Lack of credible health data biggest hurdle in insurer-hospital disputes: Subhendu Kumar Bal

Subhendu Kumar Bal, Chairperson, 25th GCA Organising Group, India and Chief Risk Officer, SBI Life Insurance

• Fragmented health data hinders claim predictability in India
• RBC norms rollout needs coordination, not just structural changes
• Medical inflation driven by broader factors, not insurers

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India’s ongoing friction between insurers, hospitals and third-party administrators (TPAs) is less about pricing and more about poor data architecture, said Subhendu Kumar Bal, Chairperson of the 25th Global Conference of Actuaries (GCA) organising group and Chief Risk Officer at SBI Life Insurance.

Speaking at a precursor to the 25th Global Conference of Actuaries 2026, Bal said inconsistent and fragmented health data remains the single biggest impediment to predictability in claims and long-term conflict resolution in the health insurance ecosystem.

Addressing questions on the prolonged tussle between insurers and hospitals over tariffs and claims, Bal said actuarial methods can only be as effective as the data they rely on.

“Our health insurance data may not be preserved in the way required for detailed actuarial analysis,” he noted. In countries with mature health systems, national health databases allow insurers and policymakers to track individual medical histories through integrated systems, enabling better pricing, risk assessment and claim predictability.

In India, however, the ecosystem remains fragmented. Data resides across insurers, TPAs and hospitals, often in inconsistent formats. “When data across parties is not aligned, predictability suffers,” he indicated, adding that actuarial modelling requires structured, standardised inputs to generate meaningful outputs.

While industry bodies, insurers and government stakeholders are working together to improve data systems, Bal acknowledged that India still has “a little way to go” before actuarial science can fully resolve systemic pricing disputes in health insurance.

RBC implementation progressing, but requires coordination

On the long-awaited rollout of Risk-Based Capital (RBC) norms, Bal said significant groundwork has already been completed.

Quantitative Impact Study-1 (QIS-1) has been concluded and analysed, while QIS-2 is currently under evaluation. Multiple committees comprising regulator representatives and industry participants are working on background modelling and impact assessment.

“It is part of a process. It is not that we do not want to do it today, nor that it should be implemented tomorrow without understanding the impact on the entire industry,” he said.

Bal described the delay as a “coordination process” rather than a structural hurdle. RBC implementation requires careful calibration within the regulatory framework, ensuring insurers understand capital implications and operational adjustments before final adoption.

While he refrained from committing to a timeline, noting that the regulator would be best placed to comment, he said both the industry and regulator are working “as quickly as possible.”

Health inflation not directly driven by insurers

On persistent medical inflation, currently estimated at 11–15 percent annually, Bal said insurers are not the primary drivers of rising healthcare costs.

“Insurance companies reimburse or provide financial support. Medical inflation depends on broader factors, cost of medicines, materials, medical advancements, environmental conditions and demographic shifts,” he said.

He added that climate-related factors and air quality could also indirectly affect health trends and claim incidence. Insurance pricing typically reflects medical inflation trends rather than causes them.

While insurers can refine product design and pricing structures, Bal suggested that structural drivers of healthcare inflation lie beyond the insurance sector alone.