Healthcare reforms, insurer accountability, and sustainability of hospitals took center stage at the landmark inaugural summit of the AHPI West UP Chapter.

Calling for urgent reforms to address growing friction between hospitals and insurers, the West UP Chapter of the Association of Healthcare Providers India (AHPI) has proposed the introduction of a ‘CIBIL-like’ rating framework for insurance companies and Third Party Administrators (TPAs). The move, AHPI leaders said, would bring much-needed transparency, accountability, and fairness to India’s healthcare ecosystem.

The demand was raised during the Inaugural Summit of the AHPI West UP Chapter, which witnessed a packed gathering of healthcare leaders, hospital administrators, and senior clinicians from across Western Uttar Pradesh.

Addressing the summit, Shri Aunjaneya Kumar Singh, Commissioner of the Moradabad Division, emphasised the importance of data-driven governance in healthcare. He urged hospitals to align their institutional data with district-level administrative insights, noting that such integration is crucial for effective policy formulation and better implementation of government health schemes.

Dr. Girdhar Gyani, Director General of AHPI, reflected on the organisation’s evolution into a credible, evidence-based platform. He highlighted AHPI’s efforts in compiling previously underexplored datasets, including accurate estimates of India’s hospital bed capacity.

Pointing to India’s low beds-per-1,000 population ratio, Dr. Gyani stressed the urgent need to expand healthcare infrastructure, especially in underserved regions. He also underlined that predictable and timely payouts under schemes such as Ayushman Bharat are vital for the financial sustainability of hospitals.

Making a strong case for insurer accountability, Dr. Anurag Mehrotra, President of the AHPI West UP Chapter, drew parallels with the financial sector. “In banking and non-banking finance, tools like CIBIL scores offer clear benchmarks for transparency and trust. Healthcare deserves a similar framework,” he said.

“The functioning of insurance companies and TPAs remains largely opaque. A standardized 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.”

In recent months, tensions between hospitals and insurance companies have intensified over issues such as low reimbursement rates, non-transparent claim deductions, and prolonged payment delays.

These disputes have even led to temporary suspension of cashless services in some hospitals, directly affecting patients. Hospital representatives pointed out that while medical inflation is rising at 12–14 per cent annually, insurers are often unwilling to revise reimbursement rates accordingly. The absence of standardized treatment costing has further deepened the conflict.

Government health schemes including Ayushman Bharat, ESIC, and CGHS were also flagged for structural challenges. Experts noted that package rates under these schemes frequently fall well below the actual cost of treatment, particularly for complex surgeries and critical care. Delayed payments, unexplained deductions, and repeated queries continue to strain hospital operations.

“The conflict between hospitals and insurance companies ultimately impacts patients. A corrective mechanism must be formulated at the earliest,” Dr. Mehrotra said.

The summit saw participation from leading hospitals and healthcare institutions across Moradabad Division, Noida, Ghaziabad, Meerut, Rampur, Amroha, and Sambhal, reflecting a collective regional engagement with pressing healthcare challenges.

Adding a technological perspective, Dr. Sunil Kapoor, Director at 4Sight Advisor, spoke on the growing role of artificial intelligence in healthcare. He highlighted AI’s expanding use in diagnostics, clinical decision-making, and operational efficiency, while stressing the need for ethical and responsible implementation.

The AHPI West UP Summit concluded with a clear message: without transparency, timely payments, and mutual trust between hospitals and insurers, healthcare delivery suffers—and patients pay the price.