The average claim size in India for 2023-24 stands at ₹70,558, up from ₹62,548 in the previous financial year, a significant increase of 11.35%, reflecting the broader surge in healthcare expenses
Bengaluru: With rising hospitalisation costs, the average claim size in India for 2023-24 has risen by 12% to ₹70,558 from ₹62,548 in the previous financial year, reflecting the broader surge in healthcare expenses, according to ACKO India Health Report 2024, prepared by ACKO general insurance.
The report said medical inflation continues to climb, currently at 14%, and lifestyle-related diseases are tightening their grip on the population.
The report draws comparison between the claims filed by genders. Men on an average claimed Rs77,543 while women claimed Rs 69,553 (without maternity).
The report revealed critical trends across various demographics, including regions, genders, and age groups derived from 60,000 health insurance claims filed with ACKO during 2023-24.
Skyrocketing Medical Costs: A Financial Wake-Up Call
Additionally, the costs of common medical procedures have escalated, with angioplasty (PTCA) costs soaring from ₹1-1.5 lakhs in 2018 to ₹2-3 lakhs in 2024, and projections suggest that the cost could reach ₹6-7 lakhs by 2030.
Similarly,kidney transplant costs have doubled, from ₹5-8 lakhs in 2018 to ₹10-15 lakhs in 2024, with expectations of surpassing ₹20 lakhs by 2030.
Disease Trends by Age Group: Vulnerability Across Life Stages
The report dives into age-specific patterns of disease vulnerability. Children under 18 are notably more susceptible to respiratory conditions, which constitute over 11% of all claims in this age group.
However, this trend reverses post the age of 18, with only 2.79% claiming between
18 to 30 and 2.98% for those between the ages of 31 to 40. After the age of 40, the rates of hospitalization for those with respiratory conditions flatline around 3%.
Another concerning trend is the sharp rise in hospitalizations due to neoplasms (tumors, both benign and malignant) and heart conditions as people age. Notably, hospitalizations for neoplasms saw a jump by 2.8 times from ages 31-40 (3.81%) to 41-50 (10.61%).
Similarly, claims related to heart, and circulatory system diseases saw a threefold increase between the ages of 31-40 (2.24%) and 41-50 (6.88%).
ACKO’s data further reveals that the largest claim related to heart disease
specifically for a cardiac procedure – filed in the past year exceeded ₹1.1 crore, while the
biggest kidney disease-related claim topped ₹24 lakhs, underscoring the severe financial impact of serious health conditions.
Regional Health Insights: Where You Live Matters
The report also highlights significant regional disparities in health risks, revealing distinct
patterns in the prevalence of various diseases across cities in the country. Kolkata and Mumbai emerged as the leading metros for circulatory system disorders, including heart attacks, strokes, and other ischemic conditions. Chennai and Pune also reported heart-related claims well above the national average.
Specifically, 7.03% of total claims in Kolkata last year were attributed to heart diseases, while Mumbai saw 7%.
Chennai and Pune followed with 6.45% and 5.50% respectively, all surpassing the national average for heart-related claims.
In terms of kidney-related diseases, Delhi NCR had the highest proportion of claims. Kochi, Secunderabad, and Bengaluru also reported kidney health claims above the national average.
In Delhi NCR, 35.3% of total claims were kidney-related, followed by Kochi at 18%.
Secunderabad (17.4%), Bengaluru (13.1%), and Jaipur (12.8%) similarly recorded kidney-
related claims exceeding the national average. The average age of kidney ailment patients across the country was 47 years.
Maternity claims trends
The report noted that a whopping 69% of maternity claims were filed for C-section deliveries while normal delivery constituted 31% of the claims in private hospitals.
Commenting on the launch of the report, Rupinderjit Singh, senior vice president, Health at ACKO said, “The insights from the ACKO India Health Report 2024 underscores the growing importance of personal health insurance in the face of rising medical costs.
This report also highlights the necessity of comprehensive coverage that ensures 100% bill payment. We believe that understanding these trends will encourage stakeholders, including insurers, to collaborate in making healthcare more affordable for everyone.”