offerings can be divided into 3 parts-

1. Coverage for preventive healthcare: To motivate policyholders to track their health on a regular basis, the guidelines provide insurance companies to allow policyholders coverage for preventive healthcare costs. Under preventive healthcare, insurers can provide coverage for the costs incurred in the following –
   • Health check-ups
   • Pharmaceuticals
   • Outpatient treatments
   • Diagnostic tests

The coverage can be offered as a part of the policy benefits or insurance companies can offer discounts to policyholders on these costs. The coverage would, however, be provided if such costs are incurred at networked hospitals or empaneled hospitals of the insurance company.

2. Benefits for wellness and healthy living: Many individuals practice a healthy lifestyle and maintain their fitness levels high. The guidelines provide that Insurer can reward such policyholders through wellness benefits in health insurance plans. This reward can be in the form of gift vouchers which policyholders can redeem on Health supplements, Sports club membership, Fitness center membership, Gym membership, Yoga membership, etc.

Furthermore, if policyholders practice healthy living during the policy tenure and fulfil the conditions of a wellness regime stipulated by the insurance company, they can be rewarded at the time of policy renewals. Insurers can offer such policyholders a discount in renewal premium or a free increase in the sum insured .

3. Coverage for excluded hospitalization costs: Certain non-medical costs are not covered under health insurance claims. The guidelines provide that insurer can offer coverage against such excluded costs as a part of wellness related

In a way these guidelines provide leeway to insurer to offer different wellness programs which in turn ensure customer engagement and reduction in claims cost.

Technology and Wellness

Last decade has seen growth of FinTech companies on country’s financial horizon. Many experiments in financial services have produced some of the unicorns of Indian financial sector. Mobile technology has assisted this process and most of the new-age FinTech companies have excellent apps which have penetrated very high percentage of mobile users. India has more than 120 crore telecom subscribers and similar number of mobile phones. Out of these over 45 crores are smartphones and over 56 crore internet users, second only to China. The FinTech story has accentuated the importance of mobile app and every business today is promoting its own app. Now catching on similar trend InsureTech companies are penetrating insurance market. One of the way to attract the consumer traffic towards their app is a free Health tracker. Existing wellness providers and these InsureTech startups are collaborating to provide app-based Health and Wellness solutions. In 2015 India had 74.42 million mobile internet users which increased to 744.06 millions in 2020. By 2025 this is expected to grow to 1.13 billion and in next five years to 1.34 billion mobile internet users by 2030. This tremendous growth in mobile-internet-app based users has almost coincided with wearable health trackers boom and the combined solutions available are catching on people’s imagination. Most mobile companies have also provided their own health tracking app and the entire market seems to be flooded with technology solutions for anyone serious about monitoring own health. As with every industry 3-4 top players will emerge capturing loyal customer base and health insurance will be next obvious offering for this segment of customers. These health tracking app solutions are synchronizing across platforms and generating large amount of data on users health and habits. The data generated by mobiles, wearables and through social media postings is available for analytics to process in form of Big Data. Artificial Intelligence (AI) and Machine Learning (ML) solutions will assist insurers to create customer health profile even without a single interaction. The insurers will be able to select and underwrite appropriate risks and push across customized product offering across same platforms. The technology will also assist insurers to drive the healthy habits and wellness behavior amongst their customer base as it will have direct impact on reduction of health claims cost. The scenario is similar to what happened in US in 1980s and one can expect insurers latching on to this data revolution to pre-underwrite health insurance offers for the customers and driving healthy habit for reduction of claims cost.

Conclusion

All this indicates very interesting two decades ahead of us. Wellness will take a center-stage for multiple industries to target the customer and insurer will be one of the key player amongst them. Next two decades should see a rapid innovation on wearables and health tracking app front wherein the customer behavior will be driven towards heathy living and mental well-being. A technology solution like diabetes patch monitor which captures customer sugar level every second providing feedback on type of food causing heighten blood sugar levels and pacemakers with built in chip providing signals on customer health are already available in the market. IoT- enabled shoes fitted with censors trying to prevent the fall in elderly by correcting balance and bio-sensing wearables are being experimented for regular use. The technology powered by huge data analytics on human movements, body-vitals and other critical data is only going to expand the wellness horizon. As the Indian economy leaps toward higher growth and prosperity, we will need highly-trained, skilled and healthy resources to take many a challenge ahead. The Government on its part through ‘Ayushman Bharat’ is encouraging healthy-living along with health coverage for more than 10 crore families. Health insurers will penetrate the remaining uncovered part of population to maximum extent. It is in insurer’s interest to promote wellness through the digital and phygital means which should ensure the healthier and productive manpower required for the country to centerstage on the worlds economic front. This means by 2042 we should be seeing a comprehensive solution taking care of all health-related aspects of customer through a digital ecosystem.