Digitally unified insurance systems can transform India's healthcare: Study

Digitally unified insurance systems can enhance transparency, reduce fragmentation and improve access under India's evolving subsidised health insurance setup, according to a new study by the Goa Institute of Management (GIM), WHO and Gates Foundation.

The one-of-its-kind comprehensive analysis conducted in collaboration with Kerala Health department has demonstrated how integrated digital health-financing platforms can reform health systems and advance India's progress towards Universal Health Coverage (UHC).

As India continues to expand subsidised health insurance schemes, the study highlights why unification of data and processes across different stakeholders is essential for improving service delivery.

The study titled "Health System Reform Powered by Data Integration of Health Financing: Lessons from India, has been published in the prestigious journal Health Systems and Reform.

"The study provides one-of-its-kind comprehensive analysis of how digitally unified insurance systems can enhance transparency, reduce fragmentation, and improve access under India's evolving subsidised health insurance setup. In addition to this, it also builds a roadmap for other countries which are in the process of modernising their health financing system," Arif Raza, Associate Professor, Goa Institute of Management, told PTI.

India's shift towards unified Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) offers a unique real-world laboratory for understanding the power of digital integration.

During the study, the research team found that prior to PMJAY, the standalone programmes each with different Information and Communication Technology (ICT) platforms, operational processes, and administrative structures had limited efficiency that resulted in weakened fraud detection, slowed system-wide reforms and hindered portability of benefits.

"This fragmentation also made it difficult for the government to monitor outcomes due to lack of visibility in spending patterns and utilisation trends. By applying the scoping-review methodology to synthesise themes across multiple sources, the research team found that unified ICT platform is not just a technological upgrade but a foundational enabler for large-scale health system transformation.

"It enables different stakeholders of health system to connect and create a central data backbone that can support long term reforms," Raza added.

The researchers found that integrated digital systems allow beneficiaries to access services across state boundaries and facility networks, eliminating the geographical restrictions of earlier schemes.

"Unified platforms allow conducting big-data analytics and using machine-learning tools to detect anomalies and reduce fraud, improving trust and accountability within insurance systems. Consolidated data systems reduce administrative duplication, streamline processes, and support real-time monitoring for policymakers and health-system managers  By demonstrating how integrating health-financing systems via unified ICT platforms can propel equity, portability and accountability, our study underscores a pivotal pathway for India and other similar health-systems to move beyond fragmented financing toward universal health coverage," he added.