New Delhi [India], July 1 : As healthcare costs pose a significant economic challenge for many Indians, Visit Health, India’s leading digital healthcare and OPD insurance platform, is taking bold steps to reshape the country’s healthcare and insurance ecosystem. In collaboration with the India InsurTech Association (IIA), a key industry body driving innovation and policy advocacy in insurance technology, Visit Health has released a ground breaking report titled “The Changing Landscape of OPD Insurance in India.” The report highlights the urgent need to expand outpatient department (OPD) insurance to address soaring medical inflation, rising incidences of day-to-day and chronic illnesses, and unsustainable out-of-pocket healthcare expenses.
With medical inflation in India at 14% and nearly 40% of healthcare costs borne directly by households, the report positions OPD insurance as a critical component of healthcare, not merely a supplemental cover, for Indian citizens.
“India cannot achieve true universal health coverage without mainstreaming OPD insurance. Everyday medical expenses—such as consultations, diagnostics, and medications—are pushing millions into financial distress,” said Anurag Prasad, Co-founder of Visit Health, at the report’s launch event in New Delhi.
Addressing the OPD Insurance Gap The report reveals a stark contrast: India’s OPD market is valued at $37.7 billion, yet insurance coverage in this segment remains below 0.1%, leaving most Indians financially vulnerable. Key findings include: • 61% of corporate employees utilize OPD benefits when offered, indicating strong latent demand.
• Medications account for 60.3% of OPD costs.
• Hypertension affects 1 in 4 Indians, and cardiovascular diseases cause 1 in 4 deaths, yet routine treatment costs are typically uninsured.
• India’s total insurance penetration is only 4% of GDP, significantly trailing countries like Taiwan (11.4%) and South Africa (11.3%).
Technology and Reform Driving the Future The report outlines a promising future for OPD insurance, driven by: • The Insurance Regulatory and Development Authority of India’s (IRDAI) “Insurance for All” vision by 2047.
• The upcoming National Health Claims Exchange (NHCX), which could reduce claim processing costs from ₹650 to ₹50.
• The rise of telemedicine (now accounting for 1 in every 35 consultations) and AI-driven digital fraud mitigation, projected to reduce losses by up to 60%.
A Call to Action for Stakeholders The report urges key stakeholders to act: • Insurers: Develop customer-centric, comprehensive plans covering general physician consultations, pregnancy, mental health, and postnatal care.
• Employers: Integrate OPD insurance into wellness programs to reduce productivity losses, with 14% of working days lost due to chronic illnesses.
• Policymakers: Create frameworks to expand OPD coverage, prevent fraud, and foster innovation.
Towards Equitable Healthcare Access Poor employee health not only affects absenteeism but also reduces productivity, even when employees are present. Timely healthcare interventions, made possible by reducing financial barriers, are essential for healthier lives. With India’s working-age population increasingly seeking proactive health solutions, demand for OPD services has surged from 5% in FY21 to 20% in FY24, signaling a significant shift in public health priorities.
The report also notes that Tier-2 and Tier-3 cities are emerging as key growth areas, particularly with increased access to digital healthcare. The convergence of affordable coverage, broader hospital networks, and customizable health plans is expected to drive insurance inclusion in underserved regions.
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