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Govt Seeks to Set Up Healthcare Sector Regulator to Facilitate Insurance for All

Written by : Nikita Saha

December 22, 2023

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Further, reports also suggest that the Ministry of Health may call a meeting of all stakeholders, including insurance companies, to thrash out a detailed plan and the role of a possible health regulator.

To achieve ‘’Insurance for All,’’ the Central government is considering establishing a health sector regulator that will also facilitate affordable health insurance coverage for all citizens.

Reportedly, preliminary discussions have been held between the ministries of finance and health over the need for a sector watchdog. This strategic move aligns with the government’s mission to achieve ‘’Insurance for All’’ while expanding health insurance and making it affordable for the citizens.

Further, reports also suggest that the Ministry of Health may call a meeting of all stakeholders, including insurance companies, to thrash out a detailed plan and the role of a possible health regulator.

Moreover, the health regulator will address the various challenges and opportunities, such as standardisation of treatment costs and settling health claims. Additionally, this initiative further seeks to broaden the scope of the National Health Claims Exchange (NHCX) which can be entrusted with more powers.

According to a recent report by the National Insurance Agency, over 400 million individuals do not have access to health insurance owing to rising healthcare costs. Other factors include lower penetration, coverage inadequacy and rising healthcare costs.

In 2019, the government reconstituted the National Health Agency as the National Health Authority (NHA), for implementing India's flagship public health insurance/assurance scheme Ayushman Bharat.

While, the Insurance Regulatory and Development Authority of India (IRDAI) regulates insurers that provide health coverage among other products.

The current determination of health insurance product pricing relies on market forces, yet there exists significant variability among insurers regarding policy terms, as well as claim restrictions and limits. Introducing a health regulator could play a pivotal role in fostering standardisation and reducing costs.

To facilitate the interoperability of health claims, the NHA has developed NHCX, serving as a protocol for the exchange of claims-related information among key stakeholders, including payers, providers, beneficiaries, and regulators.

In a meeting held in October, the finance ministry collaborated with general insurance firms, reaching a consensus that insurers would actively engage with the health ministry. They aim to enhance cashless facilities and standardise treatment costs, ultimately propelling the growth of health insurance.

IRDAI has set a visionary goal of achieving "Insurance for All'' by 2047. This commitment entails ensuring that every citizen has appropriate coverage for life, health, and property insurance.

Days back, NHA launched a date-entry mobile application designed exclusively for field-level functionaries. This application aims to streamline the implementation and monitoring of ABDM Microsites.


About Chime India

The College of Healthcare Information Management Executives (CHIME) is an executive organization dedicated to serving senior digital health leaders. CHIME includes more than 5,000 members in 56 countries and two US territories and partners with over 150 healthcare IT businesses and professional services firms. CHIME enables its members and business partners to collaborate, exchange ideas, develop professionally and advocate the effective use of information management to improve the health and care throughout the communities they serve. CHIME's members are chief information officers (CIOs), chief medical information officers (CMIOs), chief nursing information officers (CNIOs), chief innovation officers (CIOs), chief digital officers (CDOs), and other senior healthcare leaders. The CHIME India Chapter became the first international chapter outside North America in 2016 and is now a community of over 70+ members in India. For more information, please visit www.chimecentral.org

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