Health Insurance in post-COVID-19 world

Novel Coronavirus has disrupted every aspect of our lives. No industry is spared & no business untouched. One of the most impacted areas is the Health Insurance Ecosystem.

There are so many uncertainties & no clear answers to how things will change for health insurance. So here are my thoughts on what every insurance & benefits professional should watch out for in the near future.

Short Term Impact: 

1. Deferment of Planned Surgeries: Most of the non-urgent, planned surgeries have been postponed during this lockdown. This has improved the loss ratios in the short run, but this cost is bound to hit the insurers soon after restrictions are lifted. Further, the health status of some individuals - especially the ones with co-morbidities - may have worsened during this period - owing to lack of proper medical attention & monitoring. So the eventual cost of treatment could be much higher as more tests & medications will be needed, leading to longer recovery time.
2. Delayed Realization of Claims: Submission and processing of claims may have got delayed due to challenges of accessibility. Insurers may not disclose this upfront, hence it's important to keep an eye on the quantum of outstanding & IBNR (incurred but not received) claims.
3. Increase in Chronic Conditions: Lack of mobility, additional mental stress & unmonitored diets during the lockdown could lead to a rise in lifestyle conditions like diabetes & hypertension. For the diagnosed individuals, even a short disruption in their condition management efforts could lead to breaking of hard-earned healthy habits & behaviours. And people in borderline risk category could now suffer irreversibly. Another concern would be Cancer cases gone undiagnosed or diagnosed late - since health outcomes of cancers are directly related to timely diagnosis & intervention. 
4. Impact on Mental Health: It's an evident fact that our collective mental health has suffered during this crisis. The economic outlook, changes in work pattern & uncertainty about employment are causing much anxiety, depression and in some cases substance abuse. Some countries have witnessed an increase in domestic violence. 
5. Demand for Telehealth: This pandemic has given a huge boost to Telemedicine services. Many employers have provided such services as a stop-gap arrangement during the lockdown. But now, there would be an increased demand from employees for the continuation of these services. So, watch out for the cost of out-patient & pharmacy.
6. Maternity: The earliest COVID-impacted countries are reporting a spike in maternity intimations after lifting the restrictions. Whether this trend will follow in other goes remains to be seen.
7. Dental procedures: Cental services will be down to emergencies alone for the near foreseeable future. Since dental procedures require close proximity and lead to particulate matter suspension (through drills & jets), there could be concerns of around spread of respiratory infections. So the dental care industry will possibly have to undergo a radical change in treatment delivery soon.  

Long term impact: 

1. Technology in Insurance: One huge positive expected out of this crisis is that ‘Insurtech' will get a boost. Insurers have already started engaging with technology partners to improve their process efficiency, reduce cost & enhance customer engagement. The future of insurance could be fascinatingly different.
2. Healthcare Inflation: Pent-up demand for healthcare & subsequent demand-supply gap could increase medical inflation in the long run. This may translate into higher premiums, which in turn will lead to adverse selection & unstable risk pools. 
3. Preventive Care & Alternative Medicine: There will be a higher demand for vaccination, prophylactics & alternative systems of medicines. Benefit designs will need to be more accommodative.
4. Fertility Rates: Economic instability has historically been followed by a decline in fertility rates & higher age at conception. How will this particular crisis impact fertility trends, remains to be seen. 
5. Travel insurance: As the volume of business trips decreases, premium & scope of coverage for travel insurance is bound to be affected.
6. Underwriting for Pandemic Cover: Some employers & individuals got lucky by having pandemic coverage already included in the scope at a negligible premium. But now that the risk is realized, insurers are sure to change the scope of pandemic underwriting & pricing. 
7. Will insurers be more cautious in underwriting Rare Risks going forward? Climate change-related events are lurking on the horizon & we have no clue what health risks & impacts they will bring.

Purple

A newborn babe with twinkling eyes

Brings hopes of clear & bright skies
Mum is ecstatic,

dad is proud
But waiting in his future is a dark cloud

The child is 5, playing with his mates
Picks up a doll & starts combing her plaits
The boys all laugh,

and the elders all jest
This is the first of his many mistakes

“Shy & aloof, even quicker to cry
These aren’t the traits of a ‘normal’ boy”
The teacher yells

and mother stands abashed
The child of 10 just can’t figure out ‘why’

The teasing starts, then the insults & slurs
“Shouldn’t cry, shouldn’t run, that makes it even worse
I’ll keep my mouth shut &

walk the straight line.
Must endure this phase & everything will be fine”

A teenager now, he knows he’s ‘different’
He has feelings, but to their bodies he’s indifferent.
He loves to be with him

but he longs for her too
“What kind of a weirdo have I turned into!?”

Longing for a connection, for this torment to end
He gathers up his courage & confides in a friend
“You like boys,

and are also into girls?
Disgusting! Seems you want the best of both worlds!?”

Surprised & scared, shattered & ashamed,
It dawns upon him that it’s truly started to rain
“Does love demand a pronoun?

Why is life so tough?
Isn’t loving another human just good-enough!?”

His heart is pure but it’s hard to pick a side
Dissecting the dilemma, he finally decides-
“The love I feel inside

is same as yours, & real,
So whether you get it or not, I won't seek your approval”

Eventually,
The storm gives way & brings what it must
A rainbow on the horizon, on a warm comforting gust.
The rainbow brings more choices,

not just pink & blue
So choose your colors with pride & be truly ‘You’.

Part 2: How much does your vote count? State-wise differences

Republished from my LinkedIn post here

In the previous post, we saw that 'Electoral Power' - the relative power of a vote compared to national average - varies as per state. The comparison was done between the states. 

This post goes one level deeper & evaluates these differences within the states.

The spread of electors per seat within a particular state can be compared through a measure called 'standard deviation'. Higher values of standard deviation mean that the distribution of electors per seats in that state is uneven- some seats may have more electoral power & others, less.

Here are some observations supported by tables:

• Punjab, Gujarat & West Bengal have the most even electoral distribution & also have a balanced electoral power. Electors here enjoy the ideal scenario.
• Andhra Pradesh, a state with electoral power closest to the national average, has quite an unbalanced electoral distribution per seat. It would be interesting to see how the scenario has changed after separation of Telangana & redrawing of the electoral boundaries in 2014.

• Kerala & Himachal Pradesh, the states with high electoral power, have balanced distribution of electors per seat. This indicates that these states have more seats & more parliamentary representation than can be logically attributed.

 

• Rajasthan has an even distribution of electors per seat, but has lower number of seats & less parliamentary representation than can be logically attributed.
• Delhi NCT, Uttar Pradesh, Maharashtra & Madhya Pradesh account up to 164 Lok Sabha seats; that's 30.2% of the total. These states have the most skewed electoral distribution & they also have the least electoral power. This could have been done to ensure that these big states don't dominate the national scenario & smaller states get a voice in the matter.

• Here's a list of top 20 parliamentary constituencies with the highest electoral power. Interestingly, 13 out of the 20 LS seats in Kerala have the highest electoral power in India. Polling percentage in these seats is also high. 
  

• Similarly, here's the list of bottom 20 constituencies when ranked as per electoral power. Malkajgiri in Telangana has electoral population as huge as two constituencies in one - so voters there have the lowest electoral power. Also, all four seats from Bengaluru feature in the bottom 20; polling percentage in these seats is relatively low.  

In other democracies, specifically in the US, gerrymandering has become huge issue. Faults in the electoral distribution & legislative loopholes have been exploited by political parties to maximize their political gains.

Since this exercise is statistical & depends on multiple factors, it hasn't captured the attention of the masses & hasn't received much attention in media as well. But Indian voters need to be mindful of these facts, because a small change in the electoral boundaries can lead to a huge impact on national politics & ultimately, on public policy.

Over time, an average voter in the certain regions may start feeling that his/her vote is not valued enough & that we should we redraw the boundaries to make it fairer.

There is an independent body called Delimitation Commission of India which has the power to redraw the boundaries of constituencies. The current boundaries are established based on 2001 census when India's population was 102,87,37,436. It has since increased to over 130 crore - an increase of 27%, thus prompting a need for re-evaluation.

I am hopeful that this issue will get more exposure in near future.

Let's be mindful, engaged citizens and make each vote count.

Data Source: Election commission of India's Lok Sabha election report 2014

Part 1: How much does your vote count?

Republished from my LinkedIn articles

 

Note: This post is not political in nature. It's an amateur mathematical exercise.

Your vote is precious & every vote counts.

But do you think every vote counts equally? 

Well, may be not.

I collected data from the Election Commission of India's 2014 election report (as 2019 data will be published next year) & did a quick analysis. Here's what I found -

1. In 2014 LS elections, there were 83,40,82,814 eligible electors for 543 seats. So, an average of 15,36,064 electors per seat (see graph below). Thus, if a state has higher than average electors per seat, a vote cast there would have lower electoral power, and vice versa.
2. Uttar Pradesh (UP), the state with highest number of seats @80, also has the highest number of electors per seat @17,35,132. This means that a vote cast in UP accounts to 13% less compared to the national average. After UP, electors in Rajasthan (12%) & Maharashtra (9.6%) have the lowest electoral power.
3. Union territories (UT), with the exception of National Capital, and the hilly states have the lowest numbers of electors per seat. Meaning that each vote cast there has a higher than average electoral power.
4. If we exclude hilly states & UTs, electorates in Kerala have the highest electoral power - as much as 20.8% higher than national average. Odisha (9.5%) & Tamil Nadu (8%) are the next highest.
5. Andhra Pradesh (then inclusive of Telangana) is closest to the national average when it comes to electoral power. I suspect that political gerrymandering played a crucial role during the state's division in 2014. Would be interesting to see the current numbers.

 

More disparities can be found if we do this analysis at a seat level (which shall be covered in part 2 of this post); so elector power can vary greatly within a particular state. But besides the obvious political reasons, there are factors like geography, local economy, urbanization, population growth rates, migration, etc.. A longitudinal study shall reveal how much of this picture is politically influenced.

 

Data Source: Election commission of India's Lok Sabha election report 2014

Artificial Intelligence: Knocking on the doors of Creation

Since the later half of 20th century, the world has witnessed an exponential growth in information technology. Internet, cellular phones, semiconductor microprocessors, smartphones, supercomputers... One big wave after another, technological innovation spread like wildfire, pushing the boundaries of human experience to more and more alien territories. (1) Off late, the disruption has been driven by cloud storage, blockchain, cryptocurrencies, artificial intelligence, machine learning & even quantum computing. The boundaries between real & virtual, natural & artificial are blurring rapidly. And now we are at the cusp of creating new autonomous entities that can learn on their own & think for themselves. The fiction of Nueromancer, Hitchhiker's guide to the galaxy & Star trek is about to become the reality. What an exciting time to be alive!

But not everyone shares this excitement. There has been plenty of fear-mongering, negative media coverage and controversial headlines about employees being replaced with robots. Some prominent scientists- the likes of Stephan Hawking, Nick Bostrom, Bill Bibbard- and leading innovators including Elon Musk, Peter Norwig have expressed their concern over the pace of AI development and its potential societal impact. (2)

Without a doubt, the potential applications & benefits of AI are enormous. Throughout our evolutionary journey, humans have added a huge value to life through our intelligence & curiosity. But we cannot realistically predict what miracles we might achieve when our intelligence is supplemented by AI tools. Perhaps the problems that are currently beyond human understanding or capacity can only be resolved with a helping hand of a super-intelligent system. So, let me briefly make a case for AI.

Science works on the principles of repetition and agreement. What one scientist discovers is validated by another by repeating the experiment in various conditions. But our understanding may be implicitly biased or flawed as we -through our human bodies- perceive the universe in a particular way, which is limited by and filtered through our senses. So our perception of reality is just our point of view; it may not be the reality of the universe. That's why we need other beings to build more consensus on reality. And due to the present lack of other intelligent civilizations, the only option we have is to 'create' something intelligent and give it its own will and sensory assets- an Artifical Intelligence. Once such an intelligent system becomes autonomous and starts running the same scientific experiments as us, it can actively participate in the scientific process of hypotheses testing. And perhaps then we may get closer to the truth.

Like it or not, AI is here to stay & it will have an unprecedented impact on human civilization. It may very well turn out to be our greatest discovery, or our final one. Therefore, we cannot ignore the pitfalls that come with it - remember how nuclear research in min-twentieth century quickly escalated into a nuclear war? History tells us that everything that rises too quickly falls even faster. The same technology that can cure cancer, solve world hunger and eradicate poverty can lead us to a dark dystopic future. So we better watch out! Because if we don't, this famous quote from Neuromancer may haunt us forever.

"I'm the matrix, Case."
Case laughed. "Where's that get you?"
"Nowhere. Everywhere. I'm the sum total of the works, the whole show."

IBM's Art with Watson: This is one of the first artworks created by IBM's Watson- a cognitive system that combines artificial intelligence and sophisticated analytical software for optimal performance. It is named for IBM's founder, Thomas J. Watson. https://www.ibm.com/watson/artwithwatson/

Foot Notes:

1. The disruption is elegantly captured in Moore’s law

2.  Read Research Priorities for Robust and Beneficial Artificial Intelligence: an Open Letter

Hypatia: The forgotten treasure of Alexandria

"History is written by the Victors." - Winston Churchill

The story of human civilization is littered with examples which prove that our historic records are just a version of events carefully selected and presented by the victor. And this victor, without a question, has always been a man. Such is the sorry state of affairs that an entire half of human society has been denied the right of self-expression and freedom of thought for centuries, just based on a random & natural genetic outcome. And whenever a woman has stepped up to challenge this rigged system, she has been summarily suppressed, shunned & publicly vilified. No matter what their internal differences, men have gone out of the way to unite and fight against this singular threat to their dominance.

This is a story of a woman in the 4th century CE, who was doomed because of her own brilliance - Hypatia. I got introduced to Hypatia through the book I am currently reading- 'The Swerve: How the World Became Modern' by Stephan Greenblatt.

Hypatia was a Greek born, raised in Alexandria, Egypt. Imagine a world where social order is paramount and religious dogma is the law of the land. All the high posts in magistrate, education and religious matters are held by men. Now imagine yourself as a woman in such a society.

The contemporary Christian historian Socrates of Constantinople described her as follows in his Ecclesiastical History:

"There was a woman at Alexandria named Hypatia, daughter of the philosopher Theon, who made such attainments in literature and science, as to far surpass all the philosophers of her own time. Having succeeded to the school of Plato and Plotinus, she explained the principles of philosophy to her auditors, many of whom came from a distance to receive her instructions. On account of the self-possession and ease of manner which she had acquired in consequence of the cultivation of her mind, she not infrequently appeared in public in the presence of the magistrates. Neither did she feel abashed in going to an assembly of men. For all men on account of her extraordinary dignity and virtue admired her the more."

It was said that Hypatia wore a philosopher's robes (known as Tribon) in public, as a male would. She drove her own chariot, sailed her own boat, rode a horse alone out into the deserts around Alexandria. She could stand and speak before thousands of men with confidence and authority. Before she was twenty, she surpassed her famous father in mathematics and astronomy. Science, as we know it now, did not exist in 400 CE. Mathematics mingled with divination, cosmology and astronomy went hand in hand with astrology. Alchemy was a secret 'science' that did indeed work with metals and their property, but its deeper truer purpose was the manipulation of the 'spirit'. In the mystery teachings, and Hypatia was a leading teacher of the ancient mysteries, alchemy was practiced with her inner circle in an attempt to reach the Divine. So, now it's easy to see why many men perceived her as a threat- a young, beautiful, intelligent, mysterious & risk taking philosopher. Jealous with her intellect and threatened by her charm, her enemies would whisper to each other that she must be a witch. But never openly in the public.

Alexandria was going through a religious turmoil at the time. There were 3 different groups co-existing for centuries in Alexandria- Jews, Christians and Hellenistic Pagans. Hypatia was a Pagan who were thought of at that time as practitioners of black magic. Ciril- an ardent opposer of Jews and Pagans - was recently appointed as the patriarch of Alexandria by the Roman Empire. The moment he took over Alaxandria, violent skirmishes broke out at the theater, in the streets, and in front of churches and synagogues. Jews taunted and threw stones at Christians; Christians broke into and plundered Jewish shops and homes.  Cyril demanded the expulsion of the city’s large Jewish population. Alexandria’s governor Orestes, a moderate Christian, refused, and this refusal was supported by the city’s pagan intellectual elite whose most distinguished representative was the influential and immensely learned Hypatia.

Hypatia’s support to Orestes may have set the unstoppable chain reaction that led to her demise. Ciril started circulating rumors that Hypatia's absorption in astronomy, mathematics, and philosophy proves that she is a witch, practicing black magic.

In March 415 the crowd, whipped into a frenzy by one of Cyril’s henchmen, erupted. Returning to her house from a temple, Hypatia was lynched from her chariot and taken to a church that was formerly a temple to the emperor. There, after she was publicly stripped, her skin was flayed off with broken bits of pottery. The mob then dragged her corpse outside the city walls and burned it.

Their hero Cyril was eventually rewarded with sainthood. 

Hypatia's murder was symbolic of the Alexandria's intellectual atrophy & eventual downfall. Even with a privileged background & high social connections, a woman could not make it in the ancient world. I quiver to think of all those women who were not so privileged; what must have been their fate?

We owe everything to all those forgotten women... The silent underground streams who have mad the ground above greener...

The roll call by Elizabeth Thompson (1874)
Reference: The Lady Vanishes- Revisionist History by Malcolm Gladwell http://revisionisthistory.com/episodes/01-the-lady-vanishes

Zen and The Art of Motorcycle Maintenance: An Inquiry into Values

Was truly fortunate to read this masterpiece by Robert M Pirsig recently. It's such a radical work of philosophy, science & art, I was completely blown away by it. It's a deep inquiry into what is the meaning of 'quality' and how to distinguish it. 

When it comes to understanding & defining quality, the questions that everyone struggles with are:

1. If quality exists in the object,  why can't scientific instruments detect it? 
2. Is quality subjective? If so, quality would not reside in the object but in the observer. 

Since all the traditional methods of philosophy & science fall short to answer these questions, the author has laid down a completely out-of-the box contextual road-map. He states that "Quality is not a thing. It is an event. It’s a place where subject meets the object. An event where the subject becomes aware of the object... People differ about quality, not because quality is different, but because people are different in terms of experience... Quality is the continuous stimulus which our environment puts upon us to create the world in which we live. All of it."  

I was particularly struck by the following conclusion- 

A person who sees quality and feels it as s/he works, is a person who cares. A person who cares about what s/he sees and does, is a person who is bound to be given by quality. 

Sharing here some notes from this book that I found extremely useful in dealing with 'lack of gumption'. To the first time reader, it may sound a bit confusing. So I encourage everyone to read this book for themselves. These notes are just for the reference once you want to actually practice the Zen & the Art in real life.

Gumption traps:

The author calls this philosophy as 'Gumptionology 101—An examination of affective, cognitive and psychomotor blocks in the perception of Quality relationships.

Since it’s a result of the perception of Quality, a gumption trap, consequently, can be defined as anything that causes one to lose sight of Quality, and thus lose one’s enthusiasm for what one is doing.

There are 2 major types of gumption traps- Set backs and Hang-ups:

1. Setbacks (primarily caused by external conditions) 
1. Out-of-sequence-reassembly: occurs when  you're doing something for the first time. When you are almost done, you find something that's left out or is unexplained. 
• Solution: As you go about the process, maintain a thorough log of what you did, when,  how & why you did it. 
2. Intermittent failure setback: the thing that is wrong becomes right all of a sudden just as you start to fix it.
• Solution: Observe correlations. When is the failure occurring, in which conditions, what time, etc. 
3. Parts setback: when parts are to be replaced, you don't get the right parts. You may have mispecified the part, the dealer may have noted the wrong information, the part may be overpriced, etc. 
• Solution: Deal with the one supplier who is most cooperative. Keep an eye on the price-cutters, they sometimes have have good deals. Take calipers with you to measure the new part. Manufacturer your own parts. 
2. Hang-ups (primarily caused by internal conditions) 
1. Value traps: Which block affective understanding...
1. Value rigidity: Inability to revalue what one sees because of rigid commitment to previous values. The facts are right in front of you but you don’t see them. If your values are rigid, you cannot learn new facts. Happens in ‘premature diagnosis’, meaning, you are sure what’s wrong with something but then when it turns out that you are wrong, you are stuck.
• Solution: Slow down deliberately and just observe the facts. Evaluate whether what you thought was important was really important. Be with it for a while. What it the way you watch a line of fishing, and before long, you will get a nibble, a little fact asking in a timid, humble way if you are interested in it. That’s the way world keeps on happening. Be interested in it.
2. Ego: If you have a high evaluation of yourself then your ability to recognize new traps is weakened. Your ego isolates you from quality reality. When the facts show that you goofed up, you don’t accept it. The false information makes you ‘look good’ 
• Solution: Be modest. If that’s not possible, fake modesty to begin with.
3. Anxiety: You are so sure you’ll do everything wrong, you are afraid to anything at all! This makes it difficult to start anything new. So you end up fixing things that don’t need fixing & chase after imaginary ailments. You jump to wild conclusions and build all kinds of errors in the machine because of your own nervousness. These errors, when made, confirm your original underestimation of yourself. This leads to more anxiety & further errors- a self-stroking cycle.
• Solution: Work out your anxieties on paper. Read everything on the subject. Remember, it’s peace of mind you are after and not just fixing a problem. Understand the even the masters or experts goof up once in a while.
4. Boredom: You are off the ‘quality track’, you are not seeing things freshly, you’ve lost your beginner’s mind and your motorcycle is in grave danger. Boredom means your gumption supply is low & must be replenished before anything else is done.
• Solution: Stop. Do something else. If you don’t stop, a huge mistake is inevitable. Sleep. Get some coffee.
5. Impatience: You underestimate the amount of time an activity may take. And when things don’t work out, you impatience turns into anger. 
• Solution: Allow an infinite time for jobs, particularly the new or unfamiliar ones. 
2. Truth traps: These block cognitive understanding.
• In Japan, there's a concept of ‘Mu’ meaning ‘no thing’ or ’no class; not one not zero, not yes not no'. It points outside the dualistic way we see the world. It states that the context of the question is such that the question becomes too small for the truth of the answer. Our dualistic mind tends to see such Mu occurrences in nature as contextual cheating, or irrelevance, but Mu is found everywhere in nature & in science & nature’s answers are never irrelevant. (It's similar to the Quantum computing concept, where qubits do not represent the traditional dualism of 1 & 0, but 1 & 0 occur simultaneously.)
• Solution: When you come across a Mu, don’t brush it under the carpet hastily. It is an important answer. It tells the scientist that the context of the question is too small for nature to answer. So enlarge the context of the question and ask again. 
3. Muscle traps: They block psychomotor behaviors.
• Muscular insensitivity: Occurs due to lack of kinesthesia, a failure to realize that although the motorcycle is rugged and strong externally, the inside mechanisms that actually run it are delicate. This is what’s known as a ‘mechanic’s feel’.
• Solution: Realize the difference between ‘finger tight’, ’snug’ and ’tight’. Exercise ‘care’. 

“Well, if I get around all those gumption traps, then will I have the thing licked?” 

The answer, of course, is no, you still haven’t got anything licked. You’ve got to live right too. It’s the way you live that predisposes you to avoid the traps and see the right facts. You want to know how to paint a perfect painting? It’s easy. Make yourself perfect and then just paint naturally. That’s the way all the experts do it. 

The making of a painting or the fixing of a motorcycle isn’t separate from the rest of your existence. If you’re a sloppy thinker the six days of the week you aren’t working on your machine, what trap avoidances, what gimmicks, can make you all of a sudden sharp on the seventh? It all goes together. But if you’re a sloppy thinker six days a week and you really try to be sharp on the seventh, then maybe the next six days aren’t going to be quite as sloppy as the preceding six. What I’m trying to come up with on these gumption traps, I guess, is shortcuts to living right.
  

The real cycle you’re working on is a cycle called yourself. The machine that appears to be “out there” and the person that appears to be “in here” are not two separate things. They grow toward Quality or fall away from Quality together.      
   

(Thanks to Par Bolina, MD for recommending this book to me. You are an inspiring leader, mentor and beyond all, a great human being. Thank you for everything.)