Five working groups of hospitals, insurers proposed on health insurance

Five strategic working groups co-chaired by leaders from the healthcare and insurance industries will be set up on various issues concerning health insurance and formalise a roadmap for systemic reforms.

The aim is to improve insurance penetration, transparency and the overall patient experience by addressing long-standing operational gaps and coordination issues between insurers and healthcare providers. Insurance Regulatory and Development Authority of India (IRDAI) announced this following a high-level industry interaction on March 17 in which chairman Ajay Seth participated.

Most of the working groups are scheduled to begin work in April, with durations ranging from 2-4 months. The findings and recommendations from these groups will serve as a reference model for future industry standards and regulatory frameworks, the insurance regulator said in a release.

Elaborating on each of the proposed groups, IRDAI said the group on joint code of conduct will work towards developing a practical framework to strengthen trust and transparency. The focus will be on streamlining the discharge process, standardising empanelment and ensuring amicable dispute resolution.

The working group on categorisation of providers will seek to establish a data-driven methodology for classifying healthcare providers and bring consistency to empanelment and operational processes across the industry. Another group will make recommendations to accelerate the adoption of the National Health Claims Exchange (NHCX) by identify and suggesting resolutions to bottlenecks.

A working group on focused analytical studies will conduct structured studies on claim trends, the dynamics of cashless versus reimbursement claims and the drivers of medical inflation. IRDAI said these studies are intended to provide a shared analytical base for future policy reforms.

Simplified products and wellness will be mandate of the fifth working group. It will work towards designing a scalable, no-frill health insurance framework, the regulator said.

“The collaboration between payers and providers is essential for a sustainable healthcare ecosystem,” Mr.Seth told the meeting hosted by the Confederation of Indian Industry (CII) and in which top level executives from major hospitals, representatives of the Association of Health Providers India (AHPI), NatHealth, the Private Hospitals and Nursing Homes Association (PHANA), various state level health providers associations along with insurance companies participated.