What if I say that the claim settlement rate will be the biggest differentiator for insurance companies in the near future? Despite 50 crore people in India being covered under some form of health insurance, approximately 62% of healthcare expenses are still paid out-of-pocket. That’s one of the highest rates globally—and it highlights a deeper issue.

 

 

 

At DigiSparsh we believe that access without affordability is a broken promise. In my journey of building a Health-tech company for real Bharat, I’ve come to realize that the real challenge isn’t just technology adoption—it’s ensuring that the technology reaches to the right place which can help even the deepest layer of society and being able to use that seamlessly when it matters most.

It means the hospital, the insurer, and the patient are all working in sync. Sadly, this isn’t the case for a majority of Indians today. 

In this article with Windrose Capital, I am sharing what we’re witnessing on the ground: from trends shaping financial inclusion in health-tech, the challenges still holding us back, and the solutions that are starting to make a meaningful difference.   

The Landscape Today:
Progress, But Not Participation

With over 50 crore people covered under some form of health insurance India's health-tech ecosystem has seen remarkable momentum, under the government schemes like Ayushman Bharat and growing private sector participation.


 

But despite all these advancements, out-of-pocket expenditure (OOPE) still accounts for nearly 48% of total health spending in India (as per National Health Accounts 2019–20). That’s among the highest in the world, and it tells us one thing loud and clear: insurance is available, but not always accessible when it’s needed most. 

Here are some of the on-ground realities I’ve observed and verified through In my interactions with hospitals, patients, and insurance partners across the country during our work at DigiSparsh:

Patients: Insured, Yet Still Paying Out-of-Pocket
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Reimbursement Still Dominates- Even today, As per IRDIA annual report 2022-23, ~42% of health insurance claims are processed through reimbursement, not cashless. That means patients often pay the full amount upfront—sometimes in lakhs—and wait weeks or months for a refund. For many, that defeats the very purpose of having insurance.  

They want to walk into a hospital and receive care without worrying about upfront payments or confusing paperwork. 


Lack of Transparency in Deductions- There’s also a lack of clarity around deductions. When ?5,000 is cut from a ?1 lakh bill with no explanation, it leads to confusion and mistrust. Add to that the complicated process of claiming pre and post-hospitalization expenses, and the experience becomes anything but not patient-friendly.

 

Hospitals: High Friction, Low Support

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Limited Access, Manual Processes- Smaller hospitals—especially in Tier II and III cities—are often empanelled with just 2–3 insurers. That severely limits their ability to offer cashless options to a wider patient base. Hence they want a standardized portal to handle all insurers instead of juggling multiple logins, formats, and workflows.

Platforms like NHCX (National Health Claim Exchange) aim to address this by introducing uniform claim processes across the board—a long-awaited step in the right direction.

Delays in Approvals and Discharges- Moreover, pre-authorization and discharge approvals still take 3 to 6 hours on average due to fragmented workflows. Many hospitals lack a streamlined insurance desk, and staff spend more time on paperwork than on patient care. This leads to delays, revenue leakage, and ultimately, patient dissatisfaction.

Insurers: Balancing Speed with Risk
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Under Pressure to Perform- On the insurer side, there's increasing pressure to settle claims faster, but without sacrificing accuracy. The challenge? Incomplete documentation and a rising number of fraudulent claims make it harder to trust what’s being submitted.

Insurers want to process claims quickly—but only when they’re authentic. They want standardized, structured documentation from hospitals and real-time access to patient data. Most importantly, they want tools to help them detect and prevent fraud without adding manual layers to the workflow.

 

Without a standardized process or real-time validation mechanisms, insurers are forced to slow down—impacting both hospitals and patients downstream.

 

The DigiSparsh’s Approach in Enabling Inclusion

At DigiSparsh, our approach has always been to address the practical challenges faced by patients, hospitals, and insurers—especially around accessibility, speed, and transparency.

For Patients: Financial Relief Without the Wait

One of the biggest gaps in the current system is the patient’s dependence on reimbursement, which often means paying large sums upfront. We solve this by offering interest-free loans that cover treatment costs directly. Patients don’t have to worry about arranging funds at the time of hospitalization—we make the payment on their behalf to the hospital.

The documentation is minimal, and the loan ranges from ?20,000 to ?5,00,000, with flexible repayment options. Once the insurance claim is settled, the patient repays the loan—no interest charged.

We also submit the required claim documents to the insurance company, ensuring patients don't get caught in the paperwork during recovery. This, we believe, is the way to make insurance truly usable when it matters most.

 

 

For Hospitals: Instant Capital, Zero Friction

Hospitals often face a 45-60 days wait for insurance settlements. With DigiSparsh, that drops to 24 hours. We make sure hospitals get money instantly in their bank accounts, improving their capital flow and freeing up resources.

Our solution is plug-and-play—no tech integration required—and fully digital, removing manual processes and delays. It's also collateral-free, so hospitals can unlock working capital without risking their assets.

For hospitals that find insurance processing overwhelming, we also offer to outsource their insurance desk, ensuring faster, smoother claim handling with minimal in-house effort.

The Shift Is Clear, But What’s Next?


India is moving steadily toward a tech-led, interoperable health-fintech ecosystem—one where systems talk to each other, processes are standardized, and access is no longer limited by geography or paperwork.

But real inclusion will only happen when:  

  • Patients across Bharat can access cashless care with ease, regardless of which hospital or insurer they walk into.
  • Hospitals are freed from red tape, allowing them to focus on delivering care instead of chasing approvals and documentation.
  • Insurers can make fast, data-driven decisions, with the confidence that the claims they’re settling are authentic, accurate, and complete.

The road to inclusion is long, but with the right technology, the right intent, and the right partners, we can build a healthier, fairer India—one patient, one claim, one hospital at a time.

Financial inclusion in health-tech is not just a policy priority—it’s a technology challenge. One that requires alignment, collaboration, and bold problem-solving at every level of the system. Those who can solve this challenge will define the future of healthcare in India—not just as a service, but as a right that’s truly accessible.



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