In the current scenarios Indian health insurance industry can be considered to still be in its infancy. The next few years posit a plethora of challenges. Have highlighted key five areas of concern.

1. Lack of standardised transactions between the insurer and hospitals or the insurer and insured. This often results in individual interpretation and methodology for processes like claims and pre-authorization

2. Use of non-standard terminologies with regards to treatment protocols and care plans. In fact absence or minimal documentation and implementation of standard care pathways become a cause of conflict with regards to services covered/not covered for payment via the insurer. This gets further aggravated with extremely poor usage and implementation of ICD codes

3. Skewed penetration (much higher in urban India than rural) of private health insurers within the Indian population leading to asymmetric distribution of risk. This ultimately on one hand bleeds the insurer, on other hand hits the insured due to higher premiums and finally also the hospitals due to higher rejection rates

4. Non SLA based transactions between hospitals and insurers. Response time and request closure time for crucial transactions like pre-auth filling, pre-auth approval, claim filling, and claim approval is still not a strictly followed dimension.

5. Both hospital and insurer hold sensitive patient data but we are still far from having any form of implementable India specific law or guidelines to protect and securely exchange patient data between two major pillars of healthcare industry


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