National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) launched the National Health Claim Exchange (NHCX) to facilitate the exchange of claims-related information among stakeholders in the healthcare and health insurance ecosystem.
National Health Claim Exchange
- It is a digital platform designed to streamline health insurance claims processing in India.
- It will act as a centralised hub for all health claims, alleviating the administrative burden on hospitals and providing a seamless, paperless, and secure contractual framework.
- The system is designed to accommodate the dynamic and diverse healthcare system of India, aligning with IRDAI’s objective of achieving ‘Insurance for All by 2047’.
Advantages
- NHCX aims to simplify and expedite the cashless claims process, potentially reducing waiting times and out-of-pocket expenses for patients.
- NHCX streamlines claim processing by eliminating the need for multiple portals and manual paperwork, reducing administrative burdens for hospitals.
- The platform could lead to a more standardised approach to healthcare pricing through uniform data presentation and centralised validation.
- The system can help detect and prevent fraudulent claims through data verification.
Out-of-Pocket Expenditure
- Out-of-Pocket Expenditure (OOPE) is the money paid directly by households, at the point of receiving health care.
- It excludes the individuals covered under any public or private insurance or social protection scheme.
As per IRDAI, Status of Insurance in India
- Health insurance contributes to approximately 29% of the total general insurance premium income in India.
- In life insurance business, India is ranked 10th in the world. India’s share in global life insurance market was 2.73% during 2019.
- In non-life insurance business, India is ranked 15th in the world. India’s share in global non-life insurance market was 0.79% during 2019.
Insurance Penetration and Density
- Insurance penetration and density are two metrics, among others, often used to assess the level of development of the insurance sector in a country.
- Insurance penetration is measured as the percentage of insurance premiums to GDP.
- Insurance penetration which was 2.71% in 2001 has steadily increased to 3.76% in 2019 (Life 2.82% and Non-Life 0.94%).
- Insurance density is calculated as the ratio of premiums to population (per capita premium).
- The insurance density in India which was USD 11.5 in 2001, reached to USD 78 in 2019 (Life- USD 58 and Non-Life – USD 20).