In Focus by The Hindu Health insurance: Decoding the mismatch between claims filed and settled
Dec 1, 2025
Professor Indranil M., a health economist at OP Jindal Global University, dives into the troubling mismatch between health insurance claims filed and those settled in India. He highlights a 21.8% rise in claims versus only a 12.88% settlement increase, focusing on the complexities faced by seniors and the impact of rising medical costs. Indranil discusses the need for better regulations, the role of public versus private insurers in claim approvals, and the pressing concerns around medical inflation affecting affordability and access.
AI Snips
Chapters
Transcript
Episode notes
Partial Settlements Shift Costs
- Private insurers increasingly settle claims partially rather than fully, shifting costs to patients or hospitals.
- Indranil M. explains information asymmetry and disputed clinical judgments drive this partial settlement trend.
Clinical Judgment Versus Packages
- Clinical judgment vs standardized packages fuels disputes between hospitals and insurers.
- Indranil M. highlights weak regulation and large information gaps worsen induced-demand and rejection conflicts.
Scheme Expansion Strains Budgets
- Government-funded scheme expansion increased non-poor enrolment and utilization, straining state budgets.
- Delayed reimbursements then prompt private hospitals to refuse Ayushman-like scheme patients, says Indranil M.