In a strategic policy pivot, the Indian government is preparing to transfer control of the National Health Claims Exchange (NHCX) from the Health Ministry to the Finance Ministry, placing it under the regulatory purview of the Insurance Regulatory and Development Authority of India (IRDAI).
The move comes as healthcare inflation in India hits 13% in 2025, far exceeding the global average of 10%, and as rising hospital charges and insurance premiums put financial strain on both patients and insurers.
What Is NHCX and Why It Matters
The National Health Claims Exchange (NHCX) is a digital platform designed to streamline health insurance claims processing between hospitals, insurers, and third-party administrators. The platform holds immense potential to improve transparency and efficiency in the Indian healthcare ecosystem.
However, recent evaluations by the IRDAI and government authorities revealed major discrepancies in hospital billing practices. Hospitals were found to be inflating bills, particularly for patients with high insurance coverage, which in turn led to:
- Increased claim ratios for insurers
- Higher insurance premiums for consumers
- A drop in growth rate for the health insurance sector — from over 20% in previous years to just 9% in FY 2024-25
The Regulatory Shift: What Changes
Under the proposed changes:
- The Finance Ministry will now oversee the NHCX, instead of the Health Ministry.
- The IRDAI will regulate NHCX operations, ensuring that insurance claims and hospital billing are monitored with stricter compliance norms.
- Treatment costs could be standardized, and price transparency across hospitals is expected to improve.
- Insurers will gain stronger negotiating power to reject inflated claims or demand audits for suspicious bills.
Expected Impact
This shift could mark a transformational change in India’s health insurance landscape:
- Patients may finally experience more affordable premiums as inflated claims are curtailed.
- The insurance ecosystem could regain momentum and regain double-digit growth.
- Most importantly, healthcare affordability and consumer trust in private insurance may see a significant boost.
This reform aligns with India’s broader healthcare digitization strategy, which includes Ayushman Bharat Digital Mission, and seeks to bring accountability and transparency into medical billing and insurance processes.
Source: Reuters – India plans to tighten oversight of claims portal to curb rising healthcare costs
