Standard treatment workflows to help expand health cover

Mumbai: In what could pave the way for wider adoption of cashless treatment and eventually cap increase in health insurance premium, the Indian Council of Medical Research (ICMR), the National Health Authority (NHA) and the World Health Organization (WHO), have developed 157 Standard Treatment Workflows (STWs) across 28 specialties.

These workflows will guide physicians and hospitals in delivering uniform care.

"For long, we have been voicing the urgent need to standardise healthcare delivery, especially as health inflation which is nearly three times normal inflation, was putting quality care out of reach for many citizens," said Tapan Singhel, MD & CEO, Bajaj Allianz General Insurance.


Medical inflation is at 14-15%. Insurers have been saying that standardisation is necessary to bring transparency in hospital billing, prevent overcharging, and keep health insurance premiums affordable in the long run especially when medical inflation for large insurers are high.

This step, insurers say could ensure that every patient, regardless of where they go, receives consistent, evidence-based, and reliable treatment, said Singhel.

Calling for a dedicated health regulator, insurers have been saying that initiatives like NHCX, common empanelment, and greater transparency could make healthcare more accessible, affordable.

In FY24 alone, insurers settled 2.69 crore health insurance claims, disbursing nearly ₹83,500 crore. About two-thirds of these were through cashless mode, reflecting how critical hospital-insurer agreements are for patient convenience.

Insurers have been saying that rising healthcare costs and inconsistent billing practices are putting pressure on the health insurance sector. By creating a uniform system, they hope to negotiate reasonable rates with hospitals, expand cashless coverage, and keep premiums in check. The Insurance Regulatory and Development Authority of India (IRDAI) has also backed the idea.