The Indian healthcare system is facing significant challenges, with inadequate public infrastructure, a shortage of medical professionals, and low public health expenditure. The private healthcare sector is expensive, and medical insurance has become more of a tax-saving instrument than a reliable means of protection against health crises. The medical insurance crisis in India is characterized by opaque policy terms, denied claims, and a litigation burden on consumers.
In contrast, countries like Canada, Australia, and New Zealand have robust national healthcare systems that provide free state-provided healthcare, making private insurance largely redundant. India’s model, which combines underfunded public healthcare with expensive private care, urgently needs reform.
The Pradhan Mantri Bhima Yojanas, low-cost insurance schemes introduced by the Indian government, have achieved huge enrollment across semi-urban and rural populations, but they have limitations, such as inadequate coverage amounts and lack of general healthcare coverage. Suggestions for expansion include raising the coverage ceiling, including hospitalization and critical illness coverage, and introducing telemedicine and preventive healthcare services as add-ons.
The litigation propensity of Indian insurers is high, with a significant chunk of cases before Consumer Dispute Redressal Forums involving insurance disputes. Indian jurisprudence has criticized insurers’ practices, but the need for statutory penalties remains strong. Learning from the US Affordable Care Act (Obamacare), India can introduce key reforms, such as guaranteed issue, minimum essential benefits, subsidized premiums, and insurance exchanges.
To create a health ecosystem where no Indian must fear financial ruin for seeking medical care, India must introduce a twin strategy of universal healthcare provisioning and robust insurance regulation. This includes introducing punitive consequences for bad-faith insurer conduct, adapting Obamacare’s core reforms, expanding national insurance programs, and enforcing consumer-friendly judicial standards. Healthcare reform is not just a matter of policy; it is a matter of human dignity.
Drawing lessons from US cases like Harvey and Menchaca, India can impose serious financial consequences on insurers that prioritize their own interests over the insured’s welfare. The judgments in these cases illustrate that courts can impose significant financial penalties on insurers that mishandle claims, misrepresent policy terms, or fail to promptly offer reasonable settlements. By introducing similar measures, India can create a more balanced and fair insurance market. Ultimately, a comprehensive healthcare reform is essential to ensure that all Indians have access to quality and affordable healthcare, regardless of their economic background.