Govt mulls regulator for healthcare sector to facilitate insurance for all

New Delhi: The government is exploring setting up a health sector regulator that will also facilitate affordable health insurance coverage for all citizens. Two senior government officials confirmed that preliminary discussions have been held between the ministries of finance and health over the need for a sector watchdog.

The government is of the view that to achieve the vision of Insurance for All, more concentrated steps need to be taken to drive health insurance penetration and keep it affordable.

According to a recent report by the National Insurance Agency, over 400 million individuals, or about a third of the population, lack health insurance due to lower penetration, coverage inadequacy and rising healthcare costs.


"There are various challenges and opportunities, such as standardisation of treatment costs and settling health claims, that can be addressed by a sectoral regulator in the health insurance segment," said one of the officials aware of the developments.

Another official said that the Department of Health and Family Welfare under the Ministry of Health is now expected to call a meeting of all stakeholders, including insurance companies, to thrash out a detailed plan and the role of a possible health regulator.

"A health regulator can further broaden the scope of the national Health Claims Exchange and can be entrusted with more powers to function like an industry watchdog," said another official, clarifying that some of these are preliminary suggestions.

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

The Insurance Regulatory and Development Authority of India (IRDAI) regulates insurers that provide health cover among other products.

The pricing of health insurance products is currently market-determined but there is wide variance across insurers in policy terms and claim restrictions and limits. A health regulator can help bring about some standardisation and lower costs.

The NHA has developed a national Health Claims Exchange (HCX) to enable the interoperability of health claims. The HCX also serves as a protocol for exchanging claims-related information among various actors, including payers, providers, beneficiaries and regulators.

In October, the finance ministry held a meeting with general insurance firms and it was decided that insurers would look to collaborate with the health ministry to increase cashless facilities and standardise treatment costs to boost the growth of health insurance.

In a statement, the finance ministry had noted that insurers will work with states under state insurance plans to increase penetration and coverage and explore linking frauds to the CIBIL score to prevent or mitigate fraud.

The IRDAI has committed to enabling Insurance for All by 2047, where every citizen has appropriate life, health and property insurance coverage.