Delhi nursing home body alleges 'cartelization' of private insurers, seeks inflation-linked hospital tariffs

Hospitals vs insurers

The Delhi Medical Association Nursing Home Forum (DMANHF) on Thursday filed a formal complaint with the Insurance Regulatory and Development Authority of India (IRDAI), alleging cartel-like behaviour by private insurers acting through the General Insurance Council (GIC).

DMANHF has over 1500 members including nursing homes and hospitals.

The complaint, filed on August 28, accuses insurers of abusing their dominant market position by collectively imposing a “common empanelment” framework that dictates hospital tariffs and commercial terms. DMANHF claims this practice violates competition laws and undermines the sustainability of healthcare delivery.

“With private insurers controlling over 50% of India’s health insurance market, they are misusing their dominance to impose unilateral tariffs,” said Dr. VK Monga, Chairman of DMANHF. “This so-called common empanelment strips hospitals of their right to negotiate independently and threatens the future of quality healthcare in India.”

The Forum has urged IRDAI to investigate the GIC’s role, involve the Serious Fraud Investigation Office (SFIO), and mandate inflation-linked tariffs to protect patient rights and ensure continuity of cashless services.

Hospitals vs insurers

In a separate press release early this week, the General Insurance Council responded to the Association of Healthcare Providers (India)’s announcement to suspend cashless services for two major insurers — Bajaj Allianz and Care Health Insurance — from September 1. The Council called the move “arbitrary” and warned of serious consequences for patients.

“Disruption in cashless service not only impacts families through higher upfront costs but also threatens survival in critical emergencies,” the Council said. “It’s a combined responsibility of the healthcare ecosystem to protect lives and ensure health insurance remains a reliable safety net.”

The Council defended its initiatives like “Cashless Everywhere” and the National Health Claims Exchange (NHCX), which aim to streamline access to care. It also highlighted that insurers settled over Rs 87,000 crore in claims during FY24, demonstrating their commitment to policyholders.

The standoff between hospitals and insurers reflects deeper tensions in India’s healthcare financing model. DMANHF flagged that incurred claims ratios (ICRs) for major standalone health insurers stood as low as 54–67% in FY25, suggesting that a significant portion of premiums is spent on commissions and administrative costs rather than patient care.

“Insurers are prioritizing their bottom lines over the patients whom health insurance is meant to protect,” Dr. Monga added. “Anti-competitive collusion under the GIC threatens not just providers and patients but the future of India’s healthcare ecosystem.”