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

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.