[et_pb_section fb_built=”1″ admin_label=”!!! PLEASE DO NOT EDIT !!!” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_row admin_label=”!!! PLEASE DO NOT EDIT !!!” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_text admin_label=”TO BE EDITED – SUMMARY – Click on the WHEEL icon to open the textarea where you can paste or type your summary. The summary condenses the main points for the news that starts below. The summary is in bold and not longer than 300 characters, including spaces. The counter at the bottom can help.” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||20px||false|false” global_colors_info=”{}”]<\/p>\n
India\u2019s healthcare financing is plagued by high out-of-pocket spending and inefficient claim settlements, forcing many into debt. A coordinated IRDAI-RBI \u201cAffordability Pact\u201d is needed to integrate digital payments, cashless networks, and financing solutions, making health insurance truly accessible and reducing financial hardship for patients nationwide.<\/strong><\/p>\n<\/div>\n [\/et_pb_text][et_pb_text admin_label=”TO BE EDITED – TEXT OF THE NEWS – BLOCK 1 – Click on the WHEEL icon to open the textarea where you can paste or type your news. PLEASE USE ONLY THE FEATURED IMAGE FUNCTION on your right column to add the image.” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n India\u2019s healthcare system stands at a troubling juncture where rapid economic advancement coexists with deep financial strain on households. Despite progress in growth and technology, the nation\u2019s healthcare financing model continues to drive poverty. Out-of-pocket (OOP) expenditure\u2014amounting to nearly 50 per cent of total health spending according to WHO 2024 estimates\u2014remains among the highest globally. The flawed insurance claim settlement process worsens the problem, forcing patients to pay upfront for medical care before being reimbursed later. The IRDAI Annual Report for FY2023-24<\/a> highlights this structural failure: of Rs 83,493 crore in total claims settled, Rs 28,247 crore\u2014about one-third\u2014were reimbursements that required patients to pay first and recover later. This figure has surged from Rs 16,000 crore in 2018-19, reflecting a deteriorating trend that undermines the purpose of health insurance.<\/p>\n Industry experts, including Saurabh Soni of DigiSparsh, note that India\u2019s system largely runs on a \u201ccash-and-reimbursement\u201d model that lags behind the rest of the country\u2019s digital revolution. The rapid expansion of hospitals without a matching growth of cashless networks further forces patients into upfront spending. A single policy reform from IRDAI or the Reserve Bank of India (RBI) cannot resolve this issue; what is needed is a coordinated \u201cAffordability Pact\u201d between these institutions to integrate health insurance with digital banking and credit systems.<\/p>\n This proposed pact rests on six pillars aimed at reducing OOP burdens through financial and technological integration. It envisions an integrated health finance ecosystem connecting UPI, credit lines, and health wallets to insurers\u2019 real-time systems to make cashless-first packages the norm. It also proposes linking healthcare credit with insurance, allowing patients to access interest-free credit lines from regulated NBFCs or banks for 60\u201390 days until insurers reimburse hospitals directly. Expanding the universal cashless network through same-day digital settlements via regulated escrow mechanisms would strengthen hospital trust and reduce reliance on cash.<\/p>\n Further, data-driven health risk and credit scoring models could allow fairer premiums and personalized financial access, while digital claim exchanges such as the National Health Claim Exchange<\/a> (NHCX) could accelerate settlement processes. Finally, a joint IRDAI-RBI sandbox<\/a> would create a safe space for fintech and insurtech innovations such as claim financing and medical BNPL products. Together, these reforms could dissolve financial barriers in healthcare, transforming health insurance from a delayed reimbursement mechanism into an immediate safety net that ensures liquidity, dignity, and timely access to treatment for all Indians.<\/p>\n<\/div>\n [\/et_pb_text][et_pb_text admin_label=”TO BE EDITED – TEXT OF THE NEWS – BLOCK 2 – Click on the WHEEL icon to open the textarea where you can paste or type your news. PLEASE USE ONLY THE FEATURED IMAGE FUNCTION on your right column to add the image.” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" India\u2019s healthcare financing is plagued by high out-of-pocket spending and inefficient claim settlements, forcing many into debt. A coordinated IRDAI-RBI \u201cAffordability Pact\u201d is needed to integrate digital payments, cashless networks, and financing solutions, making health insurance truly accessible and reducing financial hardship for patients nationwide. India\u2019s healthcare system stands at a troubling juncture where rapid…<\/p>\n","protected":false},"author":2098,"featured_media":987789274,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":""},"categories":[],"tags":[117,122,134],"acf":[],"_links":{"self":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news\/987789271"}],"collection":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news"}],"about":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/types\/news"}],"author":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/users\/2098"}],"replies":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/comments?post=987789271"}],"version-history":[{"count":4,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news\/987789271\/revisions"}],"predecessor-version":[{"id":987789289,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/news\/987789271\/revisions\/987789289"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/media\/987789274"}],"wp:attachment":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/media?parent=987789271"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/categories?post=987789271"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/tags?post=987789271"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}