Page 194 - Ebook health insurance IC27

The Insurance Times

and automated decision support in medicine. This system is designed to promote
international comparability in the collection, processing, classification, and
presentation of these statistics.

The ICD is a core classification of WHO family of International Classifications
(WHO-FIC). The ICD is revised periodically and is currently in its tenth
edition Since Indian Insurance Industry was in its nascent stage during the
inception of the ICD, in 2004, the 10th and the latest version is considered the
best source. In India the ICD code is generally assigned by the hospital staff /
TPA at the time of discharge.

ICDs can be analyzed for the following purposes :
(i) For analysis of the general disease profile of population group.
(ii) For monitoring of the incidence and prevalence of diseases and other health

problems in relation to other variables such as the characteristics and
circumstances of the individuals affected.
(iii) For analyzing medical cost and utilization trends by location and by provider.
(iv) For analyzing impact of seasonality on disease occurrence. And
(v) For benefit pricing and negotiating costs. The ICD 10 also provides the
basis for compilation of national mortality and morbidity statistics by WHO
member states. It is a critical input for provider payment mechanism known
as Diagnosis Related Groups (DRGs) where the payment to the provider is
linked to the diagnosis of the ailment and not to the input of services.

Q8. Write a note on Insurance Information Bureau.
Ans. IRDA has a regulatory as well as a developmental mandate for health insurance,

both of which need collection and dissemination of reliable and accurate numeric
and statistical data.

198 Guide for Health Insurance