Healthcare Insurance in India: Rising or falling

In the last half a decade, medical insurance has gained immense popularity amongst Indians. Lifestyle changes in the citizens are making them more prone and vulnerable to a variety of healthcare issues. These unwanted health-related problems burden an average person with extra expenses which come in as a stressful life since the treatment costs are also not low. In such circumstances, a health insurance plan comes as a savior. While insurance companies serve with a portfolio of different schemes and policies, people lookout for the best one within their budget which can offer comprehensive coverage simultaneously.

Medi-claims in the Indian scenario:

Indian Brand Equity Foundation (IBEF) Annual Report 2017 reported that 85-90% of life insurance frauds fall in the sum assured bracket of Rs.1 Lakh to Rs.10 Lakh. An estimated 10-12 % of the claims are found to be fraudulent or suspected ones. 80 districts across the country have excelled in fraudulent claims over the last decade. And around Rs.10,000 crore was the estimated cost of frauds that were led by fake certificates and other related organized crimes.

Furthermore, per BloombergQuint’s article, only 18 % of urban Indians and 14.1 % of those in rural areas have any health insurance coverage. Out of that, many are reliant on corporate insurance plans, which come with their own set of conditions and, more importantly, have a low sum insured.

Government Initiatives:

The central government has launched its one of the ambitious projects for upgrading Indian healthcare system – the National Health Protection Scheme (NHPS). The scheme has been referred as the world’s most massive health insurance plan. The plan aims at covering ten crore families which amount to approximately 50 crore beneficiaries at large. The coverage amount will be Rs.5 lakh per family per year for secondary and tertiary healthcare. In coming years, the scheme is expected to merge with the existing plan such as Rashtriya Swasthya Bima Yojana (RSBY), along with other state insurance schemes. This cover amount is significantly higher than any other central or state government schemes.

These measures are government’s latest attempt at reforming India’s healthcare system and moving towards making India a healthy nation without any shortage of hospitals, doctors and financial aids to the needy. Moreover, in recent times, the government has also regulated the prices of critical drugs and medical equipment to make them available for the public at large at a minimum cost. Few other plans also have a roadmap of setting up government medical colleges and hospitals to combat the dismal health situation of the nation.

Although the mega-project seems to be a highly ambitious one, it will be no easy job for all the parties involved, i.e., the government, insurers, doctors, and citizens. While challenges are bound to be there and will a tough job to face them, the Indian healthcare industry will be going to have countless opportunities to flourish in the coming future.

Modernisation and Trends in Indian healthcare

Since independence, advancements in healthcare have become one of India’s largest sectors both concerning revenue & employment.

The sector is growing at a considerable pace and increasing its coverage over the nation. Healthcare comprises hospitals, telemedicine, medical tourism, health insurance, and technological advancement in the pharmaceutical sector.

In recent years, medical researchers are talking about the latest terms of healthcare industry such as IoT in healthcare, e-health, m-health, app-based diagnosis, online ambulance booking, big data analytics on the EMRs, promoting generic drugs, and so on.

Modernization of Indian healthcare:

Increase in purchasing power of the citizens, an aging population, growing health awareness had helped them to change their attitude towards a healthy life and this leads to more substantial demand for preventive health care. Here are a few of the trends that are aiding Indian healthcare:

Affordability and quality:

  • There is an increase in availability of trained medical professionals across the nation who are helping the system to make healthcare more affordable and accessible.
  • Cost-effective yet high-quality medical services and medical equipment manufacturing had placed India at a competitive place for its peers in the West and the remaining Asian countries.

Governmental policies:

  • With the aim of making India a global healthcare hub, the government provides policy support in the form of a reduced tax levy.
  • Creating and providing infrastructural aid such as building new drug testing laboratories and strengthening existing state laboratories.

The shift to lifestyle diseases:

  • With increasing urbanization and problems belonging to modern-day living in the urban culture, there has been an increment in the demand for specialized care.
  • High cholesterol, high blood pressure, obesity, poor diet, and alcohol intake cause most lifestyle diseases.


  • Telemedicine is one of the fast-emerging sectors in India with the involvement of significant hospitals such as Apollo,  AIIMS, etc.
  • As of  FY16, the telemedicine market in India was valued at US$  15 million and is expected to rise at a CAGR of 20 percent during FY16-20 to reach US$ 32 million by 2020.
  • With telemedicine, we can see growth in medical facilities in rural areas. It will aid support in low-cost consultation and diagnosis facilities in remote areas through high-speed internet connectivity.

Mobile-based health delivery:

  • Robust mobile technology infrastructure and 4G connectivity are driving mobile health initiatives in the country.
  • Medulance aims to reach emergency situations throughout the nation with its app-based model for booking an ambulance and other emergency services.
  • In India, the mobile health industry is expected to reach US$ 0.6 billion by 2017.

It was the youth who played a significant role in explaining the importance and understanding of wellness in India to their parents and loved ones and made them value health more than any other material thing. Relatively low medical cost and clinical research, a rise in medical tourism, and recognition of Indian healthcare at the global level are a few factors that are attracting patients from across the world. It is making India a desirable and developed nation for advanced medical treatment and other technological developments in the healthcare sector.

To conclude, the opportunities are prominent in the Indian healthcare segment which will create a highly efficient healthcare system for the country as well global healthcare economy in the coming years.

How startups are disrupting medical industry in India?

The Indian healthcare market is rising with technological advancements, demanding more quality healthcare and thus opening up an avenue for tech companies and startups to fulfill the astounding demand.

As per the reports of the India Brand Equity Foundation (IBEF), the Indian healthcare sector is advancing at a CAGR of 17 percent. While the industry is touted as one of the fastest-growing ones, it is expected to reach US$ 250 BN from 2008–to 20.

While the internet is also penetrating at a rapid pace, the startup ecosystem is not leaving any stone unturned to disrupt the healthcare sector with its inputs and innovation.

Here are some of the health-tech startups that are trying to make a difference in redefining the Indian healthcare system and bridging the gap between the patients, doctors, and other healthcare service providers:

Mobile-based health emergency services by Medulance:

Growing road mishaps, multiple emergency situations, and calamities – both natural and man-made had given the rising demand for emergency services in India such as ambulance services, emergency trained medical technicians, first responders, and so on. With robust mobile technology infrastructure and nationwide coverage of the 4G network helped Medulance to evolve as an app-based emergency service provider.

Medulance aims to reach out to the patients and needy at the emergency spot with the help of a request via their app. One only needs to book an ambulance online with Medulance app and their team of medical experts will reach the emergency scene at the earliest.

Stack up your medical records with DocTalk:

DocTalk, a cloud-based platform, allows its users to save all their medical records on the cloud safely. Using this AI-based, on-demand virtual assistant app, patients can access their medical files on the go, interact with doctors, update their medical history and also get prescriptions online from the doctors.  

Healthcare industry’s one-stop-shop – Practo

Started in 2007 as a SaaS platform, this Bengaluru-based startup is disrupting the Indian healthcare industry at its best. From online appointments, reaching out to nearby and available doctors, and ordering medicines online, Practo has evolved into a one-stop shop in 10 long years. The health tech is currently active in almost 40 Indian cities.

Doctors and medical practitioners at the patient’s doorstep – Portea

Portea, another Bengaluru-based start-up is offering doorstep services for patients who are staying at remote locations or those who can’t travel to hospitals in quick time. The users can have home visits with doctors, nurses, physiotherapists, and technicians. Using remote diagnostics, point-of-care devices, and other monitoring equipment; doctors and medical professionals can diagnose and prescribe medications to patients remotely.

Smart medical reports with LiveHealth:

LiveHealth is yet another startup that works as a Management Information System (MIS) for healthcare providers. From collecting samples, managing patient records, and diagnosing them to generating reports and invoices, the startup attempts to make healthcare processing smarter and more efficient. With its AI integrated system, it also assists doctors with better diagnosis and decision making.

While the Indian startup ecosystem is leading from the front for the progress of the Indian healthcare segment, we can expect much larger trends to emerge in healthcare and emergency services in the near future.

What is value-based healthcare and how it will benefit the consumers?

The Healthcare industry is revolutionizing with doctors, pharma, and drug manufacturers coming together to upscale and benefit the people with the right prescription for their better and healthy life. They’re partnering with the members of the industry to make sure the majority of patients, the needy, and every other people who need medical support and treatment receive the right care at the right time. And such responsibility is leading to a model called ‘value-based health care.’

What is value-based healthcare?

Real improvement in healthcare requires restructuring of the care delivery system. To enable a high-value delivery system, partnering with doctors, healthcare service providers, government bodies, and associations is crucial. Hence, value-based healthcare can be referred to as a healthcare delivery model in which providers, including doctors, hospitals, and pharma experts, are paid based on the results of the patient’s health. The healthcare providers and physicians help in improving patients’ health and reducing the effects and incidence of chronic disease.

In a value-based model, healthcare providers are paid based on the number of healthcare services they deliver and specific performance measures of the outcome of the service. To simplify, a patient pays for the quality of value-based care against the quantity.

Value based-healthcare in India

Although India is facing a transformational challenge when it comes to its healthcare system, the same can be addressable if the medical community comes and grows together. It needs to focus primarily on preventing and treating the life-long, acute, and proactive chronic care encompassed across India’s burgeoning middle class.

For a country with more than a billion people, creating a healthcare system to cater to this humongous population is no easy job. And move from a fee-for-service to a fee-for-value model will take time, and the transition would be a difficult task. As the Indian healthcare landscape continues to evolve and providers increase their adoption of value-based care models, they may face a low in short-term finances before hitting the long-term decline in costs. Since the costs attached are enormous, the government is also lending its helping hand with various initiatives, workshops, and financial grants. Such aid and assistance by the government are motivating enterprises, physicians, and healthcare service providers to come along and make India a healthy nation. Hence, this model could be the best method for lowering healthcare costs while increasing the quality of healthcare and helping people with healthier lives.

Medulance, an app-based ambulance booking service in New Delhi also aims to deliver value-based services to patients and those in need with its constant quality and an expert team of medical respondents.

Furthermore, the value-based healthcare movement will be possible only with the collaboration of people, organizations, and governments that believe in delivering essential health care to the citizens of the country.

Medical Tourism – a new growth factor for India’s Healthcare Sector

Medical tourism can be defined as traveling to another country to acquire a particular medical treatment. It is mainly due to the unavailability, cost difference, and quality difference of specific curative therapy in a state.

Medical tourism – while the term may be slowly buzzing on Indian soil, it’s undoubtedly creating an impact at a global level. In layman’s terms, medical tourism means traveling from one country to another for advanced medical treatment. It is mainly due to the unavailability or low-quality medical treatment in one country due to which people travel to developed nations for better and high-quality treatments.

Is India fit for medical tourism?

Health crisis is one the major concerns for any developing, and hence, medicinal aid plays a significant role in such countries both regarding economic development and for a being a healthy state.

In recent years, India is not only contributing abundantly in trading, manufacturing, and R&D of pharma and drugs industry but is also one of the leading exporters around the globe.

As per Indian Brand Equity Foundation (IBEF) Annual Report 2017, the market size of the medical tourism market in India has reached US$3.0 BN as of April 2017 and expected to reach US$ 6 billion by the closure of 2018. And when it comes to medical tourism and attraction, the number of foreign tourists coming to India for medical purposes rose by almost 50 percent to 201,333 in 2016 from 134,344 in 2015. During 2013-16, India’s medical tourism grew at a CAGR of 27 percent.

Furthermore, the Indian tourism ministry also offers financial support to accredited Medical, and Wellness Tourism Service Providers, Chambers of Commerce for organizing workshops, events, seminars and other medical tourism promotion shows.

As published in in July 2017, the Confederation of Indian Industry (CII) report titled “India Services Sector—A Multi-trillion Dollar Opportunity for Global Symbiotic Growth 2017” stated that the presence of world-class hospitals and skilled medical professionals had strengthened India’s position as a preferred destination for medical tourism. Treatment for significant surgeries in India costs only a fraction—in some cases as low as 10% of that in developed countries.

The report also stated that the global medical economy is looking out for Indian pharma players, medical talent and know-how to help them in setting up advanced medical infrastructure, and assist in latest medical technology. Thus, it leads to growing demand for India’s pharmaceutical and healthcare expertise.

Innovation in India’s healthcare industry:

While multiple reports have stated about the growing demand and current market structure of India’s healthcare economy, some firms are contributing inside out for the progress and development of the country’s health. Health tech startups are one such who are driving the sector at a decent pace. Services offered by such health tech startups vary from air ambulance, online ambulance booking, healthcare, and medical reports on mobile to even making a doctor’s appointment and receiving the diagnosis on the go. One such Delhi based startup – medulance deals in providing online ambulance services via a mobile app making it convenient for the patient or the family members to book an ambulance, and ask for first responders and other medical technicians. It performs as a handy feature for the citizens, especially of the national capital – Delhi, since it’s one of the densely populated cities of the country where pollution, road mishaps, and other health concerns have been a significant problem.

In the bottom line, cost advantage and upcoming innovations in India’s healthcare system will significantly open doors to developed countries like the USA and is already a major destination for medical tourism for countries like Bangladesh, Afghanistan, Maldives, Pakistan, Bhutan, Sri Lanka and other the Middle East and African countries.