National Health Authority working with IRDAI to streamline insurance claim process: Jt Director Vikram Pagaria
Vikram Pagaria, Joint Director of the National Health Authority, said during TechSparks 2023 Delhi that the government is putting in concerted effort to expand access to healthcare beyond Tier I cities and make the process of claiming insurance easier.
Insurance penetration in India is only about 1% of the gross domestic product (GDP). While plans are underway to increase the access to insurance and other healthcare products to the masses, the claiming process remains a hassle.
The National Health Authority (NHA) has teamed up with the Insurance Regulatory and Development Authority of India (IRDAI) to introduce the National Health Claims Exchange, aimed at streamlining the claim process for all citizens, Vikram Pagaria, Joint Director of NHA, said during a fireside chat at TechSparks 2023 in Delhi.
TechSparks–YourStory’s flagship tech and startups event—was held for the first time in Delhi on November 29 and 30, and saw the attendance by a host of startup founders, investors, and industry executives from across the country.
Through the partnership, the industry bodies are working with various hospitals and insurance providers to make insurance claiming faster and simpler. When a doctor clears a patient for discharge, all treatment details will be transmitted from the hospital’s software to the insurance company through the claims exchange, according to Pagaria.
“This will eliminate the need for dealing with tedious paperwork including taking printouts, scanning, and using multiple software,” Pagaria said, adding that the NHA is working diligently towards reducing the cost of processing a claim for a provider.
Speaking about the challenges in the healthcare industry, Pagaria noted that the lack of digitisation has been a roadblock. For instance, the entry of Unified Payments Interface (UPI) revolutionised the financial sector because banking operations were already fully digitised at the time. Similarly, public and private sector hospitals need to go digital with the help of adequate software and hardware capabilities.
“However, digitisation can be a costly affair,” Pagaria said. “To this end, we have introduced a digital health incentive scheme which, for every health record digitised, rewards Rs 20 to the hospital and Rs 5 to the healthtech company whose software is used,” Pagaria said, advising startups, SMEs, and other players in the private sector to utilise the programme to the fullest. Users can earn rewards up to Rs 4 crore in the scheme, Pagaria noted.
The NHA is also inviting the private sector to help identify the pain points in the healthcare industry, particularly with respect to digitisation of records, Pagaria added.
“The sector is extremely fragmented and still has not matured. Joint effort from different players in the industry could help fast-track growth,” the senior executive said.
There are 25,000 different hospital management information software (HMIS) companies present today, while the NHA has managed to onboard about 150-200 software companies till date. "As per my estimates, it could take another five years for the healthcare space to become mature and fully digitised," Pagaria added.
Edited by Megha Reddy