The West UP Chapter of the Association of Healthcare Providers India (AHPI) called for the establishment of a CIBIL-like rating framework for insurance companies and third-party administrators (TPAs) to bring transparency and accountability within the healthcare sector.
Addressing the inaugural summit of the AHPI UP West Chapter, Aunjaneya Kumar Singh, Commissioner, Moradabad Division, urged hospitals to align institutional data with local administrative inputs. He stated that integrating hospital-level information with district planning is central to policy formulation, including improvements across government schemes.
Dr Girdhar Gyani, Director General, AHPI, spoke on the organisation’s work with healthcare datasets, including national bed capacity. He referred to India’s beds-per-1,000 population ratio and stated that capacity expansion is required in multiple regions. He also said that regular and predictable payouts under schemes such as Ayushman Bharat are necessary for hospital operations.
Dr Anurag Mehrotra, President, AHPI West UP Chapter, said, “In bank and non-banking financial space, tools like CIBIL scores provide a clear benchmark for transparency and accountability. Healthcare deserves an equivalent framework. The current behavior of Insurance companies and TPA remains largely opaque; a standardised rating system will empower patients to make informed choices and ensure hospitals are treated as fair partners in care delivery. Such a mechanism will also benefit patients immensely.”
Hospitals and insurance companies have recently faced disputes over reimbursement rates, claim deductions and payment delays. These issues have resulted in temporary suspension of cashless services at certain hospitals. Hospitals have stated that medical inflation is rising at 12–14 per cent annually, while insurance companies reimburse at an average rate. The absence of standardised treatment costs remains a point of disagreement between healthcare providers and insurers.
Government schemes such as Ayushman Bharat, ESIC and CGHS also face issues related to package rates and payments. Package rates under these schemes are often below treatment costs, particularly for procedures and intensive care. Payments are also delayed, along with deductions and repeated queries.
“The conflict between hospitals and insurance companies ultimately impact patients. Thus, a mechanism needs to be formulated at the earliest,” Dr Anurag Mehrotra said.
The inaugural summit of the AHPI UP West Chapter was attended by members of the medical and healthcare community, with participation from hospitals across Western Uttar Pradesh. Clinicians, hospital founders, administrators and healthcare professionals from Moradabad Division, Noida, Ghaziabad, Meerut, Rampur, Amroha and Sambhal were present.
Dr Sunil Kapoor, Director, 4Sight Advisor, spoke on the role of technology in healthcare delivery. He discussed the use of artificial intelligence in diagnostics, clinical decision-making and operations, and highlighted the need for structured implementation.