Healthcare Economics and Policy

Cutting insurance commissions sounds logical. It may turn out dangerously simplistic. India wants Insurance for All by 2047. The current response is to look at lowering distributor commissions to reduce premiums. But here’s the uncomfortable question I keep coming back to: What happens to distribution when you squeeze incentives in a phygital business? Yes, premiums remain high even after GST on life and health insurance was cut from 18% to zero. Yes, acquisition costs are elevated driven by front-loaded distributor payouts. And yes, the RBI has flagged: • High distribution costs are slowing insurance penetration • Commission growth in non-life insurance has outpaced operating costs • Private life insurers saw sharp commission escalation post 2022–23 All of that is valid. But insurance is still not a click-and-buy product. It is sold, explained, nudged, and serviced. Especially for: • First-time buyers • MSMEs • Rural and semi-urban customers • Long-term life and health covers This is where the contrarian risk lies. If commissions are capped or deferred without rethinking the entire distribution model: • Agents may shift focus to easier products • Advisory quality may drop • Misselling risk could actually increase • Penetration in non-metro India could slow further Lower premiums on paper mean nothing if the product never reaches the customer. Remember: MSMEs contribute 30% to GDP and 44% to exports, yet face a ₹30 trillion credit gap. Insurance affordability matters. But insurance availability matters just as much. The real problem isn’t commissions alone. It’s how value is rewarded in distribution. If incentives reward: • Short-term sales over long-term coverage • Volume over suitability • Acquisition over persistence Then capping commissions treats the symptom, not the disease. India doesn’t just need cheaper insurance. It needs sustainable advisory economics. Otherwise, in fixing costs, we may quietly break the last-mile engine that actually sells insurance. Will lowering commissions improve penetration or push insurance further away from the people ?

Working with an interdisciplinary team, we have developed a website to communicate how the White House's proposed cuts to health research would cause losses of $16B and 68,500 jobs. Find out how your community may be impacted at SCIMaP: https://scienceimpacts.org As context, on Feb. 7th, 2025, the White House ordered across-the-board cuts to NIH funded research. The order drastically reduces the amount that universities/hospitals/institutes receive for essential facilities, services, and staff required for health research. Nearly two dozen states and allied institutions sued leading to a temporary injunction to across-the-board cuts nationwide. The NIH distributes approximately $37B in external grants/awards in FY 2024. These grants/awards have a force-magnifying effect, generating $2.56 of economic activity for each $1 supported, i.e., more than $94B in activity and more than 400K jobs (source: United for Medical Research). But this impact is hard to see and interpret. You might wonder: perhaps the impacts are focused only on a few, potentially 'elite' institutions? The answer is far different. Soon after the executive order was released, it became apparent that these across the board cuts would have damaging & consequential effects in communities across the United States, in places like State College, PA, Birmingham, AL, and across the medical research infrastructure of Texas. Led by the efforts of Allie Sinclair joint with Emily Falk, Clio Andris and more, we have developed an interactive visualization of the impact of federal cuts to health research in communities nationally. In practice, we take anticipated reductions in NIH supported grants and then leverage US census data on commuting to project the impact of these cuts across and within communities. Through interactive, data-driven visualizations, we aim to help Americans explore how research fuels the economy, supports jobs, and improves health outcomes. This website and interactive visualization is a step in that direction, with more to come joint with Alyssa (Allie) Sinclair (now at UPenn), Emily Falk (UPenn), Clio Andris (GT) + others in The Science and Community Impacts Mapping Project: https://scienceimpacts.org

As the Budget season approaches, the insurance industry and policyholders have high hopes for reforms that will make insurance more accessible and affordable for every Indian. Aligning with the IRDAI’s vision of achieving ‘Insurance for All by 2047,’ here are some expectations that could transform the insurance landscape: Reduction in GST on Insurance Premiums: Currently, the GST rate on insurance premiums is 18%, making coverage a costly affair for many. A reduction in GST will not only make insurance more affordable but also encourage more people to opt for essential coverages like health, life, and motor insurance. Separate Tax Provisions for Term and Whole Life Plans: Currently, life insurance premiums fall under Section 80C, which also includes other investment options like PPF, ELSS, and home loan principal repayment. By creating a separate tax benefit category for term and whole life insurance plans, the government can incentivize individuals to secure their families with adequate coverage instead of prioritizing purely investment-based products. Higher Tax Deduction Limits for Health Insurance: With rising medical costs, the existing tax deduction limit under Section 80D (₹25,000 for individuals and ₹50,000 for senior citizens) is insufficient. Increasing the limit to: ₹50,000 for individuals ₹1,00,000 for senior citizens will encourage people to opt for higher health insurance coverage early on, helping them combat medical inflation effectively. Affordable Health Insurance for Senior Citizens: Senior citizens often face significantly higher premiums due to their age and health risks. Enhancing tax relief for them will provide financial ease and ensure they are better covered for unforeseen medical emergencies. Insurance not only protects individuals and families but also strengthens the economy by reducing financial distress and promoting societal resilience. Incentivizing insurance purchases can bridge the protection gap and align with India’s growth vision. This Budget presents an opportunity to make insurance a household priority by easing affordability and incentivizing better coverage. Let’s hope the reforms help build a secure future for every Indian. #Budget2025 #InsuranceForAll #IRDAI #Policyholders #HealthInsurance #LifeInsurance #TaxBenefits #AffordableInsurance

As we approach open enrollment, I often hear Medicare Advantage brokers say: “We put our clients on the best plan for them.” And in many cases, that’s true. Most brokers genuinely want to help clients navigate a confusing system. But let’s be honest—sometimes this statement is more slogan than reality. Or it’s based on a narrow, short-term view of what “best” means. Why is that a problem? Because what looks like the best plan today isn’t always the best plan tomorrow. Too often, a plan is recommended because it has one flashy benefit that matches a client’s current need—a Part B rebate, a gym membership, a lower copay for one prescription, or a dental allowance. But insurance isn’t really about today. If a client develops cancer next year, or needs an expensive surgery, or finds themselves in and out of the hospital—will that same plan still protect them? Will it give them the doctors, hospitals, and drug coverage they’ll desperately need when they need it? That’s the true test. The purpose of insurance isn’t the shiny extra—it’s the safety net. It’s not about what matters in the healthiest chapter of someone’s life. It’s about being covered when health changes course, sometimes suddenly and dramatically. And that’s where brokers have to take the longer view. A plan that’s easy to sell today might not be the plan a client would choose if they could see into their own future. The real responsibility of a broker is not to ask: “What’s the best plan for you now?” It’s to ask: “What protection will serve you if your health changes?” “What’s the strongest plan for both today and tomorrow?” “How do we make sure you won’t regret this choice when you need coverage the most?” That is a much higher standard. And that’s what “best” really should mean.

Singapore’s upcoming parliamentary debate on Integrated Shield Plan (IP) rider changes goes to the heart of a difficult but necessary trade-off in healthcare financing. On one hand, rising premiums and private healthcare costs are clearly unsustainable. Insurance designs that eliminate almost all out-of-pocket expenses weaken price signals and encourage higher utilisation. This is not about bad faith by patients. It is about incentives. When the marginal cost of care approaches zero, claims rise, premiums follow, and affordability for the wider risk pool steadily erodes. On the other hand, MPs are right to ask how families will cope if deductibles and co-payments become unaffordable at moments of medical stress. Sustainability cannot come at the expense of dignity or access. Cost sharing may be economically sound, but if poorly calibrated, it risks discouraging timely care, worsening health outcomes, or imposing sudden cash-flow shocks on households least able to absorb them. This debate is often framed as a matter of individual consumer choice. In reality, it produces systemic effects. Highly comprehensive riders may feel rational for one household, but collectively they drive higher utilisation, push up costs across the system, and increase pressure on public healthcare resources. The policy question is therefore not whether cost sharing should exist, but how much risk should be socialised, how much should remain visible, and how those boundaries are enforced fairly. Affordability must also be understood more broadly than premiums alone. It includes whether families can manage sudden deductibles, whether sufficient buffers and safety nets exist, and whether support mechanisms are well targeted rather than blunt. Cost sharing works only when paired with safeguards that recognise uneven financial resilience across households. At its core, this debate is a reminder that healthcare financing is a shared responsibility. Patients, insurers, providers, and policymakers all shape outcomes through incentives and expectations. Parliament’s discussion is therefore not just about insurance riders, but about fairness, resilience, and how we design systems that remain compassionate, credible, and sustainable over the long term. What do you think?

Recommended reading! She RISES: a framework for caring cities Cities often mirror the inequalities embedded in society. She RISES: A Framework for Caring Cities, developed by surabhi tandon mehrotra, Kalpana Viswanath, Ankita Kapoor and Rwitee Mandal from Safetipin, brings this imbalance into sharp focus. It exposes how urban design and governance frequently overlook the gendered dimensions of city life, especially the invisible role of care work in sustaining urban systems. The framework is built around four core principles: Responsive, Inclusive, Safe and Equitable Spaces. Together they form an integrated approach to gender transformation through four streams of action. The first stream focuses on public spaces and infrastructure. Well-lit streets, obstacle-free pavements, safe public toilets and mixed-use neighbourhoods are presented as essential design features that enable women’s participation in urban life. The second stream addresses services and amenities, highlighting the need for childcare facilities, housing for single women, and access to affordable health care. Recognising and redistributing care work across communities, markets and the state is seen as a cornerstone of an equitable city. The third stream targets mobility and public transport. Women’s complex travel patterns, shaped by care duties and multiple destinations, require safe, affordable and well-connected systems. Gender-disaggregated data and inclusive recruitment policies in the transport sector are proposed as practical tools for change. The fourth stream concerns responses to gender-based violence, emphasising the implementation of existing laws, the establishment of crisis hubs, and public campaigns that reshape social attitudes. The She RISES framework is both analytical and operational. It is intended for planners, policy makers and urban managers who aim to embed gender sensitivity into every layer of urban governance. The report also serves as a reminder that the care economy is not peripheral but foundational to the functioning of cities. Safetipin, the social enterprise behind this work, has been collecting and analysing safety data in more than forty-five cities across Asia, Africa and Latin America. Their evidence confirms that cities designed with care in mind not only improve safety for women but also strengthen social cohesion and economic resilience for all. #GenderEquality #UrbanDevelopment #InclusiveCities #UrbanPlanning #PublicSpace #CaringCities

Where the alarms should ring is in the health benefits/insurance industry. I just did an interview in which I asserted, something I deeply believe, that these companies for the most part add only administrative costs and hassles to the healthcare industry and provide absolutely no value. Negotiated prices by insurers are often if not invariably higher than cash prices for the same procedures at the same places (see, for instance https://lnkd.in/gKk2UXaZ or do a search under the phrase are healthcare cash prices lower to find more evidence). Prior authorization has expanded in use even though the American Medical Association notes its effects to increase prices, red tape, and burdens on both healthcare providers and patients (https://lnkd.in/g_iAkgRQ). In fact, benefits administrators often deny payment of valid, even pre-authorized healthcare claims, further driving up costs and inefficiencies (see, for instance, https://lnkd.in/gBf66VEz.). Health insurers don't get better prices, don't improve access to care, and don't reliably even pay claims. In short, they add absolutely no value. One reason that the Kaiser health system is able to offer high quality at lower costs is because it is an integrated system that eliminates these third party administrators (https://lnkd.in/gUd9cnBE). Employers, when they use third party administrators, are for the most part NOT getting what they are paying for. They should change their purchasing behavior. #healthcare #KaiserPermanente #medicalcare #healthbenefits #healthcarecosts #healthinsurance #healthinsurers

Thailand’s Agriculture Revolution: The Cannabis Impact!! Thailand’s agriculture sector, a cornerstone of its economy, is undergoing a transformative shift with the legalization of cannabis. Historically, Thai agriculture has thrived on rice, rubber, and tropical fruits, employing millions and contributing significantly to GDP. However, challenges like low crop prices, climate change, and market volatility have pushed farmers to seek alternatives. Enter cannabis, a game-changer since its decriminalization in 2022, offering new opportunities and sparking debates about its long-term impact. Cannabis cultivation has opened a lucrative avenue for Thai farmers. With global demand for medical cannabis and hemp-based products soaring, small-scale farmers, particularly in rural areas, are diversifying their crops. The plant’s versatility—used in medicines, textiles, cosmetics, and food—has attracted investment and government support. In 2024, the cannabis industry was valued at over $1 billion, with projections doubling by 2030. Farmers in provinces like Chiang Mai and Nakhon Ratchasima are reaping higher profits compared to traditional crops like rice, which often yield slim margins. Training programs and cooperatives have emerged, empowering farmers with knowledge on cultivation and compliance with regulations. Beyond economics, cannabis is reshaping agricultural practices. Its relatively low water and pesticide requirements align with sustainable farming goals, a critical factor as Thailand grapples with drought and soil degradation. Hemp, a cannabis variant, is being explored for crop rotation to improve soil health, offering a greener path forward. However, challenges persist. Regulatory ambiguity, inconsistent quality control, and competition from larger corporations risk marginalizing small farmers. The black market also looms, undercutting legal sales and creating enforcement headaches. Socially, cannabis legalization has sparked cultural shifts. While Thailand’s Buddhist heritage frowns on recreational use, medical cannabis enjoys growing acceptance, with rural communities embracing its economic benefits. Yet, concerns about youth access and public health remain, prompting calls for stricter oversight. The cannabis boom is a double-edged sword for Thai agriculture. It offers a lifeline to struggling farmers and aligns with global trends toward sustainable crops, but without clear policies and equitable access, its potential could falter. As Thailand navigates this green frontier, the world watches—could this be a model for other agrarian economies with history of cannabis cultivation like India? For now, cannabis is planting seeds of change, and Thai farmers are at the forefront of this agricultural revolution.

I've spent my career helping both sides of a $217 billion argument. I have to admit, I've gone through a bit of a mid-life crisis lately. I've helped health systems maximize billing and lower denial rates. Then I've gone to the payer side and stood up cost containment strategies. I'm proud of my career, but it feels like pushing a boulder one way, then walking to the other side and pushing it back. So much of the healthcare spending problem is adversarial: $𝟳𝟬.𝟳𝗕 𝘁𝗼 𝗮𝗿𝗴𝘂𝗲 𝗮𝗯𝗼𝘂𝘁 𝗯𝗶𝗹𝗹𝘀 Providers hire appeals teams to get claims paid. Payers hire review teams to push them back. Between them, $70.7B annually goes to one question: should this bill be paid? $𝟲𝟬𝗕 𝘁𝗼 𝗲𝘅𝗽𝗹𝗮𝗶𝗻 𝘄𝗵𝗮𝘁 𝘆𝗼𝘂 𝗼𝘄𝗲 Health systems spend $40B helping you understand your bill. Insurers spend $20B on call centers to explain your EOB. You call one, they tell you to call the other. $𝟱𝟱𝗕 𝘁𝗼 𝗮𝘀𝗸 𝗮𝗻𝗱 𝗴𝗶𝘃𝗲 𝗽𝗲𝗿𝗺𝗶𝘀𝘀𝗶𝗼𝗻 Your doctor says you need a procedure, and the payer asks for proof. Providers spend $35B requesting authorization, payers spend $20B reviewing those requests - and 93% get approved anyway. $𝟮𝟬𝗕 𝗯𝗲𝗰𝗮𝘂𝘀𝗲 𝗻𝗲𝗶𝘁𝗵𝗲𝗿 𝘀𝗶𝗱𝗲 𝘁𝗿𝘂𝘀𝘁𝘀 𝘁𝗵𝗲 𝗼𝘁𝗵𝗲𝗿 Providers spend $8B proving they're not cheating. Payers spend $12B checking. $𝟭𝟭.𝟯𝗕 𝘁𝗼 𝗺𝗮𝗶𝗻𝘁𝗮𝗶𝗻 𝗹𝗶𝘀𝘁𝘀 𝘁𝗵𝗮𝘁 𝗮𝗿𝗲 𝘀𝘁𝗶𝗹𝗹 𝘄𝗿𝗼𝗻𝗴 $8.5B in provider credentialing, $2.76B in payer directory maintenance - and the lists are still wrong half the time. Add up the adversarial spending across healthcare, and you get $217 billion - roughly $650 for every person in America, spent not on care, but on providers and payers fighting each other. Other industries don't face this problem. In retail, Walmart and P&G negotiate hard, but both want products on shelves. In manufacturing, Toyota and its suppliers fight over price, but both want parts delivered. The transaction is the goal. In healthcare, one side's core function is often to prevent the transaction the other side is trying to complete. Payers benefit when they pay less. Providers benefit when they get paid more. So both sides hire armies of administrators - a growing arms race, even as every other industry sees transaction costs fall with scale and technology. The most prominent thing on this chart is actually hidden: the patient. They spend zero dollars on this fight, but they pay for every dollar of it - in premiums, in bills, and in hours on hold being told to call the other number.

𝗪𝗵𝘆 𝗚𝗲𝗼𝗽𝗼𝗹𝗶𝘁𝗶𝗰𝘀 𝗪𝗶𝗹𝗹 𝗠𝗮𝗸𝗲 𝗼𝗿 𝗕𝗿𝗲𝗮𝗸 𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗖𝗮𝗻𝗻𝗮𝗯𝗶𝘀 𝗩𝗲𝗻𝘁𝘂𝗿𝗲𝘀 Over the past eight years building and advising cannabis businesses internationally, one truth has stood out: geopolitics plays a larger role in the medical cannabis industry than many realise, and ignoring it can cost you everything. This is not just about regulatory paperwork or setting up farms. It is about understanding that the right to operate can be switched off overnight by a ministerial change, a policy reversal, or an external pressure that no business plan can predict. In my work in Colombia, we built a state-of-the-art facility, fully licensed, audited, and staffed with brilliant local teams. Yet despite doing everything 'by the book', a shifting political tide changed the environment drastically. It was not about our product quality or compliance, it was about geopolitics. Why is this so crucial? First, regulatory environments are politically driven. The mood of governments dictates whether a market is accessible or hostile. One administration may be supportive; the next may bow to populism or outdated narratives. Second, international trade barriers persist. While medical cannabis is legal in many jurisdictions internally, exporting it remains tangled in treaties and diplomatic caution. Third, supply chains are vulnerable. A promising project can be shattered by instability, regulatory delays, or shifting foreign relations. Fourth, public perception influences political action. Despite growing evidence of efficacy, cannabis still carries stigma in many parts of the world. Politicians act in response to societal fears, not always scientific facts. How to manage this? From experience, the best strategies are:  • Diversify operations across jurisdictions to avoid overexposure.  • Monitor political climates. Not just regulations, but who is rising and falling in government.  • Work with trusted local partners who understand the unwritten rules.  • Maintain the highest compliance standards, even when shortcuts are tempting.  • Hold intellectual property and core assets in stable jurisdictions.  • Insure where you can, and have a risk plan for sudden changes.  • Invest in local communities authentically, goodwill provides protection beyond legal contracts. Medical cannabis is not just a health sector opportunity. It is a deeply political endeavour that demands rigour, patience, and foresight. Those who build strong foundations, respect the geopolitical landscape, and stay agile will thrive. Those who underestimate it risk losing not just their investment, but years of work. #MedicalCannabis #Geopolitics #InternationalBusiness #CannabisIndustry #RiskManagement #MedicalCannabisLeadership #GlobalMarkets #PoliticalRisk #CannabisInvestment #CannabisBusiness