Even as journalists and researchers continue to explore different data sources and methods to understand the real extent of COVID-19 cases and deaths in India beyond official data, an analysis of insurance claims related to COVID-19 patients has been put forth as an indicator of the extent of underreporting in some states. With very few citizens having health insurance coverage, across India, the number of health insurance claims for hospitalised COVID-19 patients, and the number of life insurance claims after death from COVID-19, have been way lesser than the number of recorded COVID-19 cases and deaths. However, studying the data could help understand the underreporting by some states.
An analysis of COVID-19 insurance claim patterns by Chennai-based management consulting firm Proxima found that states like Gujarat and Telangana — where major underreporting of COVID-19 cases and deaths has been demonstrated by the media — had much higher percentage of insurance claims being made against recorded COVID-19 cases and deaths, compared to the national average. Around 85.9% of the rural population, and 80.9% of urban population, do not have any health insurance cover, according to the National Sample Survey (NSS)’s 75th round of survey on household consumption related to health. The unusually high percentage of insurance claims in states like Telangana could help understand the extent of underreporting, when compared to other states which are believed to be furnishing relatively more accurate data, Proxima’s study has suggested.
The analysis by the firm, carried out under a healthcare advocacy initiative named Project: Jeevan Raksha, is based on month wise insurance claim data shared by the General Insurance Council until May 31, 2021. The insurance claims in Telangana have been compared with figures from the neighbouring state of Andhra Pradesh, and the national average. The number of COVID-19 cases and deaths were based on the official data available from state and Union governments as on May 31.
In Andhra Pradesh, while a total of 16,93,085 COVID-19 cases have been recorded by the state government as of May 31, 2021, only 3% of this figure, or 47,585 patients, had claimed health insurance for hospitalisation, according to the data shared by the General Insurance Council. At the pan-India level, only 6% of the recorded cases had claimed insurance. Telangana, on the other hand, saw 15% of the recorded patients claim insurance.
It must be noted that the data from Andhra Pradesh, and the national-level data, is also expected to be flawed, for multiple reasons. Yet, considering them as a flawed yet relatively more reliable benchmark, Proxima has extrapolated the number of COVID-19 cases and deaths in Telangana based on the claim percentages in Andhra Pradesh and across India. If the actual percentage of claims in Telangana were 3% (like Andhra Pradesh), the total number of cases as of May 31 would have to be around 28,87,533 cases. If the percentage of claims were similar to the nationwide figures (6%), then Telangana would have around 14,43,817 cases. Even with these flawed benchmarks, Telangana’s unreported cases could be as high as 8.65 lakh to 23 lakh, since the onset of the pandemic.
A similar extrapolation of the number of deaths (based on life insurance claims of patients who died from COVID-19 in Andhra Pradesh and across India) shows that the actual COVID-19 deaths in Telangana could be as high as 11,562 to 23,125. This would suggest that around 8,281 to 19,844 COVID-19 deaths could have gone unreported between March 2020 and May 2021 in Telangana.
The Telangana government has been heavily criticised on multiple occasions for being inconsistent and unreliable in sharing data COVID-19 data. An analysis of COVID-19 bulletins prepared by several District Medical Health Officers (DMHOs) of two districts conducted by TNM in April 2021 showed that the state government was ‘officially’ underreporting the COVID-19 case count by nearly 70%.