The Delhi Medical Association Nursing Home Forum (DMA NHF) has formally lodged a complaint with the Insurance Regulatory and Development Authority of India (IRDAI), alleging anti-competitive practices by health insurers acting collectively through the General Insurance Council (GIC).
In its submission, DMA NHF has urged IRDAI to investigate the role of the GIC in cartelization, examine the abuse of dominance by private insurers, direct corrective measures to ensure fair and inflation-linked hospital tariffs, safeguard patient rights by ensuring continuity of cashless services, and involve the Serious Fraud Investigation Office (SFIO) to examine insurers’ conduct against public interest.
The Forum stated that the GIC has introduced a so-called “common empanelment” framework under which all insurers collectively dictate hospital tariffs and commercial terms. According to DMA NHF, this framework has no legal standing and amounts to illegal combined bargaining.
“With private insurers controlling over 50 per cent of India’s health insurance market, the insurers are misusing their dominant position to impose unilateral tariffs. This so-called common empanelment strips hospitals of their right to negotiate independently, artificially suppresses tariffs, and threatens the sustainability of quality healthcare services. Instead of promoting competition and protecting patient interests, insurers are hiding behind IRDAI circulars to justify bargaining as a group. This misuse of regulatory directives undermines the Competition Act and IRDAI’s very own mandate,” said Dr V K Monga, Chairman, Delhi Medical Association Nursing Home Forum (DMA NHF).
The Forum highlighted that hospitals are being forced to continue cashless services under expired contracts at old and unviable tariffs, a practice that will inevitably lead to compromises in the quality of care. India already has among the lowest hospital tariffs globally, with patients from the poorest parts of the world travelling to get high-end care at affordable costs. DMA NHF cautioned that further tariff suppression would make healthcare delivery unsustainable and discourage investment in infrastructure and modernisation.
The Forum also flagged insurers’ disproportionate spending patterns, noting that large portions of collected premiums are directed towards commissions and administrative costs rather than patient care. For FY 2024–25, incurred claims ratios (ICRs) of major standalone health insurers stood as low as 54 – 67 per cent of total income, suggesting significant inefficiency.
“This suppression is not in the interest of policyholders. Insurers are prioritising their bottom lines over the patients whom health insurance is meant to protect. We are raising this issue inthe larger interest of hospitals, nursing homes, healthcare providers, and most importantly, patients. Anti-competitive collusion under the GIC threatens not just providers and patients but the future of India’s healthcare ecosystem. We urge IRDAI to act swiftly to restore fair play, ensure sustainability for providers, and protect patient rights,” Dr Monga added.